ATI LPN
PN ATI Comprehensive Predictor
1. What are the key nursing considerations for a patient with a central venous catheter?
- A. Maintain sterility during dressing changes
- B. Change the dressing weekly
- C. Monitor blood pressure and fluid balance
- D. Monitor the catheter site for infection
Correct answer: A
Rationale: The correct answer is A: Maintain sterility during dressing changes. It is crucial to maintain sterility during dressing changes for patients with central venous catheters to prevent infections. Changing the dressing weekly (Choice B) is not frequent enough to prevent infections effectively. Monitoring blood pressure and fluid balance (Choice C) is important for overall patient care but not specific to central venous catheter management. While monitoring the catheter site for infection (Choice D) is important, the key consideration is to prevent infections through proper sterile techniques during dressing changes.
2. A client has developed phlebitis at the IV site. What is the next step the nurse should take?
- A. Administer an anti-inflammatory medication
- B. Discontinue the IV and notify the provider
- C. Apply a cold compress over the IV site
- D. Increase the IV flow rate to prevent dehydration
Correct answer: B
Rationale: When a client develops phlebitis at the IV site, the nurse's immediate action should be to discontinue the IV and notify the healthcare provider. Phlebitis is inflammation of the vein, and leaving the IV in place can lead to complications such as infection or thrombosis. Administering an anti-inflammatory medication (choice A) may not address the root cause and delay the necessary intervention. Applying a cold compress (choice C) may provide temporary relief but does not address the need to remove the source of inflammation. Increasing the IV flow rate (choice D) is contraindicated as it can exacerbate the phlebitis by causing more irritation to the vein.
3. Which dietary advice is most appropriate for a client with chronic kidney disease?
- A. Increase intake of fruits and vegetables
- B. Limit intake of potassium-rich foods
- C. Increase intake of dairy products
- D. Reduce intake of protein-rich foods
Correct answer: B
Rationale: The most appropriate dietary advice for a client with chronic kidney disease is to limit intake of potassium-rich foods. In chronic kidney disease, the kidneys have difficulty filtering potassium from the blood, leading to high levels that can be harmful. Therefore, reducing potassium intake is crucial to prevent complications. Choices A, C, and D are not the best options for individuals with chronic kidney disease. Increasing intake of fruits and vegetables (choice A) may actually increase potassium consumption. Increasing intake of dairy products (choice C) can lead to higher phosphorus and potassium levels. Reducing protein-rich foods (choice D) is not the primary focus in the early stages of chronic kidney disease, as protein is necessary for overall health unless kidney function declines significantly.
4. A client reports difficulty having a bowel movement. What is the most appropriate intervention?
- A. Administer a laxative to relieve constipation
- B. Encourage the client to increase fiber intake
- C. Advise the client to rest in bed to avoid straining
- D. Encourage the client to exercise to stimulate bowel movement
Correct answer: B
Rationale: The correct answer is to encourage the client to increase fiber intake. Fiber helps promote regular bowel movements by adding bulk to the stool, making it easier to pass. Administering a laxative (Choice A) should not be the first-line intervention as it can lead to dependency and may not address the underlying cause of constipation. Advising the client to rest in bed (Choice C) may worsen constipation as physical activity helps stimulate bowel movements. Encouraging the client to exercise (Choice D) is beneficial, but increasing fiber intake is more directly related to improving bowel movements in this scenario.
5. A client who is to undergo an exercise stress test is being taught by a nurse. Which of the following statements by the client indicates an understanding of the teaching?
- A. I should eat a large meal 2 hours before the test
- B. I should avoid drinking water before the test
- C. I should stop taking my blood pressure medication
- D. I should report any chest pain during the test
Correct answer: D
Rationale: The correct answer is D: 'I should report any chest pain during the test.' This statement indicates an understanding of the teaching because reporting chest pain during an exercise stress test is crucial as it may signify cardiac distress. Choices A, B, and C are incorrect. Eating a large meal 2 hours before the test is not recommended as it may affect the results. Avoiding drinking water before the test is also not advisable as staying hydrated is important. Stopping blood pressure medication without medical advice can be dangerous, especially before a stress test.
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