ATI Fundamentals Proctored Exam LPN

ATI Fundamentals Proctored Exam LPN Related

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What is nurse's primary critical observation when performing an assessment for determining an Apgar score?

  • A. Heart rate
  • B. Respiratory rate
  • C. Presence of meconium
  • D. Evaluation of Moro reflex
Correct Answer: A

Rationale: Apgar score assesses newborn vitality at 1 and 5 minutes post-birth across five criteria: heart rate, respiration, muscle tone, reflex, color. Heart rate (choice A) is primary; absent (<60 bpm = 0, <100 = 1, >100 = 2) dictates immediate resuscitation, making it the most critical. Respiratory rate (choice B) follows, but weak/absent breathing often ties to heart rate. Meconium (choice C) isn't scored directly, though it flags distress. Moro reflex (choice D) tests tone/reflex, secondary to vitals. A is correct, as heart rate drives initial intervention. Nurses prioritize it, ensuring rapid response to stabilize the infant.

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The coronary vessels, unlike any other blood vessels in the body, respond to sympathetic stimulation by

  • A. Vasoconstriction
  • B. Vasodilatation
  • C. Decreases force of contractility
  • D. Decreases cardiac output
Correct Answer: B

Rationale: The coronary vessels are unique because they respond to sympathetic stimulation with vasodilatation, unlike most other blood vessels which constrict. Sympathetic stimulation activates the fight-or-flight response, increasing heart rate and oxygen demand. To meet this demand, the coronary arteries dilate to supply more blood to the heart muscle. Vasoconstriction (A) is incorrect as it would reduce blood flow, countering the heart's needs during stress. Decreases in force of contractility (C) or cardiac output (D) are unrelated to the vascular response and pertain more to myocardial function, not the coronary vessels' behavior. This vasodilatation is mediated by beta-adrenergic receptors, ensuring adequate perfusion during heightened activity, making B the correct choice.

What can you expect from Marianne, who is currently at the ONSET stage of fever?

  • A. Hot, flushed skin
  • B. Increase thirst
  • C. Convulsion
  • D. Pale,cold skin
Correct Answer: D

Rationale: Fever's onset (chill phase) features vasoconstriction e.g., pale, cold skin as the body raises its setpoint. Hot, flushed skin (flush phase), thirst (later), or convulsions (hyperpyrexia) follow. Nurses expect this initial response e.g., shivering in Marianne, guiding warming measures, per fever physiology.

The nurse is caring for an infant with developmental dysplasia of the hip. The nurse should expect to:

  • A. Prepare the infant for application of a body cast
  • B. Teach the mother to keep the infant in the prone position
  • C. Explain that surgery will be necessary within the first 3 months
  • D. Tell the mother that the condition will correct itself without treatment
Correct Answer: A

Rationale: For developmental dysplasia of the hip (DDH), a body cast (spica) is often applied to maintain hip alignment, a common intervention post-reduction in infants, guided by orthopedics. Prone positioning, early surgery, or spontaneous correction aren't standard treatment stabilizes the joint. Nurses prepare families for this, explaining its role in preventing long-term disability, ensuring compliance and comfort.

You are caring for a client who has just returned from surgery and has received intravenous morphine minutes before leaving the recovery room. You need to assess the client's pain now and again at which of the following times?

  • A. in 20 to 30 minutes
  • B. in one hour
  • C. in two hours
  • D. in 3 to 4 hours
Correct Answer: A

Rationale: Post-morphine pain assessment at 20-30 minutes evaluates peak effect, critical post-surgery. Later checks miss this window. Nurses time this for efficacy.

Which of the following statement is TRUE about assault?

  • A. Touching the client without consent
  • B. An intentional threat
  • C. Causes physical harm
  • D. All of the above
Correct Answer: B

Rationale: Assault is an intentional threat (B), per law e.g., menacing gesture, no contact needed. Touching (A) is battery, harm (C) not required, all (D) oversteps. B truly defines assault's intent, making it correct.

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