ATI LPN
ATI PN Comprehensive Predictor 2020
1. What are the common causes of postoperative pain and how should it be managed?
- A. Surgical incision and muscle tension
- B. Nerve damage and wound complications
- C. Hypotension and respiratory issues
- D. Infection at the incision site
Correct answer: A
Rationale: Postoperative pain is commonly caused by the surgical incision and muscle tension. The correct answer is A. Surgical incisions cause tissue damage, triggering pain responses. Muscle tension can result from factors like positioning during surgery or guarding due to pain. Managing postoperative pain caused by surgical incisions and muscle tension involves the use of analgesics to alleviate discomfort. Choices B, C, and D are incorrect. Nerve damage and wound complications may also cause pain but are not as common as surgical incisions and muscle tension. Hypotension and respiratory issues are not direct causes of postoperative pain. Infection at the incision site can lead to pain, but it is a specific complication rather than a common cause of postoperative pain.
2. A nurse is caring for a client who requests information about advance directives. Which of the following responses should the nurse make?
- A. It's a living will outlining your funeral wishes
- B. It's a document that allows you to donate organs
- C. It includes end-of-life care instructions
- D. It provides legal guardianship rights
Correct answer: C
Rationale: The correct response is C: 'It includes end-of-life care instructions.' An advance directive is a legal document that outlines a client's preferences for medical treatment and end-of-life care in case they are unable to communicate. Choice A is incorrect because an advance directive focuses on healthcare decisions, not funeral arrangements. Choice B is incorrect as organ donation is a separate process from advance directives. Choice D is incorrect as advance directives do not provide legal guardianship rights, but rather specify healthcare wishes.
3. What is the most appropriate action for a healthcare provider to take when a patient is experiencing a seizure?
- A. Protect the patient's head
- B. Restrain the patient's movements
- C. Insert an airway
- D. Give the patient water
Correct answer: A
Rationale: During a seizure, the most appropriate action for a healthcare provider is to protect the patient's head. This helps prevent injury, especially considering the involuntary movements and potential thrashing associated with seizures. Restraint should be avoided as it can lead to further injury or distress for the patient. Inserting an airway is not recommended during an active seizure as the patient's airway may not be obstructed, and it could pose a risk of injury. Giving the patient water during a seizure is also not advisable as there is a risk of aspiration. Therefore, the priority is to ensure the patient's safety by protecting their head.
4. A nurse manager is discussing the responsibility of nurses caring for clients who have Clostridium difficile. Which of the following information should the nurse include in the teaching?
- A. Assign the client to a room with a negative air-flow system
- B. Use alcohol-based hand sanitizer when leaving the client's room
- C. Clean contaminated surfaces in the client's room with a phenol solution
- D. Have family members wear a gown and gloves when visiting
Correct answer: D
Rationale: The correct answer is D because having family members wear a gown and gloves when visiting a client with Clostridium difficile is essential to prevent the spread of infection. Options A, B, and C are incorrect. Negative air-flow systems are not necessary for preventing the spread of C. difficile. While alcohol-based hand sanitizers are effective for routine hand hygiene, they may not be sufficient for C. difficile. Cleaning contaminated surfaces with a phenol solution is not the most effective method for preventing the spread of C. difficile, as spores can be resistant to many disinfectants.
5. When a nurse questions a medication prescription as too extreme due to a client's advanced age and unstable status, this action exemplifies which ethical principle?
- A. Fidelity
- B. Autonomy
- C. Justice
- D. Non-maleficence
Correct answer: D
Rationale: The correct answer is D: Non-maleficence. Non-maleficence refers to the ethical principle of avoiding harm. In this scenario, the nurse questions the medication prescription to prevent potential harm to the client, demonstrating the principle of non-maleficence. Choice A, fidelity, pertains to being faithful and keeping promises, which is not the focus of the scenario. Choice B, autonomy, relates to respecting a client's right to make decisions about their care, not the nurse's actions. Choice C, justice, involves fairness and equal treatment, which is not directly applicable to the nurse questioning a medication prescription to prevent harm.
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