ATI RN
Concept of Family Health Nursing Care Questions
Question 1 of 5
An alcohol-dependent patient was hospitalized at 0200 today. When would the nurse expect withdrawal symptoms to peak?
Correct Answer: B
Rationale: The correct answer is B because alcohol withdrawal symptoms typically peak between 24 to 48 hours after the patient stops drinking. This timeframe aligns with the onset of symptoms such as tremors, anxiety, and hallucinations. Choices A, C, and D are incorrect because withdrawal symptoms do not peak within 6 to 8, 72, or 96 hours after drinking cessation. It is crucial for the nurse to monitor the patient closely during this critical period to manage and prevent potential withdrawal complications.
Question 2 of 5
During the third week of treatment, the spouse of a patient in an alcoholism rehabilitation program says, 'After discharge, I’m sure everything will be just fine.' Which remark by the nurse will be most helpful to the spouse?
Correct Answer: B
Rationale: The correct answer is B because it acknowledges the spouse's optimism while also gently highlighting the potential challenges that may arise during the recovery process. By pointing out that new problems may emerge as the patient adjusts to a life without alcohol, the nurse prepares the spouse for potential difficulties and encourages realistic expectations. Choice A is incorrect because it only acknowledges the spouse's support without addressing the potential challenges ahead. Choice C is incorrect because it focuses solely on stress avoidance rather than preparing for the overall adjustment process. Choice D is incorrect because it emphasizes monitoring the patient's behavior rather than addressing the spouse's outlook and potential struggles.
Question 3 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 4 of 5
Which nursing diagnosis would likely apply to both patients with paranoid schizophrenia and patients with amphetamine-induced psychosis?
Correct Answer: B
Rationale: The correct answer is B: Disturbed thought processes. Both patients with paranoid schizophrenia and amphetamine-induced psychosis commonly experience altered thinking patterns, hallucinations, and delusions. This nursing diagnosis addresses the cognitive disruptions present in both conditions. Incorrect choices: A: Powerlessness - This diagnosis refers to a lack of control over one's life situation, which may not be a primary concern for these patients. C: Ineffective thermoregulation - This diagnosis relates to the body's ability to maintain temperature, which is not typically affected in these conditions. D: Impaired oral mucous membrane - This diagnosis is related to issues with the mouth's lining and is not typically associated with paranoid schizophrenia or amphetamine-induced psychosis.
Question 5 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.