ATI RN
Adult Health Nursing Answer Key Questions
Question 1 of 9
A patient presents with sudden-onset weakness and sensory loss on one side of the body along with difficulty speaking and understanding speech. Imaging reveals an acute infarction involving the right middle cerebral artery territory. Which of the following neurological conditions is most likely responsible for these symptoms?
Correct Answer: C
Rationale: The patient is presenting with sudden-onset weakness and sensory loss on one side of the body along with difficulty speaking and understanding speech, which are classic symptoms of a stroke. The involvement of the right middle cerebral artery territory on imaging suggests an acute infarction, confirming an ischemic stroke. Ischemic stroke occurs due to a blockage or obstruction within a blood vessel supplying blood to the brain, leading to a lack of oxygen and nutrients reaching brain tissue. This results in neurological deficits corresponding to the affected area of the brain. In contrast, a transient ischemic attack (TIA) would present with similar symptoms but resolve within 24 hours without evidence of acute infarction on imaging. Intracerebral hemorrhage and subarachnoid hemorrhage involve bleeding into the brain tissue or the space surrounding the brain, respectively, resulting in different clinical presentations.
Question 2 of 9
A woman in active labor is experiencing meconium-stained amniotic fluid. What is the nurse's priority action?
Correct Answer: B
Rationale: Meconium-stained amniotic fluid indicates that the fetus may have passed stool in utero, which can lead to potential respiratory problems once born due to meconium aspiration. The priority action for the nurse in this situation is to prepare for immediate delivery to expedite the removal of the fetus from the contaminated environment and provide necessary interventions such as suctioning of the airway to prevent aspiration of meconium. Prompt delivery is crucial to minimize the risk of complications related to meconium aspiration syndrome. Administering oxygen, inserting a urinary catheter, and notifying the neonatal resuscitation team can be important subsequent actions, but the immediate focus should be on delivering the baby.
Question 3 of 9
Which of the following herbal medicines is recommended by the department for cough?
Correct Answer: D
Rationale: The herbal medicine recommended by the Department of Health for cough is Lagundi (scientific name: Vitex negundo). Lagundi has been found to have properties that can help relieve cough, asthma, and other respiratory conditions. It has been traditionally used as a natural remedy for these purposes and has gained recognition for its effectiveness in managing cough symptoms. Additionally, Lagundi is also known for its anti-inflammatory and analgesic properties, further supporting its use in addressing respiratory ailments.
Question 4 of 9
Which of the following definition MOST accurately describes meningomyelocele? It is _______.
Correct Answer: C
Rationale: Meningomyelocele is a type of neural tube defect where there is a protrusion of the spinal cord, cerebrospinal fluid, and meninges through a defect in the vertebrae, forming a sac on the surface of the back. This condition occurs during fetal development when the neural tube fails to close completely, leading to the exposure of the spinal cord and its coverings. This herniation can result in a range of neurological deficits and complications, requiring surgical repair shortly after birth to prevent further damage and infections.
Question 5 of 9
Which of the following is precipitating factor for Ella`s feeling of wanting to die?
Correct Answer: A
Rationale: The death of Lory is the precipitating factor for Ella's feeling of wanting to die. Losing someone close to us can lead to feelings of profound sadness, grief, and hopelessness, which may trigger thoughts of wanting to die. The impact of losing a loved one can be devastating and overwhelming, often leading individuals to question the meaning of life and their own mortality. In Ella's case, the death of Lory has likely caused a significant emotional upheaval, contributing to her desire to end her own life. It is essential to address these feelings of loss and provide support and intervention to help Ella cope with her grief and prevent any self-harm.
Question 6 of 9
Which of the following is a common oral manifestation of celiac disease characterized by enamel defects with horizontal or vertical grooves on the teeth?
Correct Answer: B
Rationale: Enamel hypoplasia is a common oral manifestation of celiac disease characterized by defects in the enamel of the teeth. These defects can appear as horizontal or vertical grooves on the teeth. Enamel hypoplasia is caused by disruptions in the formation of enamel during tooth development, leading to thin enamel or localized pitting. It can affect the appearance and strength of the teeth, making them more prone to sensitivity and breakdown. In individuals with celiac disease, enamel hypoplasia may occur due to malabsorption of essential nutrients like calcium and vitamin D. Therefore, when observing oral manifestations such as enamel defects with grooves, it is important to consider the possibility of celiac disease as an underlying cause.
Question 7 of 9
During a shift handover, the nurse receives information about a patient's condition from the outgoing nurse. What action by the nurse demonstrates effective communication during the handover process?
Correct Answer: C
Rationale: Option C, summarizing key points and asking clarifying questions as needed, demonstrates effective communication during the handover process. This action ensures that the nurse fully understands the information being provided and helps to prevent misunderstandings or missing critical details. By summarizing key points, the nurse confirms their understanding and can ask for clarification on any areas that are unclear. Effective communication during handovers is essential for maintaining patient safety and continuity of care.
Question 8 of 9
Before the education plan of the staff nurse can be finalized and implemented, it is best that it is reviewed by the
Correct Answer: A
Rationale: Before finalizing and implementing the education plan for the staff nurse, it is important to have the plan reviewed by the nurse supervisor. The nurse supervisor is directly responsible for overseeing the staff nurses and their education and training needs. They have a good understanding of the staff nurse's current skills, areas for improvement, and training requirements. By involving the nurse supervisor in the review process, you can ensure that the education plan is aligned with the overall goals and needs of the nursing staff and the department. Additionally, the nurse supervisor can provide valuable input and insights to help tailor the education plan to meet the specific needs of the staff nurses under their supervision.
Question 9 of 9
The nurse closely monitors the work she delegated to the barangay health worker. She is legally guided by this principle
Correct Answer: A
Rationale: Respondent superior is a legal doctrine that holds an employer (such as a nurse) responsible for the actions of their employees (such as a barangay health worker) performed within the scope of their employment. In the scenario provided, the nurse delegated tasks to the barangay health worker, making the health worker an agent of the nurse. By closely monitoring the delegated work, the nurse is fulfilling her legal responsibility under the principle of respondent superior to ensure that the health worker performs their duties properly and in accordance with professional standards.