ATI RN
Adult Health Nursing Study Guide Answers Questions
Question 1 of 9
Signs such as using tissues to doorknobs develop because the patient is ________.
Correct Answer: A
Rationale: Signs such as using tissues to doorknobs suggest that the patient is unconsciously controlling unacceptable impulses or feelings. This behavior falls under the category of defense mechanisms, specifically displacement, where the individual redirects their emotions from a threatening target to a safer one. In this case, the patient may be experiencing anxiety or fear related to contamination or germs, leading them to use tissues to avoid touching doorknobs directly. It is a way for the patient to manage their underlying emotions, albeit unconsciously, through this compulsive behavior.
Question 2 of 9
A patient presents with progressive hearing loss, tinnitus, and vertigo. Audiometric testing reveals sensorineural hearing loss with a "carrot-shaped" configuration. Which of the following conditions is most likely responsible for this presentation?
Correct Answer: C
Rationale: Ménière's disease is characterized by the triad of symptoms including progressive sensorineural hearing loss, tinnitus, and vertigo. The audiometric testing in Ménière's disease often shows a "carrot-shaped" configuration, which refers to low-frequency hearing loss initially and eventually spreading to involve higher frequencies. This distinctive pattern of hearing loss helps differentiate Ménière's disease from other causes like Presbycusis (age-related hearing loss) or Noise-induced hearing loss. Acoustic neuroma can present with unilateral sensorineural hearing loss but typically does not exhibit the specific "carrot-shaped" configuration seen in Ménière's disease.
Question 3 of 9
On the first postpartum day, a primiparous patient complains of perineal pain that was unrelieved by Ibuprofen 400 mg given two hours ago. Nurse Kayla should assess for which of the following?
Correct Answer: C
Rationale: In a primiparous patient who complains of unrelieved perineal pain on the first postpartum day, Nurse Kayla should assess for a perineal hematoma. A perineal hematoma is a collection of blood in the perineal tissues and can cause significant pain and discomfort. It can be a result of trauma during delivery or due to a blood vessel rupture. This condition requires prompt assessment and intervention to prevent complications such as infection or excessive bleeding. Vaginal laceration would typically be identified during the delivery process and would have been repaired by the healthcare provider. History of drug abuse, while important to know for overall patient care, is not as relevant in this immediate postpartum pain assessment. Puerperal infection usually presents with other signs such as fever, foul-smelling discharge, and uterine tenderness, which are not mentioned in this scenario.
Question 4 of 9
A patient presents with gradual-onset memory loss, impaired judgment, and personality changes. Over time, the patient develops difficulty with language, motor function, and coordination. Which of the following neurological conditions is most likely responsible for these symptoms?
Correct Answer: B
Rationale: The symptoms described such as memory loss, impaired judgment, personality changes, difficulty with language, motor function, and coordination all point towards Alzheimer's disease. Alzheimer's is a progressive neurodegenerative disease that primarily affects memory and cognitive functions. Over time, it leads to severe impairment in daily activities and overall functioning. While Parkinson's disease, Huntington's disease, and ALS can also present with neurological symptoms, the combination of gradual-onset memory loss, cognitive decline, and functional impairments seen in this scenario is most characteristic of Alzheimer's disease.
Question 5 of 9
It a medicine is unavailable and therefore not given to the patient, how is it charted?
Correct Answer: B
Rationale: When a medication is unavailable and therefore not given to the patient, it is important to document this in the Nurses Notes along with an explanation. Leaving it blank (Option A) may lead to confusion or errors as the reason for not administering the medication would not be clear. Using an asterisk or mark as per hospital protocol (Option C) may not provide enough information about why the medication was missed. Writing the letter (Option D) without any explanation would not suffice in terms of documentation and accountability. Therefore, signing and making an explanation in the Nurses Notes (Option B) is the correct way to chart when a medication is unavailable. This ensures proper documentation of the situation and helps in maintaining the continuity of care for the patient.
Question 6 of 9
A postpartum client presents with sudden, severe chest pain and dyspnea. Which nursing action is most appropriate?
Correct Answer: C
Rationale: Sudden, severe chest pain and dyspnea in a postpartum client could be indicative of a potential serious condition, such as a pulmonary embolism or postpartum cardiomyopathy, which require immediate medical attention. Therefore, the most appropriate nursing action would be to notify the healthcare provider immediately for further evaluation and management. Placing the client in a semi-Fowler's position may provide some comfort but does not address the underlying cause of the symptoms. Administering supplemental oxygen therapy may be necessary once the healthcare provider assesses the client. Encouraging deep breathing exercises may not be appropriate if the client is experiencing severe chest pain and dyspnea, as it could worsen the situation.
Question 7 of 9
A patient with a history of chronic obstructive pulmonary disease (COPD) is prescribed ipratropium bromide inhaler. Which instruction should the nurse provide to the patient regarding ipratropium inhaler use?
Correct Answer: C
Rationale: The nurse should instruct the patient to hold their breath for at least 10 seconds after inhaling the medication from the ipratropium bromide inhaler. This allows the medication to reach deep into the lungs and be more effective. Holding the breath also helps reduce the risk of side effects such as throat irritation. It is essential for optimal drug delivery and therapeutic effect.
Question 8 of 9
Nurse Mary randomly seleted individuals in the community who will be part of a project. Which of the following ethical principle is observed by the nurse?
Correct Answer: A
Rationale: By randomly selecting individuals in the community for the project, Nurse Mary is upholding the ethical principle of autonomy. Autonomy refers to respecting individuals' right to make their own decisions and choices. In this scenario, Nurse Mary is not imposing her own preferences or biases but rather allowing individuals in the community to have an equal opportunity to participate in the project. Random selection ensures that the process is fair and gives everyone an equal chance to be involved, respecting their autonomy.
Question 9 of 9
A patient presents with chest pain, dyspnea, and a friction rub heard on auscultation. An electrocardiogram (ECG) shows diffuse ST-segment elevation. Which cardiovascular disorder is most likely responsible for these symptoms?
Correct Answer: D
Rationale: The clinical presentation of chest pain, dyspnea, and a friction rub heard on auscultation is suggestive of pericarditis. The diffuse ST-segment elevation seen on the electrocardiogram (ECG) is a classic finding in pericarditis, known as the "universal sign." In contrast, stable angina typically presents with chest pain on exertion that is relieved by rest or nitroglycerin, while unstable angina presents with chest pain at rest or with minimal exertion. Acute myocardial infarction would typically present with ST-segment elevation in specific leads correlating with the area of myocardial ischemia/infarction. However, in the context of diffuse ST-segment elevation and symptoms suggestive of inflammation (friction rub), the most likely diagnosis is pericarditis.