ATI RN
Psychotropic Medication Side Effects Questions
Question 1 of 5
The nurse is assessing a 1-week-old infant and is testing his muscle strength. The nurse lifts the infant with hands under the axillae and notices that the infant starts to 'slip' between the hands. The nurse should:
Correct Answer: C
Rationale: Rationale for Choice C: 1. At 1 week old, infants should exhibit some resistance when lifted under the axillae. 2. If the infant "slips" between the hands, it suggests weakness in the shoulder muscles. 3. This weakness could indicate a potential neuromuscular issue or developmental delay. 4. Further assessment and monitoring of the infant's muscle strength are necessary. Summary of Other Choices: A. A fractured clavicle would present with localized pain and tenderness, not slipping when lifted. B. Spinal deformities would not typically cause slipping between the hands when lifted. D. While infant musculature is undeveloped, slipping when lifted under the axillae is not a normal finding and should be further investigated.
Question 2 of 5
A patient has a severed spinal nerve as a result of trauma. Which statement is true in this situation?
Correct Answer: C
Rationale: Step 1: Spinal nerves carry both sensory and motor information. Step 2: When a spinal nerve is severed, the sensory input from that specific dermatome is lost. Step 3: The adjacent spinal nerves do not compensate for the severed nerve's sensory function. Step 4: Therefore, the correct answer is C, as sensations for the dermatome served by the severed nerve are lost. Summary: A: Incorrect - Severing a spinal nerve affects sensory and motor functions, not just motor. B: Incorrect - Sensation is lost in the dermatome served by the severed nerve. D: Incorrect - Spinal nerves contain both sensory and motor components, so a severed nerve affects both functions.
Question 3 of 5
In obtaining a health history on a 74-year-old patient, the nurse notes that he drinks alcohol daily and that he has noticed a tremor in his hands that affects his ability to hold things. With this information, what response should the nurse make?
Correct Answer: B
Rationale: Step 1: Assess if alcohol consumption is related to tremor by asking if the tremor changes when drinking. Step 2: Tremors can be alcohol-related or caused by other factors, hence a targeted question is crucial. Step 3: Addressing alcohol consumption and tremor relationship helps in understanding the patient's condition. Step 4: Other choices are incorrect as they do not directly address the potential relationship between alcohol consumption and tremor.
Question 4 of 5
The assessment of a 60-year-old patient has taken longer than anticipated. In testing his pain perception, the nurse decides to complete the test as quickly as possible. When the nurse applies the sharp point of the pin on his arm several times, he is only able to identify these as one 'very sharp prick.' What would be the most accurate explanation for this?
Correct Answer: B
Rationale: The correct answer is B: This response is most likely the result of the summation effect. This phenomenon occurs when multiple stimuli are perceived as one due to rapid succession. In this case, the nurse applied the sharp point of the pin several times quickly, causing the patient to perceive them as one sharp prick. This is a normal physiological response and does not indicate hyperesthesia, inadequate poking force, or variations in pain perception across different areas of the arm.
Question 5 of 5
To assess the head control of a 4-month-old infant, the nurse lifts up the infant in a prone position while supporting his chest. The nurse looks for what normal response? The infant:
Correct Answer: A
Rationale: The correct answer is A because at 4 months old, infants typically demonstrate head control by lifting their head and arching their back when placed in a prone position. This response indicates developing neck and back muscles strength. Option B is incorrect as extending the arms and dropping down the head does not demonstrate proper head control. Option C is incorrect as flexing the knees and elbows with a straight back is not indicative of head control. Option D is incorrect as holding the head at 45 degrees and keeping the back straight is not the expected response for assessing head control in a 4-month-old infant.