ATI LPN
Medical Surgical ATI Proctored Exam
1. When working with a client who has chronic constipation, what should be included in client teaching to promote normal bowel function?
- A. Use glycerin suppositories on a regular basis
- B. Limit physical activity in order to promote bowel peristalsis
- C. Consume high-residue, high-fiber foods
- D. Resist the urge to defecate until the urge becomes intense
Correct answer: C
Rationale: Consuming high-residue, high-fiber foods is essential in promoting normal bowel function and preventing constipation. These foods help add bulk to the stool, making it easier to pass and preventing constipation. Glycerin suppositories may provide short-term relief but are not a long-term solution for chronic constipation. Physical activity actually helps promote bowel peristalsis, so limiting it would not be beneficial. Delaying defecation can lead to stool hardening and worsening constipation.
2. The client with a history of heart failure is taking furosemide (Lasix). Which laboratory result should the nurse monitor closely?
- A. Serum sodium.
- B. Serum potassium.
- C. Serum calcium.
- D. Serum magnesium.
Correct answer: B
Rationale: Furosemide (Lasix) is a loop diuretic that can lead to potassium loss, causing hypokalemia. Monitoring serum potassium levels is crucial to prevent complications such as cardiac dysrhythmias associated with low potassium levels.
3. A client with heart failure is prescribed furosemide (Lasix). Which instruction should the nurse include in the client's teaching plan?
- A. Take the medication before bedtime.
- B. Report any weight gain of more than 2 pounds in a day.
- C. Increase your intake of high-sodium foods.
- D. Limit your fluid intake to less than 1 liter per day.
Correct answer: B
Rationale: In heart failure, fluid retention is a concern. Furosemide helps manage this by promoting diuresis. Instructing the client to report weight gain exceeding 2 pounds in a day is crucial as it can indicate fluid accumulation, prompting timely intervention to prevent worsening heart failure symptoms and complications.
4. What action should the healthcare provider take to reduce the risk of vesicant extravasation in a client receiving intravenous chemotherapy?
- A. Administer an antiemetic before starting the chemotherapy.
- B. Instruct the client to drink plenty of fluids during the treatment.
- C. Keep the head of the bed elevated until the treatment is completed.
- D. Monitor the client's intravenous site hourly during the treatment.
Correct answer: D
Rationale: Monitoring the intravenous site hourly is essential to identify early signs of extravasation, such as swelling or pain, which can help prevent tissue damage. Prompt detection allows for immediate intervention, minimizing the risk of serious complications associated with vesicant extravasation.
5. A client with type 2 diabetes mellitus is prescribed metformin (Glucophage). Which instruction should the nurse provide?
- A. Take the medication on an empty stomach.
- B. Limit your fluid intake while on this medication.
- C. Monitor your blood glucose levels regularly.
- D. Avoid eating foods high in potassium.
Correct answer: C
Rationale: Monitoring blood glucose levels regularly is crucial for clients with type 2 diabetes who are taking metformin. This helps assess the effectiveness of the medication in managing blood sugar levels and allows for timely adjustments in the treatment plan if needed. By monitoring blood glucose levels, the client and healthcare team can work together to achieve optimal diabetes control and prevent complications associated with uncontrolled blood sugar levels.
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