ATI RN
Adult Health Nursing Answer Key Questions
Question 1 of 9
Which of the following is the initial teachinggiven to the patient with ALS having problems in communication?
Correct Answer: C
Rationale: In ALS (Amyotrophic Lateral Sclerosis), communication difficulties may occur as the disease progresses and affects the muscles responsible for speech. It is crucial to initiate early measures to assist the patient in communicating effectively. Using pre-signals before the loss of speech can be helpful in maintaining communication with the patient. These pre-signals can include gestures, writing tools, communication boards, or technology-assisted communication devices. By introducing and practicing these pre-signals early on, the patient can adapt and utilize alternative communication methods before the loss of speech becomes more challenging. This proactive approach can significantly improve the patient's ability to communicate and maintain a sense of connection with others.
Question 2 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 3 of 9
Deductive Reasoning process is applied in:
Correct Answer: C
Rationale: Deductive reasoning is a logical process in which conclusions are drawn from a set of premises or given information. In quantitative research, this type of reasoning is commonly used to test hypotheses and make predictions based on theories and existing knowledge. Researchers start with established theories or hypotheses and then collect data to either support or refute them. This structured approach aligns with the principles of deductive reasoning and is a key characteristic of quantitative research methodology.
Question 4 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 5 of 9
Which of the following clinical findings is most consistent with a diagnosis of pneumonia?
Correct Answer: A
Rationale: The clinical findings of inspiratory crackles (also known as rales) and dullness to percussion are most consistent with a diagnosis of pneumonia. Inspiratory crackles are abnormal lung sounds heard on auscultation and are typically due to the presence of fluid or mucus in the alveoli. Dullness to percussion can indicate consolidation of lung tissue, which is a common finding in pneumonia where the alveolar spaces are filled with inflammatory exudate. These findings suggest localized lung pathology and are commonly observed in patients with pneumonia. Hemoptysis and pleuritic chest pain (Choice B) are more suggestive of pulmonary embolism or pleurisy. Clubbing of the fingers and cyanosis (Choice C) are signs of chronic hypoxemia and are not specific to pneumonia. Decreased breath sounds and tracheal deviation (Choice D) are more indicative of conditions such as a pneumoth
Question 6 of 9
The nurse is conducting an assessment to her patient who has edema of the lower extremities due to congestive heart failure. If edema is graded on a scale of +1 (no visible edema in the leg) to 4+ (leg very swollen), what will the Nurse document in her chart if her assessment findings of the edema is SLIGHTLY swollen?
Correct Answer: B
Rationale: In the grading system used for edema, +1 indicates no visible edema in the leg, +2 indicates slight edema with indentations that quickly resolve, +3 indicates moderate edema with deeper indentations that may take longer to resolve, and +4 indicates severe edema with very swollen legs. In this case, since the edema is described as slightly swollen, the appropriate grade to document would be +2.
Question 7 of 9
What is the PRIORITY of care for patient diagnosed with Guillain-Barre Syndrome?
Correct Answer: A
Rationale: The priority of care for a patient diagnosed with Guillain-Barre Syndrome is the maintenance of respiratory function. Guillain-Barre Syndrome can cause paralysis, including respiratory muscles, leading to respiratory failure. Ensuring adequate ventilation and oxygenation is crucial to prevent complications such as respiratory failure and the need for mechanical ventilation. Monitoring for signs of respiratory distress, such as shortness of breath, decreased oxygen saturation, and diminished lung sounds, is essential in providing prompt intervention and support for the patient's respiratory needs. Other aspects of care, such as prevention of decubitus ulcers, control of urinary tract infections, and replacement of fluid and electrolytes, are also important but not as immediate or life-threatening as ensuring adequate respiratory function in these patients.
Question 8 of 9
During the first contact of the patient with the nurse, the latter should demonstrate the following behavior, which the EXCEPTION of _______.
Correct Answer: D
Rationale: During the first contact with a patient, a nurse should demonstrate caring, encouraging, and comforting behaviors. These qualities help create a positive and supportive environment for the patient. However, compelling behavior, which implies forcing or pressuring someone to do something, is not appropriate during the initial interaction with a patient. It is essential for the nurse to build trust and rapport with the patient, and compelling behavior can be counterproductive to establishing a nurturing relationship. Thus, compelling is the exception among the given choices for the nurse's behavior during the first contact with a patient.
Question 9 of 9
A patient presents with grouped vesicles on an erythematous base, affecting the lips and perioral region. The patient reports a history of similar episodes triggered by sunlight exposure and stress. Which of the following conditions is most likely responsible for this presentation?
Correct Answer: A
Rationale: The patient's presentation with grouped vesicles on an erythematous base affecting the lips and perioral region, triggered by sunlight exposure and stress, is classic for herpes simplex labialis, commonly known as cold sores. Herpes simplex virus type 1 (HSV-1) is responsible for cold sores and is highly contagious. Recurrent episodes can be triggered by factors like UV exposure, stress, illness, and hormonal changes. Symptoms typically start with tingling or burning sensations before progressing to grouped vesicles that rupture, forming crusts. Treatment may involve antiviral medications to reduce the severity and duration of symptoms. Perioral dermatitis typically presents with papules and pustules around the mouth, while angular cheilitis involves fissures and inflammation at the corners of the mouth. Allergic contact dermatitis would present with erythema, pruritus, and possibly vesicles in