ATI RN
Foundations and Adult Health Nursing Test Bank Questions
Question 1 of 5
During a home visit, a member of the family you're visiting who has been using marijuana for three years tells theyou that he wants to be 'detoxified'.� It is important for the nurse to ____.
Correct Answer: B
Rationale: Identifying the patient's stage of change is crucial when someone expresses a desire to be "detoxified" from a substance like marijuana. The Transtheoretical Model (Stages of Change) outlines different stages individuals go through when making behavior changes. By identifying which stage the patient is in (precontemplation, contemplation, preparation, action, maintenance, or relapse), the nurse can tailor interventions and support accordingly. This approach helps ensure that interventions are effective and appropriate for the individual's readiness for change. It is important to meet the patient where they are in their journey towards detoxification and offer support and guidance accordingly.
Question 2 of 5
A patient receiving palliative care for end-stage renal disease expresses distress over changes in body image due to edema and weight gain. What intervention should the palliative nurse prioritize to address the patient's concerns?
Correct Answer: C
Rationale: The most appropriate intervention for the palliative nurse to prioritize in this situation is to offer emotional support and validate the patient's feelings about body image changes. End-stage renal disease can lead to significant physical changes such as edema and weight gain, which can impact a patient's body image and self-esteem. By providing emotional support and validating the patient's feelings, the nurse can help address the patient's distress and concerns, improving their overall psychological well-being. While providing education on dietary modifications (choice B) and prescribing diuretic medications (choice D) may be important aspects of managing fluid retention and edema, addressing the patient's emotional distress and body image concerns should be the initial priority in a palliative care setting. Encouraging the patient to accept their body changes (choice A) may overlook the emotional impact these changes have on the patient, making choice C the most appropriate intervention.
Question 3 of 5
A woman in active labor demonstrates persistent occiput posterior fetal position, leading to prolonged labor and severe back pain. What nursing intervention should be prioritized to facilitate fetal rotation and optimize labor progress?
Correct Answer: A
Rationale: Assisting the mother into a hands-and-knees position should be prioritized to facilitate fetal rotation and optimize labor progress in the case of persistent occiput posterior fetal position. This position helps in promoting fetal rotation to a more favorable position for delivery by allowing the baby's head to move into the anterior position. It can help alleviate back pain and may help reduce the duration of labor. This simple maneuver can sometimes correct the malposition without the need for interventions like instrumental delivery. It is a non-invasive and effective technique that can be easily implemented by healthcare providers to support the progression of labor.
Question 4 of 5
A patient presents with a thyroid nodule and signs of compression such as difficulty swallowing and breathing. Fine-needle aspiration biopsy reveals malignant cells with nuclear features suggestive of papillary thyroid carcinoma. Which endocrine disorder is most likely responsible for these symptoms?
Correct Answer: D
Rationale: Papillary thyroid carcinoma is a type of thyroid cancer that arises from follicular cells of the thyroid gland. It often presents as a thyroid nodule that can cause symptoms of compression due to its enlarging size. The compression symptoms, such as difficulty swallowing and breathing in this case, occur when the thyroid nodule becomes large enough to press on adjacent structures in the neck. Fine-needle aspiration biopsy can confirm the presence of malignant cells with nuclear features typical of papillary thyroid carcinoma, further supporting the diagnosis.
Question 5 of 5
Type I IgE-mediated immediate hypersensitivity reaction is promptly managed with ____.
Correct Answer: B
Rationale: Type I IgE-mediated immediate hypersensitivity reactions, such as anaphylaxis, are promptly managed with epinephrine. Epinephrine is the first-line treatment for anaphylaxis as it helps counteract the severe symptoms by relaxing the muscles in the airways, constricting blood vessels, and decreasing swelling. It acts quickly to reverse the potentially life-threatening effects of the allergic reaction and is crucial in managing anaphylaxis effectively. Other medications like antihistamines (e.g., diphenhydramine) and corticosteroids may be used as adjuncts, but epinephrine remains the primary treatment for immediate hypersensitivity reactions.
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