ATI RN
Human Growth and Development Exam Questions
1. What reflex protects an infant from strong stimulation?
- A. Moro
- B. eye-blink
- C. sucking
- D. palmar grasp
Correct answer: B
Rationale: The correct answer is B: eye-blink. The eye-blink reflex is the one that protects an infant from strong stimulation by causing them to quickly shut their eyes in response to sudden bright light or a loud noise. This reflex helps to safeguard the infant's sensitive eyes from potential harm. The Moro reflex (choice A) is the startle reflex, the sucking reflex (choice C) helps with feeding, and the palmar grasp reflex (choice D) is when the infant's fingers close around an object placed in their hand; none of these reflexes specifically protect the infant from strong stimulation.
2. A nurse is planning care for a client who has pneumonia. Which of the following interventions should the nurse include in the plan of care?
- A. Place the client in the supine position.
- B. Perform chest percussion every 4 hours.
- C. Administer oxygen via nasal cannula.
- D. Limit fluid intake to 1,500 mL/day.
Correct answer: B
Rationale: The correct intervention for a client with pneumonia is to perform chest percussion every 4 hours. Chest percussion helps loosen secretions and improve airway clearance in clients with pneumonia. Placing the client in the supine position can worsen breathing, so it is incorrect. Administering oxygen via nasal cannula is a common intervention for clients with respiratory issues but is not specific to pneumonia. Limiting fluid intake to 1,500 mL/day may not be appropriate as pneumonia can lead to dehydration, so it is not the priority intervention.
3. A client who has a new prescription for warfarin is being taught about the medication's adverse effects by a nurse. Which of the following client statements indicates an understanding of the teaching?
- A. ''I should expect mild bruising around my elbows.''
- B. ''I should report a red rash to my provider.''
- C. ''I should stop taking this medication if I develop a cough.''
- D. ''I should expect black, tarry stools.''
Correct answer: D
Rationale: The correct answer is D. Black, tarry stools can indicate gastrointestinal bleeding, a serious adverse effect of warfarin that requires immediate medical attention. Option A is incorrect because while bruising is a common side effect of warfarin, it is not limited to the elbows. Option B is incorrect as a red rash is not a typical adverse effect of warfarin. Option C is also incorrect because developing a cough is not a reason to discontinue warfarin unless advised by a healthcare provider.
4. Employees are eligible to take a leave of absence if they have worked for the employer for at least: (EXCEPT)
- A. At least 1,250 hours during the previous 12 months.
- B. At least 12 months.
- C. At least six months.
- D. At a work site with 50 employees within a 75-mile radius.
Correct answer: C
Rationale: Employees are eligible to take a leave of absence if they have worked for the employer for at least 12 months, have worked at least 1,250 hours during the previous 12 months, and are at a work site with 50 or more employees, or at a site where 50 workers are employed within 75 miles of the work site. The statement 'At least six months' is incorrect as the requirement is for 12 months of work to be eligible for a leave of absence.
5. A new psychiatric nurse states, 'This client's use of defense mechanisms should be eliminated.' Which is a correct evaluation of this nurse's statement?
- A. Defense mechanisms can be self-protective responses to stress and need not be eliminated.
- B. Defense mechanisms are a maladaptive attempt by the ego to manage anxiety and should always be eliminated.
- C. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged but not eliminated.
- D. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.
Correct answer: A
Rationale: The correct evaluation is that defense mechanisms can be self-protective responses to stress and do not necessarily need to be eliminated. These mechanisms help individuals reduce anxiety during times of stress. It is crucial for the nurse to understand that defense mechanisms serve a purpose and can be a normal part of coping. However, if defense mechanisms significantly hinder the client's ability to develop healthy coping skills, they should be addressed and explored. Eliminating defense mechanisms entirely without considering the individual's overall coping strategies can be counterproductive and may lead to increased distress for the client. Choice B is incorrect because not all defense mechanisms are maladaptive; some can be adaptive and helpful. Choice C is incorrect because labeling individuals as having weak ego integrity based on their use of defense mechanisms is stigmatizing and oversimplified. Choice D is incorrect because fostering and encouraging defense mechanisms without differentiation can lead to maladaptive behaviors and reliance on these mechanisms instead of healthier coping strategies.
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