ATI RN
Foundations and Adult Health Nursing Test Bank Questions
Question 1 of 9
A woman in active labor has been diagnosed with placenta previa. What is the priority nursing intervention?
Correct Answer: A
Rationale: In the case of a woman in active labor with placenta previa, the priority nursing intervention is to prepare for an immediate cesarean section. Placenta previa is a condition in which the placenta covers part or all of the cervix, which can lead to severe bleeding during labor and delivery. The risk of hemorrhage is significant, making a cesarean section the safest option for both the mother and the baby in this situation. It is crucial to act promptly to prevent complications and ensure the well-being of both the mother and the baby. Administering intravenous oxytocin to augment labor or inserting a Foley catheter to monitor urine output would not address the immediate risk of hemorrhage associated with placenta previa. Implementing bed rest and continuous fetal monitoring may be part of the overall care plan but not the priority intervention in this urgent situation.
Question 2 of 9
Which danger sign would warrant stoppage of pills?
Correct Answer: D
Rationale: An elevation of blood pressure would warrant stoppage of pills. High blood pressure, or hypertension, in a 4-year-old child is abnormal and needs prompt medical attention. Giving pills without monitoring or stopping them if blood pressure is elevated can lead to serious health complications. It is important to address the underlying cause of high blood pressure in a child, which may require further evaluation and management by a healthcare provider.
Question 3 of 9
The PRC-Board of Nursing (PR-BON) has the power to regulate Nursing Practice in the Philippines. The regulatory functions include the following except
Correct Answer: D
Rationale: The Philippine Regulatory Commission - Board of Nursing (PRC-BON) has the power to regulate nursing practice in the Philippines.
Question 4 of 9
A patient with a history of Hodgkin lymphoma presents with fever, chills, and generalized malaise. Laboratory tests reveal pancytopenia, circulating Reed-Sternberg cells, and bone marrow involvement. Which of the following conditions is most likely to cause these findings?
Correct Answer: D
Rationale: The patient is presenting with symptoms and laboratory findings consistent with a paraneoplastic syndrome related to Hodgkin lymphoma. In this case, the fever, chills, generalized malaise, pancytopenia, circulating Reed-Sternberg cells, and bone marrow involvement are all indicative of a paraneoplastic syndrome associated with Hodgkin lymphoma. Paraneoplastic syndromes are a group of disorders that are triggered by an abnormal immune response to a neoplasm, such as Hodgkin lymphoma, leading to various systemic manifestations.
Question 5 of 9
The elderly should be affforded health protection by
Correct Answer: D
Rationale: Regular health check-ups play a crucial role in the prevention, early detection, and management of health issues, especially for the elderly. By ensuring that the elderly receive regular health check-ups, healthcare providers can monitor their health status, detect any potential health problems early on, and provide appropriate medical interventions. This proactive approach can help protect the elderly from developing serious health issues or complications. Additionally, regular health check-ups can also promote overall health and well-being, allowing healthcare professionals to address any existing health concerns and provide necessary treatments or recommendations to maintain the elderly's health and quality of life.
Question 6 of 9
The client asks the nurse about using decongestant nasal sprays. Which of the following statements by the nurse is CORRECT regarding its use?
Correct Answer: C
Rationale: The correct statement regarding the use of decongestant nasal sprays is that "Nasal sprays should not be used for more than three days because it can worsen congestion." Prolonged use of decongestant nasal sprays can lead to rebound congestion, where the congestion worsens with extended use. Therefore, it is important to limit the use of these sprays to avoid this side effect. It is recommended to use decongestant nasal sprays for no longer than three consecutive days.
Question 7 of 9
A woman in active labor has been diagnosed with placenta previa. What is the priority nursing intervention?
Correct Answer: A
Rationale: In the case of a woman in active labor with placenta previa, the priority nursing intervention is to prepare for an immediate cesarean section. Placenta previa is a condition in which the placenta covers part or all of the cervix, which can lead to severe bleeding during labor and delivery. The risk of hemorrhage is significant, making a cesarean section the safest option for both the mother and the baby in this situation. It is crucial to act promptly to prevent complications and ensure the well-being of both the mother and the baby. Administering intravenous oxytocin to augment labor or inserting a Foley catheter to monitor urine output would not address the immediate risk of hemorrhage associated with placenta previa. Implementing bed rest and continuous fetal monitoring may be part of the overall care plan but not the priority intervention in this urgent situation.
Question 8 of 9
A patient with a severe bacterial infection has elevated levels of C-reactive protein (CRP) in their blood. Which of the following functions does CRP primarily serve during the acute phase response?
Correct Answer: B
Rationale: During the acute phase response, C-reactive protein (CRP) primarily serves to activate the complement system. CRP binds to phosphocholine on the surface of pathogens, allowing for the activation of the classical pathway of the complement system. This leads to the recruitment of immune cells, opsonization of pathogens, and enhancement of phagocytosis. The activation of the complement system by CRP plays a crucial role in the host defense against infections, aiding in the elimination of pathogens and the resolution of inflammation.
Question 9 of 9
Which procedure has to be done to the patient to establish a definitive diagnosis of lung cancer?
Correct Answer: C
Rationale: Bronchoscopy is a procedure that allows direct visualization of the inside of the airways in the lungs. It is considered the most definitive method to establish a diagnosis of lung cancer as it can directly visualize any abnormal growths or tumors in the bronchial tubes. During bronchoscopy, tissue samples can be collected for biopsy to confirm the presence of cancer cells. This procedure is more accurate compared to other diagnostic methods such as chest x-ray, CT scan, cytological study of sputum, or magnetic resonance imaging in confirming a diagnosis of lung cancer.