ATI RN
Adult Health Nursing Test Banks Questions
Question 1 of 9
A postpartum client who is breastfeeding expresses concerns about breast engorgement and discomfort. What nursing intervention should be prioritized to alleviate symptoms?
Correct Answer: A
Rationale: The most appropriate nursing intervention to alleviate breast engorgement and discomfort in a breastfeeding client is to encourage frequent breastfeeding or pumping sessions. Engorgement occurs when the breasts become overly full of milk, causing them to become swollen, firm, and painful. By ensuring that the baby breastfeeds frequently, the client can effectively empty the breasts, which helps to relieve engorgement and discomfort. Encouraging the client to breastfeed on demand and ensuring proper latching can help prevent further engorgement issues. Pumping can also be useful if the baby is unable to feed directly from the breast or to relieve engorgement between feedings. This intervention addresses the root cause of the problem and promotes the client's comfort and breastfeeding success. Applying cold packs, using a supportive bra or breast binder, and administering oral analgesics may provide some relief for discomfort but do not address the underlying issue of engorgement.
Question 2 of 9
Which of the following is the PRIORITY action of the nurse for Sonny who is on Oxygen therapy?
Correct Answer: A
Rationale: Checking the flow of oxygen is the priority action because it ensures that Sonny is receiving the correct amount of oxygen prescribed by the healthcare provider. Before connecting the flow meter to the oxygen outlet, turning on the oxygen, or attaching the humidifier, it is crucial to verify that the flow rate is appropriate for Sonny's condition. Monitoring and adjusting the oxygen flow will help maintain the desired oxygen saturation levels and prevent potential complications related to oxygen therapy.
Question 3 of 9
Nurses should have knowledge about professional organization. Which of t he following is the accredited professional organization of nurses?
Correct Answer: B
Rationale: The Philippine Nurses Association, Inc. (PNA) is the accredited professional organization of nurses in the Philippines. PNA is recognized as the official organization of all registered nurses in the country, dedicated to fostering high standards of nursing practice, education, and professional growth. It plays a key role in advocating for the rights and welfare of nurses, as well as promoting the advancement of the nursing profession in the Philippines. Membership in the PNA provides nurses with access to valuable resources, networking opportunities, and support for continuous professional development.
Question 4 of 9
Despite the short staffing, Nurse Cirila also has the responsibility to maintain safe environment for her pediatric patients. The following are the indicators that Nurse Cirila has achieved this goal, EXCEPT __________.
Correct Answer: C
Rationale: The indicators listed indicate measures that Nurse Cirila can take to maintain a safe environment for her pediatric patients. However, assessing the competencies of staff before delegating a task is more related to ensuring effective delegation and appropriate task assignment rather than directly ensuring a safe environment for patients. While it is important to delegate tasks to qualified staff, this specific action does not directly contribute to maintaining a safe environment in the same manner as the other indicators listed (proper waste disposal, infection control, emergency protocols).
Question 5 of 9
You accidentally touch Claudia's eyelid during eye drop instillation causing her to blink. What should have you done to prevent this from occurring?
Correct Answer: B
Rationale: Tilt back Claudia's head slightly would have been the correct action to prevent her from blinking during eye drop instillation. By tilting her head back, you create a more stable position for instilling the eye drops, reducing the likelihood of accidental contact with her eyelid. Additionally, tilting the head back slightly helps in making it easier for the drops to enter the eye and stay within the conjunctival sac, improving the efficacy of the medication.
Question 6 of 9
When the nurse placed the patient in restraints before using other methods of intervention, she/he violated the patient's rights to ______.
Correct Answer: C
Rationale: Placing a patient in restraints before utilizing other less restrictive interventions violates the patient's right to receive treatment in the least restrictive environment. Restraints should be used as a last resort when all other options have been exhausted, as they can be restrictive to the patient's movement and freedom. Patients have the right to be treated in a manner that minimizes limitations on their personal freedom and autonomy. Restraints should only be utilized when absolutely necessary for the safety of the patient or others.
Question 7 of 9
The patient has been ordered a regimen to treat a urinary tract infection and notifies the nurse that the patient's urine has turned an orange color. The nurse recognizes that the patient is most likely being treated with which drug?
Correct Answer: D
Rationale: Phenazopyridine HCl (Pyridium) is a medication commonly used to relieve the pain, burning, and discomfort associated with urinary tract infections (UTIs). One of the notable side effects of Phenazopyridine is the discoloration of urine, turning it a rusty-red or orange color. This color change is harmless and temporary, but it can be alarming to patients who are unaware of this side effect. Therefore, if a patient undergoing treatment for a UTI notices their urine has turned orange, it is most likely due to the administration of Phenazopyridine.
Question 8 of 9
A patient presents with central obesity, moon face, buffalo hump, and purple striae. Laboratory tests reveal elevated cortisol levels. Which endocrine disorder is most likely responsible for these symptoms?
Correct Answer: D
Rationale: The patient's presentation of central obesity, moon face, buffalo hump, purple striae, and elevated cortisol levels strongly suggest Cushing's syndrome. Cushing's syndrome is a disorder characterized by excessive levels of cortisol, either due to an endogenous (e.g., adrenal tumor) or exogenous (e.g., prolonged steroid use) source. The classic physical features of Cushing's syndrome include central obesity with thin extremities (truncal obesity), moon face (rounding and reddening of the face), buffalo hump (accumulation of fat between the shoulders), and purple striae (stretch marks that are wide and purple in color). In the context of the elevated cortisol levels, these clinical signs are highly indicative of Cushing's syndrome. Hyperthyroidism, hypothyroidism, and diabetes mellitus would not typically present with the specific combination of symptoms described.
Question 9 of 9
A patient is prescribed a beta-blocker for the management of migraine headaches. Which adverse effect should the nurse monitor closely in the patient?
Correct Answer: B
Rationale: Beta-blockers work by blocking the effects of adrenaline on beta receptors in the body. One common adverse effect of beta-blockers is bradycardia, or a slowed heart rate. Since the patient is being prescribed a beta-blocker for migraine headaches, it is important for the nurse to monitor closely for signs and symptoms of bradycardia such as dizziness, fatigue, and fainting. Monitoring the heart rate regularly and reporting any significant decrease to the healthcare provider is essential to prevent complications associated with bradycardia. Compared to the other options, bradycardia is the most relevant adverse effect to monitor in a patient prescribed a beta-blocker.