ATI RN
Age Specific Populations Questions
Question 1 of 5
A 17-year-old client is admitted to the ED after being alternately hyperalert and difficult to arouse. His symptoms all started within the last few hours, during which time he became disoriented and confused. His behavior was agitated and restless, and his memory was impaired, especially for recent events. The client displayed some delusions and misinterpretations of his surroundings. The nurse's first action should be to:
Correct Answer: A
Rationale: The correct answer is A: Take the client's vital signs. The first step in assessing any client in the emergency department is to ensure their physiological stability. Vital signs provide essential information about the client's current physical condition, such as heart rate, blood pressure, respiratory rate, and temperature. In this case, the client's alternating states of hyperalertness and difficulty in arousal, disorientation, confusion, agitation, memory impairment, delusions, and misinterpretations of surroundings indicate a potential medical emergency. Therefore, taking the client's vital signs is crucial to determine if there are any immediate life-threatening conditions that need to be addressed promptly. Summary of other choices: B: Restrain the client to prevent injury - Restraint should only be used as a last resort for safety concerns and after assessing the client's physical condition. C: Obtain a PRN order for a psychotropic medication - Administering psychotropic medication should not be the first action without assessing the client's physical condition and
Question 2 of 5
A nurse caring for a patient with bulimia nervosa should teach the patient about:
Correct Answer: C
Rationale: Rationale for Correct Answer (C): 1. Patients with bulimia nervosa often engage in purging behaviors, leading to electrolyte imbalances. 2. Hypokalemia is a common complication due to vomiting, which can have serious consequences. 3. Educating the patient about hypokalemia symptoms is crucial for early detection and intervention to prevent complications. Summary of Incorrect Choices: A. Self-monitoring of food intake is important but not the priority as addressing electrolyte imbalances. B. Weight gain is not a recommended goal for patients with bulimia nervosa. D. While self-esteem maintenance is important, addressing acute physical health risks takes precedence.
Question 3 of 5
A rape victim asks a nurse, 'How do I know whether this attack was my fault?' Which response by the nurse is therapeutic?
Correct Answer: A
Rationale: The correct answer is A because it focuses on supporting the victim in understanding that vulnerability does not equate to blame. This response helps the victim separate self-blame from the responsibility of the perpetrator. Choice B is incorrect as it undermines the victim's autonomy. Choice C is incorrect as it offers false reassurance and ignores the complexity of the situation. Choice D is incorrect as option A provides a therapeutic response that addresses the victim's emotional needs.
Question 4 of 5
An elderly client who lives with her daughter and son-in-law and their three children reveals that her daughter sometimes slaps her when she does not move fast enough or spills things. The daughter is a mid-level business executive who is under considerable stress at work. The children are often left in the care of the elderly client. The husband is often out of town on business trips. The daughter states, 'I have so much to do that I become frustrated when my mother can't move fast enough or causes me extra work.' The nurse caring for the mother could appropriately suggest:
Correct Answer: A
Rationale: The correct answer is A: Family therapy. Family therapy is the most appropriate suggestion because it addresses the dysfunctional dynamics within the family and provides an opportunity for all family members to work through their issues. In this scenario, the daughter's stress at work and lack of coping skills are contributing to the abuse of the elderly client. Family therapy can help the family communicate effectively, set boundaries, and address underlying issues causing the abuse. Choice B (Individual counseling for the daughter) may help the daughter address her stress and coping mechanisms, but it does not address the family dynamics that are contributing to the abuse. Choice C (Respite care for the elderly client) provides temporary relief but does not address the root cause of the issue. Choice D (None of the above) is incorrect as family therapy is the most appropriate intervention in this case.
Question 5 of 5
An elderly woman is brought to the clinic by her daughter. The client states that she has had a cold for several days. Her daughter states that her mother has been confused about when her routine medications are to be taken and that her mother has never experienced confusion before. Based on this information, it is important that the nurse ask the client whether:
Correct Answer: A
Rationale: The correct answer is A: There is a history of mental illness in the family. This is important because the sudden onset of confusion in an elderly person could be indicative of a new mental health issue or cognitive decline. Asking about a family history of mental illness can provide valuable insights into potential genetic predispositions or underlying conditions that may be contributing to the client's confusion. Choices B and C are incorrect because the client's own history of mental health diagnosis or ability to recall a physician visit are not directly related to the sudden onset of confusion. Choice D is incorrect because asking about a family history of mental illness could provide crucial information in understanding the client's current condition.