ATI RN
Foundations and Adult Health Nursing Study Guide Answers Questions
Question 1 of 9
Which of the following is NOT TRUE of type 2 diabetes Mellitus?
Correct Answer: C
Rationale: Type 2 diabetes mellitus is characterized by insulin resistance in the peripheral tissues and defective beta cell secretion with loss of insulin. In type 2 diabetes, there is typically not destruction of beta cells from an autoimmune mechanism that leads to lack of insulin and hyperglycemia as seen in type 1 diabetes mellitus. Instead, in type 2 diabetes, the pancreas initially produces insulin, but the body's cells become resistant to its effects. This results in hyperglycemia due to the inability of the body to properly regulate blood sugar levels. Therefore, choice C is not true for type 2 diabetes mellitus.
Question 2 of 9
A patient in the ICU develops acute respiratory distress syndrome (ARDS) with severe hypoxemia refractory to conventional oxygen therapy. What intervention should the healthcare team prioritize to improve the patient's oxygenation?
Correct Answer: D
Rationale: In the scenario described, the patient is experiencing severe hypoxemia refractory to conventional oxygen therapy, indicating a need for advanced respiratory support. When a patient with ARDS fails to respond to conservative management, including mechanical ventilation strategies, prone positioning, and recruitment maneuvers, the next step may involve extracorporeal membrane oxygenation (ECMO). ECMO provides a way to bypass the lungs and oxygenate the blood directly, allowing for enhanced gas exchange and support for severely compromised respiratory function. Therefore, in this critical situation, prioritizing the recommendation for ECMO can offer the patient the best chance of improving oxygenation and survival.
Question 3 of 9
A patient has been advised by the psychiatrist that he needs inpatient hospitalization. The patient agrees, signs the admission forms, and agrees to receive treatment. What type of admission is this?
Correct Answer: C
Rationale: This type of admission is considered voluntary because the patient willingly agrees to be admitted to the hospital for treatment. The patient has signed the admission forms and consented to receive the necessary care, indicating a willingness to participate in their treatment plan. In a voluntary admission, the individual retains the right to make decisions about their treatment and can choose to leave the hospital against medical advice if they wish to do so.
Question 4 of 9
During a patient assessment, the nurse observes signs of distress and discomfort. What action should the nurse take to address the patient's needs?
Correct Answer: C
Rationale: The correct action for the nurse to take when observing signs of distress and discomfort in a patient during assessment is to offer emotional support and actively listen to the patient's concerns. Ignoring the patient's distress may lead to worsening of the patient's condition and can be detrimental to the patient's well-being. Documenting the findings and informing the healthcare provider later is important but should not be the immediate response when a patient is in distress. Administering pain medication without further assessment is also not appropriate as the nurse needs to understand the underlying cause of the distress before providing appropriate interventions. Offering emotional support and actively listening to the patient's concerns can help the nurse understand the patient's needs, provide comfort, and potentially address the root cause of the distress.
Question 5 of 9
Which of the following actions is appropriate for managing a conscious patient with a suspected heat cramp?
Correct Answer: C
Rationale: Providing oral rehydration with electrolyte solutions is the appropriate action for managing a conscious patient with suspected heat cramps. Heat cramps are muscle pains or spasms that often occur during intense exercise in hot environments when a person sweats excessively, losing both fluids and electrolytes. Replenishing lost fluids and electrolytes through oral rehydration helps address the underlying cause of the cramps and provides relief to the patient. Massaging the affected muscles vigorously can potentially worsen the condition, applying cold packs is not usually recommended for heat-related conditions, and encouraging the patient to continue strenuous activity can lead to further complications.
Question 6 of 9
The nurse is aware that the proper management of poisoning includes the following EXCEPT to
Correct Answer: A
Rationale: Hemoperfusion is not a standard management technique for poisoning. The other options are commonly used methods in managing poisoning cases.
Question 7 of 9
Which of the following actions is indicated in the management of a patient with an open chest wound (sucking chest wound)?
Correct Answer: A
Rationale: An open chest wound, also known as a sucking chest wound, can lead to a collapsed lung and respiratory distress. Immediate management involves sealing the wound to prevent air from entering the pleural space and further compromising the patient's respiratory function. Applying a sterile dressing over the wound helps to prevent contamination and occluding the wound with an airtight covering, such as an occlusive dressing, can effectively reduce the risk of a tension pneumothorax, a serious complication that can arise from a sucking chest wound. These interventions help to stabilize the patient's condition and improve the chances of a successful recovery. Administering supplemental oxygen, though beneficial, would be secondary to the primary management of sealing the chest wound. Providing emotional support is important but addressing the physical emergency takes precedence. Elevating the patient's legs would not be appropriate in managing an open chest wound.
Question 8 of 9
The 5's strategy to prevent dengue infection includes the following, EXCEPT
Correct Answer: B
Rationale: The 5's strategy to prevent dengue infection includes Search and Destroy mosquito breeding places, seek early consultation at the nearest health care facility, say no to fogging spraying, and misting in hot spot areas. While using mosquito repellent on exposed skin is a common preventive measure against mosquito bites, applying it all over your body is not included in the official 5's strategy for dengue prevention. The focus of the 5's strategy is on eliminating mosquito breeding sites, seeking medical advice early in case of symptoms, and avoiding certain mosquito control methods like fogging in hot spot areas.
Question 9 of 9
Nurse Roberto assesses a 32 year old female client who appears very anxious, restless and irritable. The client has marked increase rate and depth of respirations. Based on the information gathered, the client is experiencing which of the following imbalances?
Correct Answer: A
Rationale: The client is exhibiting signs and symptoms of respiratory alkalosis. When a person is experiencing respiratory alkalosis, there is an excessive loss of carbon dioxide (CO2) from the body, leading to elevated blood pH. The marked increase in the rate and depth of respirations as well as symptoms of anxiety, restlessness, and irritability are characteristic of respiratory alkalosis. This condition can be caused by hyperventilation, anxiety, or fever, which result in excessive elimination of CO2 from the body, leading to an imbalance in the acid-base status. Treatment for respiratory alkalosis involves addressing the underlying cause, such as providing reassurance to decrease anxiety or managing the breathing pattern to normalize CO2 levels.