ATI RN
Concept of Family Health Nursing Care Questions
Question 1 of 5
A patient who was admitted for a heroin overdose received naloxone (Narcan), which improved the breathing pattern. Two hours later, the patient reports muscle aches, abdominal cramps, gooseflesh and says, 'I feel terrible.' Which analysis is correct?
Correct Answer: C
Rationale: The correct analysis is C: Symptoms of opiate withdrawal are present. The patient's presentation of muscle aches, abdominal cramps, gooseflesh, and feeling terrible are classic symptoms of opiate withdrawal. Naloxone, as an opioid antagonist, reversed the effects of heroin leading to withdrawal symptoms. This is a typical response seen in patients who have been given naloxone to counteract opioid overdose. Choices A and B are incorrect as they do not align with the patient's clinical presentation and pharmacological understanding. Choice D is also incorrect as there is no indication that the patient has resumed heroin use.
Question 2 of 5
A nurse is called to the home of a neighbor and finds an unconscious person still holding a medication bottle labeled pentobarbital sodium. What is the nurse’s first action?
Correct Answer: D
Rationale: The correct answer is D: Establish a patent airway. The first action in any emergency situation involving an unconscious person is to ensure their airway is open and clear to facilitate breathing. This is crucial for maintaining oxygenation and preventing potential complications like hypoxia. Testing reflexes (A) and checking pupils (B) are important assessments but not the immediate priority in this situation. Initiating vomiting (C) is contraindicated as it can lead to further complications, especially if the person has ingested a potentially harmful substance.
Question 3 of 5
Select the most appropriate outcome for a patient completing the fourth alcohol detoxification program in 1 year. Before discharge, the patient will
Correct Answer: B
Rationale: The correct answer is B because stating 'I see the need for ongoing treatment' demonstrates insight and willingness to engage in further treatment, indicating a readiness for change. This is crucial for someone who has completed multiple detox programs in a short period. Choice A (using rationalization in healthy ways) may not address the underlying issues leading to repeated detox programs. Choice C (identifying constructive outlets for expression of anger) is important but not the most urgent concern after detox. Choice D (developing a trusting relationship with one staff member) is beneficial but does not address the need for ongoing treatment.
Question 4 of 5
A nurse can assist a patient and family in which aspects of substance abuse relapse prevention? Select all that apply.
Correct Answer: A
Rationale: The correct answer is A because rehearsing techniques to handle stressful situations is a crucial aspect of substance abuse relapse prevention. By practicing coping strategies, the patient can effectively navigate triggers and prevent relapse. Choices B, C, and D are incorrect: B: Advising residential treatment is not a proactive relapse prevention strategy and does not empower the patient to manage triggers independently. C: Identifying life skills is important, but alone it may not directly address relapse prevention techniques. D: Isolating from support systems contradicts the importance of social support in recovery and may lead to feelings of loneliness and vulnerability, increasing the risk of relapse.
Question 5 of 5
Which statement made by a mental health nurse demonstrates the need for further education regarding active listening as a therapeutic communication technique?
Correct Answer: C
Rationale: The correct answer is C because asking the client why he blames others is not a recommended approach in active listening. This statement shows a lack of understanding of active listening principles. Active listening focuses on listening without judgment or assumptions, understanding the client's perspective, and reflecting back their feelings. Asking why a client blames others can come across as confrontational and may hinder the therapeutic relationship. Choices A, B, and D demonstrate an understanding of active listening principles by emphasizing the importance of silence, avoiding sharing personal experiences, and refraining from giving direct advice, respectively.