ATI RN
Adult Health Nursing Answer Key Questions
Question 1 of 9
A patient expresses frustration with the treatment plan proposed by the healthcare team. What is the most appropriate response from the nurse?
Correct Answer: B
Rationale: The most appropriate response from the nurse when a patient expresses frustration with the treatment plan proposed by the healthcare team is to empathize with the patient's frustration and explore their concerns further. It is important to actively listen to the patient, acknowledge their feelings, and address any questions or uncertainties they may have about the treatment plan. By engaging in open communication and demonstrating empathy, the nurse can foster a therapeutic relationship with the patient and work towards finding a solution that is mutually agreeable and beneficial for the patient's well-being. Dismissing the patient's concerns (Option A) or ignoring their frustration (Option C) can lead to a breakdown in communication and trust, which may ultimately impact the patient's compliance with the treatment plan. Similarly, telling the patient that they have no choice but to follow the treatment plan (Option D) can be perceived as dismissive and confrontational, which is not conducive to promoting patient-centered care.
Question 2 of 9
After 3 years being assigned in the Operating Room, Merle in interested to actively join which appropriate professional organization?
Correct Answer: A
Rationale: ORNAP stands for Operating Room Nurses Association of the Philippines. As Merle has been assigned in the Operating Room for 3 years and is interested in actively joining a professional organization related to this field, ORNAP would be the most appropriate choice. ORNAP focuses on promoting excellence in perioperative nursing practice through education, research, and collaboration. By joining ORNAP, Merle can further enhance her knowledge and skills in the Operating Room setting, as well as network with other professionals in the same field.
Question 3 of 9
An 80-years-old male, admitted for emergency suturing of the forehead sustained from accident fall while gardening under local sedation us received in the ward. Which nursing intervention is APPROPRIATE to facilitate effective communication with this patient?
Correct Answer: A
Rationale: Option A is the most appropriate nursing intervention to facilitate effective communication with the 80-year-old male patient. This approach involves waiting for the patient to be fully awake before discussing important information about the surgery and potential post-surgery events with both the patient and family. This allows the patient to fully comprehend the information provided and ask any necessary questions. Effective communication is crucial in promoting patient understanding and cooperation, especially in older adults who may require additional time to process information due to factors such as age-related cognitive changes. It is important to ensure that the patient receives clear and accurate information to support their recovery process and reduce anxiety.
Question 4 of 9
A patient with terminal cancer is experiencing severe pain despite receiving analgesics. Which intervention by the palliative nurse is most appropriate?
Correct Answer: D
Rationale: In a situation where a patient with terminal cancer is experiencing severe pain despite receiving analgesics, consulting with a pain management specialist is the most appropriate intervention. Pain management specialists have expertise in managing complex pain situations, especially in cases of terminal illness where pain control is crucial for improving quality of life. The specialist can review the current pain management plan, suggest alternative or adjunct therapies, adjust medication dosages, or explore different types of analgesics to optimize pain relief for the patient. Collaborating with a pain management specialist can help ensure the patient receives the most effective and personalized pain management approach tailored to their specific needs. Increasing the dose of analgesics, administering a different type of analgesic, or recommending non-pharmacological techniques may be appropriate interventions but should be guided by a specialist to ensure safe and effective pain management in a palliative care setting.
Question 5 of 9
A retired nurse stops to help in an emergency at the scene of an accident, if the injured party files suit and the, the nurse would probably be covered by
Correct Answer: D
Rationale: The Good Samaritan Law offers legal protection to individuals who voluntarily provide assistance at the scene of an emergency or accident. These laws vary by state, but generally, they grant immunity from civil liability for the individual providing aid as long as they act in good faith and without expectation of compensation. In this case, the retired nurse who stopped to help in the emergency at the scene of an accident would likely be covered by the Good Samaritan Law, protecting her from being sued by the injured party for any unintended consequences of her efforts to assist.
Question 6 of 9
A woman in active labor is receiving intravenous antibiotics for group B streptococcus (GBS) prophylaxis. What maternal assessment finding indicates a potential adverse reaction to the antibiotics?
Correct Answer: B
Rationale: Urticaria (hives) and pruritus (itching) are common signs of an allergic reaction to antibiotics, including those used for GBS prophylaxis during labor. Other signs of an adverse reaction may include flushing, fever, chills, and anaphylaxis. It is important to monitor the woman closely for any signs of an allergic reaction and to intervene promptly if one occurs to ensure the safety of both the mother and the baby.
Question 7 of 9
As Nurse Pedrito prepares for the day's visits, which of the following patients should be seen FIRST? A client with ________.
Correct Answer: C
Rationale: The patient with a history of congestive heart failure and dyspnea should be seen FIRST by Nurse Pedrito. Congestive heart failure is a serious condition that can lead to acute exacerbations and requires prompt assessment and management. Dyspnea (shortness of breath) is a common symptom of heart failure and can indicate worsening cardiac function or fluid overload, which requires immediate attention to prevent further complications. Timely assessment and intervention for heart failure exacerbations can help prevent hospital admissions and improve patient outcomes. Therefore, prioritizing this patient for assessment and intervention is crucial to ensure their safety and well-being.
Question 8 of 9
A woman in active labor experiences a prolonged latent phase, characterized by irregular contractions and minimal cervical dilation. What maternal condition should the nurse assess for that may contribute to this abnormal labor pattern?
Correct Answer: A
Rationale: Maternal dehydration can lead to a prolonged latent phase in labor due to inadequate hydration affecting the progress of labor. Dehydration can cause decreased blood volume, leading to poor uterine perfusion and inefficient uterine contractions. It also contributes to reduced amniotic fluid volume and can lead to maternal exhaustion. Therefore, assessment and correction of maternal hydration status are crucial in improving labor patterns and preventing complications during labor and delivery.
Question 9 of 9
A postpartum client reports persistent, severe perineal pain despite analgesic medication. On assessment, the nurse observes ecchymosis and swelling of the perineum. Which nursing action is most appropriate?
Correct Answer: C
Rationale: The presence of ecchymosis (bruising) and significant swelling in the perineum despite analgesic medication suggests a potential complication such as a hematoma. A hematoma is a collection of blood that can occur due to trauma or during childbirth. It is important to notify the healthcare provider immediately so that further assessment and interventions, such as drainage of the hematoma, can be initiated promptly to prevent complications and alleviate the client's pain. Applying ice packs or encouraging the client to sit on a donut cushion may provide temporary relief but will not address the underlying issue of a potentially serious hematoma. Administering additional analgesic medication may not be effective in this case if the pain is primarily due to the hematoma. Prompt notification of the healthcare provider is crucial for proper management of this situation.