ATI RN
Foundations and Adult Health Nursing Test Bank Questions
Question 1 of 9
What is the primary purpose of a cervical collar in the management of trauma patients?
Correct Answer: B
Rationale: The primary purpose of a cervical collar in the management of trauma patients is to immobilize the cervical spine. This is crucial in cases of suspected cervical spine injury to prevent any further damage and to maintain spinal stability. By providing support and restricting movement in the cervical spine region, a cervical collar helps prevent potential spinal cord injuries and associated neurological deficits. It is essential to immobilize the cervical spine until a thorough evaluation can be carried out to determine the extent of injury, as any movement of the spine during this period can worsen the damage.
Question 2 of 9
A patient presents with gradual, painless visual field loss in both eyes, particularly in the peripheral vision. Tonometry reveals elevated intraocular pressure (IOP). Which of the following conditions is most likely responsible for this presentation?
Correct Answer: A
Rationale: The patient presents with gradual, painless visual field loss in both eyes, particularly in the peripheral vision, which is characteristic of glaucoma. The elevated intraocular pressure (IOP) on tonometry further supports a diagnosis of glaucoma. Open-angle glaucoma is the most common type of glaucoma and typically presents insidiously with a slow progression of vision loss. In open-angle glaucoma, the drainage angle of the eye remains open but becomes less efficient over time, leading to increased intraocular pressure and optic nerve damage. This results in peripheral visual field loss. Closed-angle glaucoma, on the other hand, presents more acutely with sudden eye pain, redness, and blurred vision due to a sudden increase in intraocular pressure from a blocked drainage angle. Age-related macular degeneration and diabetic retinopathy typically do not present with elevated IOP or peripheral visual field loss.
Question 3 of 9
A woman in active labor experiences irregular and ineffective uterine contractions, resulting in prolonged cervical dilation. What nursing intervention should be implemented to address this abnormal labor pattern?
Correct Answer: A
Rationale: A woman experiencing irregular and ineffective uterine contractions with prolonged cervical dilation may indicate labor dystocia, also known as abnormal labor progression. To address this issue, the nursing intervention that should be implemented is to encourage the mother to ambulate and change positions frequently. This can help optimize fetal positioning and encourage descent through the birth canal by using gravity to aid in the progression of labor. Changing positions can also potentially improve the quality and effectiveness of contractions, leading to more successful cervical dilation and labor progress. Encouraging ambulation and position changes are non-invasive, patient-centered interventions that can be helpful in managing labor dystocia before considering more invasive interventions like cesarean section.
Question 4 of 9
When determining the existence of malpractice, which factor is NOT considered?
Correct Answer: D
Rationale: When determining the existence of malpractice, intent is not considered as a factor. Malpractice typically involves unintentional actions or negligence rather than a deliberate intent to cause harm. The key factors that are usually considered in a malpractice case include duty (a legal obligation to provide a certain standard of care), causation (the link between the provider's actions and the patient's injury), and the existence of an injury resulting from the provider's actions or omissions. Intent does not play a direct role in malpractice cases, as they are focused on the standard of care provided by the healthcare professional and the harm caused as a result.
Question 5 of 9
Before transferring the patient to the operating room (OR), the nurse notices a discrepancy between the surgical consent form and the planned procedure. What should the nurse do?
Correct Answer: C
Rationale: When a nurse notices a discrepancy between the surgical consent form and the planned procedure, it is essential to consult the surgeon for clarification. The surgeon is the primary decision-maker regarding the surgical procedure and can provide insight into why the discrepancy exists and how to proceed. It is crucial to ensure that everyone is on the same page before moving forward with the surgery to prevent errors, ensure patient safety, and maintain legal and ethical standards. Consulting the surgeon allows for the issue to be addressed promptly and for the appropriate steps to be taken to resolve the discrepancy before proceeding with the surgery.
Question 6 of 9
The blood protein involved in the immune system is:
Correct Answer: C
Rationale: Globulin is the blood protein involved in the immune system. There are different types of globulins, including immunoglobulins (antibodies) that play a crucial role in the body's defense against infections. These antibodies bind to foreign substances, such as bacteria and viruses, helping the immune system to recognize and destroy them. Thrombin is a clotting protein, albumin is a protein responsible for maintaining osmotic balance in the blood, and hemoglobin is a protein found in red blood cells that carries oxygen.
Question 7 of 9
Which of the following conditions is characterized by degenerative changes in the intervertebral discs, leading to narrowing of the disc space and osteophyte formation?
Correct Answer: B
Rationale: Spondylosis is a condition characterized by degenerative changes in the intervertebral discs, leading to narrowing of the disc space and the formation of osteophytes (bone spurs). This degenerative process commonly occurs with aging and can cause symptoms such as neck or back pain, stiffness, and reduced range of motion. Spondylosis is a common finding on imaging studies like X-rays and MRI scans in individuals over the age of 50 and is a natural part of the aging process of the spine.
Question 8 of 9
Following a severe traumatic brain injury, a patient is experiencing alterations in consciousness characterized by periods of wakefulness but with no meaningful interaction with the environment. Which term best describes this state?
Correct Answer: B
Rationale: A vegetative state, now more commonly referred to as unresponsive wakefulness syndrome, describes a condition where the patient is awake but with no awareness of themselves or their surroundings. This state usually follows a severe brain injury, such as traumatic brain injury. Patients in a vegetative state may have sleep-wake cycles, open their eyes, and even exhibit reflex movements, but they do not demonstrate any meaningful interaction with the environment. Differentiating between coma and vegetative state is important, as coma implies a complete lack of consciousness, while patients in a vegetative state have preserved wakefulness without awareness. Minimally conscious state (choice C) refers to a condition where there are some minimal signs of awareness or purposeful interaction, making it a different state than the one described in the scenario. Locked-in syndrome (choice D) is a condition where the patient is conscious and aware but unable to move or communicate due to paralysis, which is not consistent
Question 9 of 9
Which danger sign would warrant stoppage of pills?
Correct Answer: D
Rationale: An elevation of blood pressure would warrant stoppage of pills. High blood pressure, or hypertension, in a 4-year-old child is abnormal and needs prompt medical attention. Giving pills without monitoring or stopping them if blood pressure is elevated can lead to serious health complications. It is important to address the underlying cause of high blood pressure in a child, which may require further evaluation and management by a healthcare provider.