ATI RN
Adult Health Nursing Answer Key Questions
Question 1 of 5
As Nurse Pedrito prepares for the day's visits, which of the following patients should be seen FIRST? A client with ________.
Correct Answer: C
Rationale: The patient with a history of congestive heart failure and dyspnea should be seen FIRST by Nurse Pedrito. Congestive heart failure is a serious condition that can lead to acute exacerbations and requires prompt assessment and management. Dyspnea (shortness of breath) is a common symptom of heart failure and can indicate worsening cardiac function or fluid overload, which requires immediate attention to prevent further complications. Timely assessment and intervention for heart failure exacerbations can help prevent hospital admissions and improve patient outcomes. Therefore, prioritizing this patient for assessment and intervention is crucial to ensure their safety and well-being.
Question 2 of 5
A pregnant woman presents with severe lower abdominal pain and vaginal bleeding. On examination, cervical motion tenderness and unilateral adnexal tenderness are noted, along with an adnexal mass on the affected side. Which of the following conditions is the most likely cause of these symptoms?
Correct Answer: A
Rationale: The clinical presentation of severe lower abdominal pain and vaginal bleeding in a pregnant woman, along with cervical motion tenderness, unilateral adnexal tenderness, and an adnexal mass on the affected side, is highly concerning for an ectopic pregnancy. Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tube. The presence of an adnexal mass and tenderness on one side is indicative of potential tubal involvement and can mimic symptoms of pelvic inflammatory disease. Prompt evaluation and management are crucial in ectopic pregnancy to prevent life-threatening complications associated with rupture of the fallopian tube.
Question 3 of 5
A nurse is preparing to assist with a bone marrow biopsy procedure for a patient. What action should the nurse prioritize to ensure patient comfort during the procedure?
Correct Answer: C
Rationale: Prioritizing the application of a topical anesthetic cream to the biopsy site is essential to ensure patient comfort during the bone marrow biopsy procedure. This will help numb the area where the biopsy needle will be inserted, reducing the pain and discomfort experienced by the patient. Administering intravenous sedation may not always be needed for a bone marrow biopsy and should be decided by the healthcare provider based on the patient's individual needs. Providing distraction techniques such as music or relaxation exercises can be helpful, but they may not be as effective at reducing the physical discomfort caused by the procedure. Allowing the patient to eat or drink up to one hour before the procedure is important for other reasons, such as preventing potential complications during sedation or anesthesia, but it is not directly related to ensuring comfort during the biopsy itself.
Question 4 of 5
Which of the following nursing measures would the nurse LEAST CONSIDERS to Patient Ellie with oxytocin drip?
Correct Answer: D
Rationale: While all of the nursing measures listed are important considerations when managing a patient receiving oxytocin drip, the nurse would least consider informing the patient about potential complications. The reason for this is that it is the responsibility of the healthcare provider (such as the physician or advanced practice nurse) to inform the patient about potential complications of a medication or treatment. Nurses are instrumental in providing education and support to patients, but in the case of informing patients about potential complications, this task typically falls under the purview of the prescribing provider. The primary focus of the nurse in this situation would be to assess, administer, monitor, and educate the patient as appropriate, ensuring safe and effective care delivery.
Question 5 of 5
A patient presents with watery diarrhea, abdominal cramps, and nausea after consuming contaminated water from a stream during a camping trip. Laboratory tests reveal oocysts in the stool sample. Which of the following parasites is most likely responsible for this infection?
Correct Answer: C
Rationale: Cryptosporidium parvum is a parasite commonly found in contaminated water sources such as streams or lakes. It causes an infection called cryptosporidiosis, which often presents with symptoms like watery diarrhea, abdominal cramps, and nausea. The oocysts of Cryptosporidium parvum can be identified in stool samples, making it the likely culprit in this scenario. Giardia lamblia, another common waterborne parasite, can also cause similar symptoms but is characterized by trophozoites rather than oocysts in stool samples. Entamoeba histolytica is associated with amoebic dysentery and does not typically present with watery diarrhea. Cyclospora cayetanensis is another parasite causing gastrointestinal symptoms but is not as commonly associated with contaminated water sources as Cryptosporidium parvum.
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