ATI RN
Concept of Family Health Care Questions
Question 1 of 5
The nurse is contributing to a teaching plan. What information should the nurse include that identifies the methods in which HIV can be transmitted? (Select all that apply.)
Correct Answer: D
Rationale: Step 1: HIV is primarily transmitted through body fluids containing high concentrations of the virus, such as semen. Step 2: Semen contains a high viral load, making it a common mode of HIV transmission. Step 3: Other body fluids like urine, sweat, and saliva do not typically contain high enough levels of the virus to transmit HIV. Step 4: Therefore, option D (Semen) is correct as it aligns with the established modes of HIV transmission. Summary: Urine, sweat, and saliva do not pose a significant risk for HIV transmission due to their low viral load. Semen, on the other hand, contains high concentrations of the virus, making it a primary mode of transmission.
Question 2 of 5
A patient admitted yesterday for injuries sustained in a fall while intoxicated believes bugs are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis?
Correct Answer: D
Rationale: The correct answer is D: Risk for injury. This is the priority nursing diagnosis because the patient's current state of agitation and anxiety, coupled with the belief of bugs crawling on the bed, poses an immediate risk for self-injury. The patient's altered mental status and intoxication increase the likelihood of accidental harm. Explanation for other choices: A: Ineffective airway clearance - While this is always a critical concern, the patient's current presentation does not indicate any immediate threat to the airway. B: Ineffective coping - While the patient may be experiencing distress, the primary focus should be on addressing the risk of injury given the patient's altered mental status. C: Ineffective denial - While the patient may be experiencing hallucinations, the primary concern is the risk of injury rather than the patient's denial of the situation.
Question 3 of 5
A patient admitted to an alcoholism rehabilitation program says, 'I’m just a social drinker. I usually have a drink or two at brunch, a few cocktails in the afternoon, wine at dinner, and several drinks during the evening.' Which defense mechanism is evident?
Correct Answer: D
Rationale: The correct answer is D: Denial. The patient's statement reflects denial as they are minimizing their alcohol consumption by categorizing it as normal social drinking. Denial is a defense mechanism where a person refuses to acknowledge a reality or truth to protect themselves from anxiety or discomfort. In this scenario, the patient is not accepting the reality of their excessive drinking habits. Explanation for other choices: A: Rationalization - This defense mechanism involves justifying behavior with logical reasoning. The patient is not providing logical reasoning for their drinking habits. B: Introjection - This defense mechanism involves internalizing external beliefs or values. The patient's statement does not indicate internalizing external beliefs. C: Projection - This defense mechanism involves attributing one's unacceptable thoughts or emotions to others. The patient is not projecting their drinking habits onto others.
Question 4 of 5
When a person first begins drinking alcohol, two drinks produce relaxation and drowsiness. After 1 year, four drinks are needed to achieve the same relaxed, drowsy state. Why does this change occur?
Correct Answer: B
Rationale: The correct answer is B: Tolerance develops. Tolerance occurs when the body adapts to repeated exposure to alcohol, requiring higher doses to achieve the same effect. Initially, two drinks were sufficient, but over time, the body adjusts, leading to the need for four drinks to achieve the same level of relaxation and drowsiness. This change is not due to the alcohol being less potent (A), antagonistic effects (C), or hypomagnesemia (D). Tolerance is a well-documented phenomenon in the context of alcohol consumption, explaining the increased amount needed to achieve the desired effect.
Question 5 of 5
A nurse with a history of narcotic dependence is found unconscious in the hospital locker room after overdosing. The nurse is transferred to the inpatient chemical dependence unit for care. Which attitudes or behaviors by nursing staff may be enabling?
Correct Answer: A
Rationale: The correct answer is A because conveying understanding that pressures associated with nursing practice underlie substance use may enable the nurse's behavior by justifying or excusing the substance dependence. This attitude may inadvertently support the nurse's addiction by overlooking the need for accountability and treatment. Choices B, C, and D are incorrect because: B: Pointing out that work problems are the result, but not the cause, of substance dependence does not enable the behavior. It acknowledges the issue without excusing or enabling it. C: Conveying empathy when the nurse discusses fears of disciplinary action by the state board of nursing is not enabling behavior. It shows support and understanding without condoning the substance misuse. D: Providing health teaching about stress management is not enabling behavior. It focuses on addressing the underlying issues rather than enabling or excusing the substance dependence.