In case of poisoning, the nurse is aware that the main goals in poisoning are to ________. I. inactivate the poison II. administer the specific antidote III. induce the patient to vomit IV. support vital organ functions

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Question 1 of 9

In case of poisoning, the nurse is aware that the main goals in poisoning are to ________. I. inactivate the poison II. administer the specific antidote III. induce the patient to vomit IV. support vital organ functions

Correct Answer: A

Rationale: In cases of poisoning, the main goals are to inactivate the poison to prevent further harm, administer the specific antidote if available to counteract the effects of the poison, and support vital organ functions to help the patient recover. Inducing the patient to vomit (III) is not always recommended as it can potentially cause more harm, especially if the ingested substance is corrosive. Therefore, the most appropriate goals in poisoning are to inactivate the poison, administer the specific antidote, and support vital organ functions.

Question 2 of 9

A rape victim tells the emergency nurse, I feel so dirty. Help me take a shower before I get examined. The nurse should:

Correct Answer: C

Rationale: The correct response for the nurse in this situation would be to offer the victim a shower after evidence is collected. It is essential to preserve any physical evidence that may be present from the assault during the forensic examination. Allowing the victim to shower before evidence is collected could potentially compromise the evidence and hinder the investigation. The nurse should provide support to the victim during this difficult time and assure them that they will have the opportunity to shower once the necessary evidence is obtained. It is also crucial for the nurse to offer empathy and understanding while explaining the importance of preserving any evidence related to the assault.

Question 3 of 9

A patient in the ICU develops acute gastrointestinal bleeding (GIB) requiring urgent intervention. What intervention should the healthcare team prioritize to manage the patient's bleeding?

Correct Answer: A

Rationale: The healthcare team should prioritize performing endoscopic hemostasis with mechanical or thermal techniques in a patient with acute gastrointestinal bleeding (GIB) requiring urgent intervention. This approach involves directly visualizing the bleeding site and applying methods such as clipping, coagulation, or band ligation to stop the bleeding. Endoscopic hemostasis is considered the gold standard for managing acute GIB as it allows for both diagnostic and therapeutic intervention in real-time, offering a targeted and effective way to control bleeding and prevent recurrent episodes. Administering proton pump inhibitors (PPIs) may help in reducing gastric acid secretion and promoting ulcer healing but is not the primary intervention for actively bleeding patients. Implementing strict bed rest may be necessary in some cases to minimize physical exertion, but it is not the primary intervention to manage acute GIB. Transfusion of fresh frozen plasma to correct coagulopathy may be necessary if

Question 4 of 9

Sandro is taking pemoline (Cylert) for ADHD. The nurse must be aware of which of the following side effects?

Correct Answer: D

Rationale: Pemoline (Cylert) is a central nervous system stimulant used in the treatment of ADHD. One of the significant potential side effects of pemoline is hepatotoxicity, which can manifest as elevated liver function test results. Therefore, the nurse must monitor the patient's liver function regularly while they are taking pemoline to monitor for any signs of liver damage or dysfunction. It is essential to educate the patient about the signs and symptoms of liver problems, such as jaundice (yellowing of the skin or eyes), abdominal pain, nausea, or dark urine, and to report any such symptoms immediately to their healthcare provider. Regular monitoring and early detection of liver function abnormalities can help prevent severe liver damage in patients taking pemoline.

Question 5 of 9

A patient receiving palliative care for end-stage liver disease experiences severe pruritus. What intervention should the palliative nurse prioritize to address the patient's symptoms?

Correct Answer: D

Rationale: In end-stage liver disease, pruritus (itching) can be a distressing symptom caused by the accumulation of bile salts in the skin due to impaired liver function. Cholestyramine and other bile acid sequestrants are the primary treatment for managing pruritus in these patients. These medications bind to the bile salts in the intestine, preventing their reabsorption and reducing the itching symptoms. Antihistamines may not be as effective for this type of pruritus since it is not histamine-mediated. Topical corticosteroids are generally not recommended for long-term use in liver disease due to the risk of systemic absorption and adverse effects. Avoiding hot showers or baths may provide some temporary relief but is not a definitive treatment. Therefore, prioritizing the prescription of cholestyramine or bile acid sequestrants would be the most appropriate intervention to address the severe pruritus in a patient with end-stage liver disease

Question 6 of 9

Which of the following actions is INAPPROPRIATE for a nurse leader to apply in a work setting?

Correct Answer: A

Rationale: While it is important for nurse leaders to seek input and feedback from staff members, the inappropriate aspect of this action lies in the lack of clarity. The option contains a typographical error "natter" instead of "matter," which may lead to confusion and hinder effective communication. Additionally, the word choice of "opinion" instead of a more structured and strategic approach like "feedback" or "input" could be improved for professional communication in the workplace. Therefore, this action may not be considered appropriate in a work setting due to potential misunderstandings that can arise from the lack of clarity in communication.

Question 7 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 8 of 9

A woman in active labor demonstrates persistent occiput posterior fetal position, contributing to prolonged labor and severe back pain. What nursing intervention should be prioritized to facilitate fetal rotation and optimize labor progress?

Correct Answer: A

Rationale: Placing the mother in a hands-and-knees position can help facilitate fetal rotation from occiput posterior to the desired occiput anterior position. This position utilizes gravity to assist in the repositioning of the baby, ultimately helping to alleviate back pain and promoting more efficient labor progress. It allows the baby's head to descend properly into the pelvis, potentially reducing the risk of a prolonged labor or the need for instrumental delivery. Additionally, being in this position can help the mother feel more comfortable and empowered during labor. Overall, assisting the mother into a hands-and-knees position is a non-invasive, low-risk intervention that can have a positive impact on both the mother and baby's well-being during labor.

Question 9 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.

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