A patient admitted to the ICU develops acute myocardial infarction (MI) with ST-segment elevation on electrocardiogram (ECG). What intervention should the healthcare team prioritize to manage the patient's MI?

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Foundations and Adult Health Nursing Test Bank Questions

Question 1 of 9

A patient admitted to the ICU develops acute myocardial infarction (MI) with ST-segment elevation on electrocardiogram (ECG). What intervention should the healthcare team prioritize to manage the patient's MI?

Correct Answer: A

Rationale: In a patient with acute myocardial infarction (MI) presenting with ST-segment elevation on ECG, the healthcare team should prioritize performing emergent coronary angiography for revascularization. This intervention, also known as primary percutaneous coronary intervention (PCI), involves opening up the blocked coronary artery responsible for the MI. Timely reperfusion of the affected artery is crucial in reducing myocardial damage and improving outcomes in acute MI patients. PCI is considered the preferred method for revascularization in patients with ST-segment elevation MI, as it has been shown to be more effective and associated with better outcomes compared to fibrinolytic therapy.

Question 2 of 9

As a nurse, which of the following are the critical factors for successful integration of loss during the grieving process?

Correct Answer: B

Rationale: Accurate assessment and intervention by the nurse or helping person are critical factors for successful integration of loss during the grieving process. This involves the nurse's ability to assess the patient's grieving process effectively, identify their needs, provide appropriate support, and intervene when necessary. By utilizing proper assessment techniques and offering timely interventions, the nurse helps facilitate the patient's journey through the grieving process, promoting healthy coping mechanisms and ultimately assisting in achieving successful integration of their loss. Trustworthiness and a healthy attitude about grief are important qualities for a nurse, but without accurate assessment and intervention, the grieving process may not progress smoothly.

Question 3 of 9

A patient with renal failure presents with confusion, seizures, asterixis, and a sweet odor to the breath. Laboratory findings reveal severe metabolic acidosis, hyperkalemia, and elevated blood urea nitrogen (BUN) and creatinine levels. What is the most likely diagnosis?

Correct Answer: B

Rationale: The patient's presentation with renal failure, confusion, seizures, asterixis, and a sweet odor to the breath, along with laboratory findings of severe metabolic acidosis, hyperkalemia, and elevated BUN and creatinine levels, is consistent with uremic encephalopathy. Uremic encephalopathy is a neurological complication of acute or chronic renal failure resulting from the buildup of uremic toxins in the blood, leading to various neurological symptoms such as confusion and seizures. The sweet odor to the breath can be attributed to the presence of urea, a waste product that accumulates in renal failure. Other metabolic abnormalities like hyperkalemia and severe metabolic acidosis are also common in renal failure. It is crucial to promptly recognize and manage uremic encephalopathy to prevent further neurological complications.

Question 4 of 9

A patient presents with sudden-onset, painless vision loss in the right eye. Fundoscopic examination reveals a cherry-red spot at the macula and attenuated retinal vessels. Which of the following conditions is most likely responsible for this presentation?

Correct Answer: A

Rationale: The patient's presentation of sudden-onset, painless vision loss in the right eye, along with a cherry-red spot at the macula and attenuated retinal vessels, is classic for central retinal artery occlusion (CRAO). In CRAO, there is a sudden blockage of the central retinal artery, leading to ischemia of the retina. The cherry-red spot represents the preserved choroid blood flow against the ischemic retina. The attenuated retinal vessels are a result of decreased blood flow in the retinal circulation. This condition is considered an ophthalmic emergency and requires immediate evaluation and management to prevent permanent vision loss.

Question 5 of 9

A patient presents with progressive weakness, muscle atrophy, and fasciculations, primarily involving the upper and lower extremities. Over time, the patient develops difficulty swallowing and breathing. Which of the following neurological conditions is most likely responsible for these symptoms?

Correct Answer: C

Rationale: The symptoms described are classic for amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease. ALS is a progressive neurodegenerative disease that affects nerve cells in the brain and spinal cord, leading to muscle weakness and atrophy. Patients typically present with weakness, muscle atrophy, fasciculations (muscle twitching), and eventually develop difficulty swallowing and breathing due to involvement of the muscles responsible for these functions. Parkinson's disease (Choice A) is a neurodegenerative disorder characterized by tremors, rigidity, and bradykinesia but does not typically present with muscle atrophy or fasciculations as described in the case. Guillain-Barré syndrome (GBS) (Choice B) is an acute inflammatory condition affecting peripheral nerves, leading to ascending paralysis, which is usually reversible. Myasthenia gravis (Choice D) is an autoimmune disorder that affects neu

Question 6 of 9

A characteristic of qualitative research data is that they are what

Correct Answer: A

Rationale: Qualitative research data are typically in text form rather than numeric or statistical data. This means that the data collected through qualitative research methods are descriptive and usually presented in the form of words, phrases, or narratives. Qualitative data often involve subjective interpretations, opinions, and in-depth insights, making text a more suitable format for capturing these nuances compared to numerical or quantitative data. The focus in qualitative research is on understanding experiences, meanings, and perspectives, which are best conveyed through textual data.

Question 7 of 9

A postpartum client presents with sudden chest pain, dyspnea, and tachycardia. Which nursing action should be prioritized?

Correct Answer: D

Rationale: Sudden chest pain, dyspnea, and tachycardia in a postpartum client can be indicative of serious conditions such as pulmonary embolism or myocardial infarction. These conditions are emergencies that require immediate medical attention. Notifying the healthcare provider immediately is the priority to ensure prompt evaluation and intervention to address the potential life-threatening situation. While other nursing interventions such as elevating the head of the bed, providing supplemental oxygen therapy, and administering analgesics may be necessary, they should be done after notifying the healthcare provider to ensure appropriate management of the underlying cause.

Question 8 of 9

A patient with a history of chronic kidney disease is prescribed erythropoietin-stimulating agents (ESAs) for anemia management. Which parameter should the nurse monitor closely during ESA therapy?

Correct Answer: B

Rationale: When a patient with chronic kidney disease is prescribed erythropoietin-stimulating agents (ESAs) for anemia management, the parameter that should be monitored closely by the nurse is the hemoglobin levels. Hemoglobin levels indicate the patient's response to ESA therapy and are essential in assessing the effectiveness of the treatment in addressing anemia. Monitoring hemoglobin levels helps ensure that the patient's anemia is controlled within the target range to avoid both the risks of under-treatment (resulting in persistent anemia) and over-treatment (increased risk of adverse outcomes such as hypertension, stroke, or cardiovascular events).

Question 9 of 9

A patient presents with well-demarcated, hypopigmented macules with fine scaling, affecting the trunk and proximal extremities. The patient reports a history of sun exposure and outdoor activities. Which of the following conditions is most likely responsible for this presentation?

Correct Answer: A

Rationale: The presentation described in the question is characteristic of tinea versicolor, a fungal skin infection caused by Malassezia furfur. The hypopigmented macules with fine scaling are often seen on the trunk and proximal extremities, particularly in areas that are more prone to sebum production. Patients with tinea versicolor may have a history of sun exposure and outdoor activities as the organism responsible for the infection thrives in warm, humid environments. Treatment typically involves the use of topical antifungal agents such as ketoconazole or selenium sulfide.

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