ATI RN
ATI Gastrointestinal System Quizlet
1. Five days after undergoing surgery, a client develops a small-bowel obstruction. A Miller-Abbott tube is inserted for bowel decompression. Which nursing diagnosis takes priority?
- A. Imbalanced nutrition: Less than body requirements
- B. Acute pain
- C. Deficient fluid volume
- D. Excess fluid volume
Correct answer: C
Rationale: For a client with a small-bowel obstruction and a Miller-Abbott tube, deficient fluid volume is the priority nursing diagnosis.
2. A 1-year-old child will receive her scheduled MMR vaccination shortly. The nurse should teach the child's parents that she may develop what possible adverse effect related to the administration of this vaccine?
- A. Cough and fever
- B. Pallor and listlessness
- C. Serum sickness
- D. Nausea and vomiting
Correct answer: A
Rationale: The correct answer is A: Cough and fever. After receiving the MMR vaccine, some children may experience mild adverse effects such as a low-grade fever and a mild cough. These symptoms are normal reactions to the vaccine and indicate that the child's immune system is responding appropriately. Choices B, C, and D are incorrect because pallor and listlessness, serum sickness, nausea, and vomiting are not common adverse effects associated with the MMR vaccine in children.
3. A client has a new prescription for nitroglycerin sublingual tablets. Which of the following instructions should the nurse include?
- A. Take a tablet every 5 minutes for pain relief, up to three doses.
- B. Take this medication with a glass of water.
- C. Chew the tablet for faster absorption.
- D. Store the tablets in a refrigerator.
Correct answer: A
Rationale: The correct answer is A: 'Take a tablet every 5 minutes for pain relief, up to three doses.' Nitroglycerin sublingual tablets are used to relieve chest pain or to prevent chest pain before activities known to cause angina. The tablets should be taken every 5 minutes for pain relief, up to three doses, as prescribed. Choice B is incorrect because nitroglycerin sublingual tablets should be placed under the tongue until they dissolve, not taken with water. Choice C is incorrect because nitroglycerin sublingual tablets should not be chewed but placed under the tongue for absorption. Choice D is incorrect because nitroglycerin tablets should be stored in their original container at room temperature away from light and moisture.
4. Child protective services have removed 10-year-old Christopher from his parents' home due to neglect. Christopher reveals to the nurse that he considers the woman next door his 'nice' mom, that he loves school, and gets above-average grades. The strongest explanation of this response is:
- A. Temperament
- B. Genetic factors
- C. Resilience
- D. Paradoxical effects of neglect
Correct answer: C
Rationale: Christopher's positive outlook, strong school performance, and forming a bond with the neighbor indicate resilience. Resilience refers to the ability to adapt and thrive despite facing adversity, such as being removed from his parents' home due to neglect. His ability to maintain a positive attitude and excel in school despite the challenging circumstances highlights his resilience.
5. How do social determinants impact health?
- A. They directly affect health behaviors and outcomes.
- B. They primarily influence genetic predisposition.
- C. They have minimal impact on overall health.
- D. They determine access to health resources.
Correct answer: A
Rationale: Social determinants play a significant role in impacting health by directly influencing health behaviors and outcomes. These determinants include factors such as socioeconomic status, education, neighborhood, and access to healthcare, which shape the conditions in which individuals live, work, and age, ultimately affecting their health status.
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