ATI RN
Adult Health Nursing Answer Key Questions
Question 1 of 9
Which of the following is precipitating factor for Ella`s feeling of wanting to die?
Correct Answer: A
Rationale: The death of Lory is the precipitating factor for Ella's feeling of wanting to die. Losing someone close to us can lead to feelings of profound sadness, grief, and hopelessness, which may trigger thoughts of wanting to die. The impact of losing a loved one can be devastating and overwhelming, often leading individuals to question the meaning of life and their own mortality. In Ella's case, the death of Lory has likely caused a significant emotional upheaval, contributing to her desire to end her own life. It is essential to address these feelings of loss and provide support and intervention to help Ella cope with her grief and prevent any self-harm.
Question 2 of 9
A nurse is preparing to perform a bedside bronchoscopy procedure for a patient. What action should the nurse take to ensure patient safety during the procedure?
Correct Answer: B
Rationale: The correct action for the nurse to ensure patient safety during a bedside bronchoscopy procedure is to obtain informed consent from the patient or their legal representative. Informed consent is a vital ethical and legal requirement before any medical procedure. It ensures that the patient understands the risks, benefits, and alternatives of the procedure, as well as gives the patient the authority to make decisions about their healthcare. By obtaining informed consent, the nurse ensures that the patient has been properly informed and agrees to undergo the bronchoscopy, which promotes patient autonomy and safety. Administering sedation, using topical anesthesia, and restricting food intake are also important aspects of bronchoscopy preparation, but obtaining informed consent is the primary action to prioritize patient safety.
Question 3 of 9
A patient with a history of heart failure is prescribed spironolactone. Which electrolyte imbalance is the patient at risk for developing with spironolactone therapy?
Correct Answer: B
Rationale: Spironolactone is a potassium-sparing diuretic commonly used in the management of heart failure. One of the significant side effects of spironolactone is hyperkalemia, which is an elevated level of potassium in the bloodstream. Spironolactone works by blocking the action of aldosterone, a hormone that regulates potassium and sodium balance in the body. By inhibiting aldosterone, spironolactone reduces potassium excretion in the urine, leading to potential accumulation of potassium in the body.
Question 4 of 9
A pregnant woman presents with severe lower abdominal pain and vaginal bleeding. On examination, cervical motion tenderness and unilateral adnexal tenderness are noted, along with an adnexal mass on the affected side. Which of the following conditions is the most likely cause of these symptoms?
Correct Answer: A
Rationale: The clinical presentation of severe lower abdominal pain and vaginal bleeding in a pregnant woman, along with cervical motion tenderness, unilateral adnexal tenderness, and an adnexal mass on the affected side, is highly concerning for an ectopic pregnancy. Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tube. The presence of an adnexal mass and tenderness on one side is indicative of potential tubal involvement and can mimic symptoms of pelvic inflammatory disease. Prompt evaluation and management are crucial in ectopic pregnancy to prevent life-threatening complications associated with rupture of the fallopian tube.
Question 5 of 9
A patient receiving palliative care for end-stage heart failure experiences paroxysmal nocturnal dyspnea. What intervention should the palliative nurse prioritize to manage the patient's symptoms?
Correct Answer: B
Rationale: Elevating the head of the bed to improve respiratory mechanics is the most appropriate intervention for managing paroxysmal nocturnal dyspnea in a patient with end-stage heart failure. By keeping the head of the bed elevated, gravity helps reduce the pooling of fluid in the lungs, making it easier for the patient to breathe and reducing dyspnea. This strategy can help improve oxygenation and decrease the sensation of breathlessness, providing relief for the patient. Administering diuretic medications (Option A) can also be beneficial to reduce fluid overload, although positioning remains a key intervention. Encouraging the patient to sleep in a reclined position (Option C) can help alleviate symptoms, but specifically elevating the head of the bed is a more targeted approach. Referring the patient to a sleep specialist (Option D) may not be necessary at this time, as the primary concern is managing the acute symptom of paroxysmal nocturnal dyspnea
Question 6 of 9
A patient presents with sudden onset of severe chest pain radiating to the back, hypotension, and a widened mediastinum on chest X-ray. Which cardiovascular disorder is most likely responsible for these symptoms?
Correct Answer: D
Rationale: #NAME?
Question 7 of 9
A woman in active labor is receiving intravenous antibiotics for group B streptococcus (GBS) prophylaxis. What maternal assessment finding indicates a potential adverse reaction to the antibiotics?
Correct Answer: B
Rationale: Urticaria (hives) and pruritus (itching) are common signs of an allergic reaction to antibiotics, including those used for GBS prophylaxis during labor. Other signs of an adverse reaction may include flushing, fever, chills, and anaphylaxis. It is important to monitor the woman closely for any signs of an allergic reaction and to intervene promptly if one occurs to ensure the safety of both the mother and the baby.
Question 8 of 9
When one has a Cushing disease the focal structure affected is the _______.
Correct Answer: B
Rationale: When one has Cushing's disease, the focal structure affected is the pituitary gland. Cushing's disease is caused by the overproduction of adrenocorticotropic hormone (ACTH) by the pituitary gland. This excess ACTH stimulates the adrenal glands to produce too much cortisol, leading to the symptoms associated with Cushing's disease. Therefore, the primary issue originates in the pituitary gland, not the other structures mentioned in the question.
Question 9 of 9
While preparing the operating room (OR) for a surgical procedure, the nurse notices a malfunctioning anesthesia machine. What is the nurse's priority action?
Correct Answer: C
Rationale: The nurse's priority action when noticing a malfunctioning anesthesia machine in the operating room should be to inform the anesthesia provider immediately. Anesthesia providers are responsible for administering anesthesia safely during surgical procedures, and they need to be made aware of any equipment issues promptly to ensure patient safety. Continuing with the surgical procedure using a malfunctioning anesthesia machine can pose serious risks to the patient's well-being. Using an alternative anesthesia machine may be an option, but informing the anesthesia provider first ensures that the appropriate action is taken to address the issue effectively. Documenting the malfunction in the equipment log is important for record-keeping purposes, but it should not take precedence over informing the anesthesia provider and taking immediate action to address the problem.