ATI RN
Age Specific Care Quiz Questions
Question 1 of 5
The client interprets the proverb 'A rolling stone gathers no moss' as 'As long as the rock keeps moving, it won't turn green.' This is an example of:
Correct Answer: C
Rationale: Concrete thinking refers to interpreting things in a literal or factual way without grasping the underlying meaning. In this question, the client's interpretation of the proverb demonstrates a lack of understanding of the metaphorical meaning behind it. By focusing on the literal aspect of the stone not turning green, the client displays concrete thinking. Mutism, flight of ideas, and loose association are unrelated to the client's interpretation of the proverb, making them incorrect choices.
Question 2 of 5
A patient with swelling and a laceration above the right eye states, 'I don't know what caused me to fall and cut my head on the door frame in my bedroom. I'm lucky my spouse was home to take me to the hospital.' The patient's spouse appears nervous but smiles when mentioning that the patient is 'so clumsy at times.' Which nursing intervention should the nurse give priority attention to when addressing this patient's needs?
Correct Answer: A
Rationale: The correct answer is A: Provide a thorough assessment that includes a focus on signs of old injuries. This is the priority intervention because the patient's statement, combined with the spouse's behavior, raises suspicion of potential domestic abuse. By assessing for signs of old injuries, the nurse can gather crucial information to determine if the patient is a victim of abuse. Choice B: Interview the patient regarding the circumstances surrounding this suspicious fall may be important, but assessing for signs of old injuries takes priority as it provides concrete evidence of potential abuse. Choice C: Directly ask the patient if spousal abuse is occurring or has ever occurred is necessary, but the patient may not feel comfortable disclosing abuse directly. Assessing for old injuries can provide objective evidence. Choice D: Notify security that there is a possibility that this patient is a victim of physical abuse is premature without concrete evidence. Assessing for old injuries should be done first to gather information before taking further action.
Question 3 of 5
A victim of physical abuse by her domestic partner is being treated for a broken humerus. Which indicator for the outcome of Abuse protection is most important to achieve before the patient leaves the emergency department?
Correct Answer: A
Rationale: The correct answer is A because a safety plan is crucial for the victim's immediate safety and future protection. It helps the victim know what to do in case of danger, ensuring a proactive approach to safety. Choice B may not always be feasible or effective in preventing further abuse. Choice C, while important, does not guarantee safety outside the emergency department. Choice D is beneficial but does not address the immediate safety concerns as effectively as having a safety plan in place. Thus, completing and reviewing a workable safety plan is the most important indicator for the outcome of abuse protection in this scenario.
Question 4 of 5
A client with catatonic schizophrenia has been posturing, standing with his left arm upraised and his right foot off the floor. For the most part, he ignores attempts at nursing intervention but will occasionally walk, sit, or lie down for a few minutes. The client eats standing up if the nurse brings a tray to the room. The priority nursing order would be to:
Correct Answer: B
Rationale: The correct answer is B: Assess for lower extremity edema bid. It is important to assess for lower extremity edema in this client with catatonic schizophrenia as posturing in a standing position for prolonged periods can lead to decreased circulation and potential development of edema. This assessment is crucial to monitor the client's physical health and prevent complications such as deep vein thrombosis. Choice A is incorrect as insisting the client sit or lie down for 30 minutes hourly may not address the underlying issue of potential lower extremity edema and could potentially worsen the client's condition by causing distress. Choice C is incorrect as providing high-calorie drinks hourly does not address the immediate physical health concern of lower extremity edema and may not be appropriate without a comprehensive assessment of the client's nutritional needs. Choice D is incorrect as taking the client to activities therapy once daily does not address the immediate need for assessing lower extremity edema and may not be suitable if the client's physical health
Question 5 of 5
A patient with schizophrenia is admitted to the psychiatric unit in an acutely disturbed, violent state. He is given several doses of haloperidol (Haldol) and becomes calm and approachable. During rounds the nurse notices the patient has his head rotated to one side in a stiffly fixed position. His lower jaw is thrust forward and he appears severely anxious. The patient has ______, and the nurse should ______.
Correct Answer: A
Rationale: The correct answer is A: a dystonic reaction"¦administer PRN IM benztropine (Cogentin). 1. Dystonic reaction is characterized by involuntary muscle contractions, causing abnormal posture or movements. 2. The patient's symptoms of head rotation, jaw thrust, and severe anxiety align with dystonic reaction. 3. Benztropine is an anticholinergic medication used to treat dystonic reactions by blocking acetylcholine in the brain. 4. Administering benztropine promptly can alleviate the symptoms and prevent complications. Other choices are incorrect: B: Tardive dyskinesia develops with long-term antipsychotic use, presenting as repetitive, involuntary movements. Seeking a change in drug or dosage is not appropriate for acute dystonic reaction. C: Waxy flexibility is a symptom of catatonia, not related to the patient's presentation of dystonic reaction. D: Akathisia is restlessness and agitation often caused by