ATI RN
Adult Health Med Surg Nursing Test Banks Questions
Question 1 of 5
A patient with acute respiratory distress syndrome (ARDS) develops refractory hypoxemia despite maximal ventilatory support and prone positioning. Which of the following adjunctive therapies is most likely to improve oxygenation and reduce mortality in this patient?
Correct Answer: C
Rationale: In a patient with ARDS who is experiencing refractory hypoxemia despite maximal ventilatory support and prone positioning, the use of extracorporeal membrane oxygenation (ECMO) is a potentially life-saving adjunctive therapy. ECMO works by providing temporary support for gas exchange outside the body, allowing the lungs to rest and heal while providing adequate oxygenation and carbon dioxide removal. The use of ECMO has been associated with improved oxygenation and reduced mortality in severe cases of ARDS, especially in patients who fail conventional therapies. High-frequency oscillatory ventilation (HFOV) has not consistently shown mortality benefit in ARDS, continuous renal replacement therapy (CRRT) is not directly indicated for hypoxemia in ARDS, and inhaled nitric oxide (iNO) has shown limited benefit in improving oxygenation in ARDS without a clear impact on mortality.
Question 2 of 5
A patient with a history of chronic liver disease presents with bruising, petechiae, and mucosal bleeding. Laboratory tests reveal prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT) with decreased platelet count. Which of the following conditions is most likely to cause these findings?
Correct Answer: B
Rationale: Disseminated intravascular coagulation (DIC) is a condition characterized by widespread activation of coagulation leading to both thrombosis and hemorrhage. In patients with chronic liver disease, especially in the setting of advanced cirrhosis, DIC can develop due to factors such as decreased synthesis of coagulation factors and impaired clearance of activated clotting factors. The patient in this scenario presents with signs of both abnormal bleeding (bruising, petechiae, mucosal bleeding) and laboratory findings consistent with DIC, including prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT) along with decreased platelet count.
Question 3 of 5
A patient presents with severe headache, blurred vision, and fatigue. Laboratory tests reveal elevated white blood cell count, thrombocytosis, and presence of JAK2 V617F mutation. Which of the following conditions is most likely to cause these findings?
Correct Answer: B
Rationale: The patient's presentation of severe headache, blurred vision, and fatigue, along with the laboratory findings of elevated white blood cell count, thrombocytosis, and JAK2 V617F mutation, are characteristic of essential thrombocythemia. This is a myeloproliferative neoplasm characterized by the clonal proliferation of megakaryocytes, leading to an increased platelet count. The JAK2 V617F mutation is commonly found in essential thrombocythemia and other myeloproliferative disorders. The symptoms of essential thrombocythemia can be related to the increased blood viscosity and risk of thrombosis due to the elevated platelet count. Polycythemia vera would present with elevated red blood cell count, hemoglobin, and hematocrit, along with other features such as pruritus after a hot bath. Chronic myeloid leukemia (CML
Question 4 of 5
A patient presents with recurrent episodes of epistaxis, gum bleeding, and easy bruising. Laboratory tests reveal prolonged bleeding time, normal platelet count, and normal PT and aPTT. Which of the following conditions is most likely to cause these findings?
Correct Answer: A
Rationale: The clinical presentation of recurrent episodes of epistaxis, gum bleeding, and easy bruising, along with laboratory findings of prolonged bleeding time, normal platelet count, and normal coagulation studies (PT and aPTT) are highly suggestive of Von Willebrand disease. Von Willebrand disease is the most common inherited bleeding disorder and is characterized by a deficiency or dysfunction of von Willebrand factor (vWF), which plays a key role in platelet adhesion and aggregation. The prolonged bleeding time is due to impaired platelet adhesion to the damaged vessel wall in the absence of functional vWF. Normal platelet count and normal PT/aPTT help differentiate Von Willebrand disease from other bleeding disorders such as hemophilia and platelet function disorders like Glanzmann thrombasthenia and Bernard-Soulier syndrome.
Question 5 of 5
A patient presents with sudden-onset unilateral facial droop, arm weakness, and slurred speech. Symptoms began approximately 30 minutes ago but have partially resolved since then. Which of the following neurological conditions is most likely responsible for these symptoms?
Correct Answer: A
Rationale: The presentation of sudden-onset unilateral facial droop, arm weakness, and slurred speech that partially resolved within 30 minutes is more consistent with a transient ischemic attack (TIA) rather than an ischemic or hemorrhagic stroke. TIAs are caused by temporary decreases in blood flow to a specific area of the brain, leading to transient neurological deficits that typically last for less than 24 hours. In this case, the symptoms partially resolving suggest a temporary and reversible ischemic event, characteristic of a TIA. Ischemic strokes involve more prolonged or permanent impairment due to blockage of a blood vessel supplying the brain, while hemorrhagic strokes involve bleeding within the brain tissue or the surrounding membranes.