Vital Signs Health Assessment

ATI RN · Vital Signs Health Assessment

Question 1 of 61

The nurse is examining a 2-year-old child. What is the best way to begin the assessment?

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ATI RN · Vital Signs Health Assessment

Question 2 of 61

The nurse is assessing for inflammation in a dark-skinned person. Which technique is the best?

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ATI RN · Vital Signs Health Assessment

Question 3 of 61

In assessing the tonsils of a 30 year old, the nurse notices that they are involuted, granular in appearance, and appear to have deep crypts. What is correct response to these findings?

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ATI RN · Vital Signs Health Assessment

Question 4 of 61

A patient has suddenly developed shortness of breath and appears to be in significant respiratory distress. After calling the physician and placing the patient on oxygen, which of these actions is the best for the nurse to take when further assessing the patient?

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ATI RN · Vital Signs Health Assessment

Question 5 of 61

When assessing the apical pulse, where should the nurse place the stethoscope?

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ATI RN · Vital Signs Health Assessment

Question 6 of 61

Which of the following symptoms is relevant to the cardiovascular system?

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ATI RN · Vital Signs Health Assessment

Question 7 of 61

All the following are benefits of ice in the treatment of acute tendinitis except which of the following?

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ATI RN · Vital Signs Health Assessment

Question 8 of 61

During a respiratory assessment, the nurse notes that the patient has increased tactile fremitus over the left lower lung field. What does this finding suggest?

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ATI RN · Vital Signs Health Assessment

Question 9 of 61

Which of the following would lead you to suspect a hydrocele versus other causes of scrotal swelling?

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ATI RN · Vital Signs Health Assessment

Question 10 of 61

According to the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, high blood pressure for adults is defined as...

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ATI RN · Vital Signs Health Assessment

Question 11 of 61

The nurse is conducting a class for new graduate nurses. During the teaching session, the nurse should keep in mind that novice nurses are more likely to make their decisions using:

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ATI RN · Vital Signs Health Assessment

Question 12 of 61

When inspecting the skin of a patient, the nurse notes a bluish tinge to the skin. What condition would the nurse document?

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ATI RN · Vital Signs Health Assessment

Question 13 of 61

When assessing a patient, the nurse notes that the left femoral pulse as diminished, 1+/4+. What should the nurse do next?

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ATI RN · Vital Signs Health Assessment

Question 14 of 61

In assessing for an S4 heart sound with a stethoscope, the nurse would listen with the:

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ATI RN · Vital Signs Health Assessment

Question 15 of 61

A 31-year-old patient tells the nurse that he has noticed pain in his left ear when people speak loudly to him. The nurse knows that this finding:

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ATI RN · Vital Signs Health Assessment

Question 16 of 61

During a cardiovascular assessment, the nurse observes that the patient has a rapid, irregular pulse. What is the most likely diagnosis?

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ATI RN · Vital Signs Health Assessment

Question 17 of 61

A physical therapist obtains an x-ray of a 14-year-old female recently referred to physical therapy after experiencing an increase in back pain following activity. The patient previously participated in competitive gymnastics but states that her back pain is worsening. The x-ray shows evidence consistent with:

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ATI RN · Vital Signs Health Assessment

Question 18 of 61

You are palpating the abdomen and feel a small mass. Which of the following would you do next?

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ATI RN · Vital Signs Health Assessment

Question 19 of 61

Which of the following symptoms is most likely to be documented under the musculoskeletal system in the review of systems?

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ATI RN · Vital Signs Health Assessment

Question 20 of 61

As the nurse enters a patient's room, the nurse finds her crying. The patient states that she has just found out that the lump in her breast is cancer and says, 'I'm so afraid of, um, you know.' The nurse's most therapeutic response would be to say in a gentle manner:

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ATI RN · Vital Signs Health Assessment

Question 21 of 61

A nurse attempts to count the respiratory rate for a patient via inspection and finds that the patient is breathing at such a shallow rate that it cannot be counted. What is an alternative method of determining the respiratory rate for this patient?

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ATI RN · Vital Signs Health Assessment

Question 22 of 61

A 1-month-old infant has a head measurement of 34 cm and has a chest circumference of 32 cm. Based on the interpretation of these findings, the nurse would:

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ATI RN · Vital Signs Health Assessment

Question 23 of 61

A patient is experiencing dyspnea. What is the nurses priority action?

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ATI RN · Vital Signs Health Assessment

Question 24 of 61

A nurse is assessing a client's body temperature and obtains a reading of 102Ã‚Â°F (38.9Ã‚Â°C). What action should the nurse take?

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ATI RN · Vital Signs Health Assessment

Question 25 of 61

During a skin assessment, the nurse notices that a Mexican-American patient has skin that is yellowish-brown; however, the skin on the hard and soft palate is pink and the patient's scleras are not yellow. From this finding, the nurse could probably rule out:

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ATI RN · Vital Signs Health Assessment

Question 26 of 61

A 45-year-old woman presents with a complaint of muscle weakness, particularly in the upper limbs. She also reports difficulty swallowing and double vision. On examination, she has ptosis and weakness of the proximal muscles. What is the most likely diagnosis?

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ATI RN · Vital Signs Health Assessment

Question 27 of 61

Considered the 5th vital sign:

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ATI RN · Vital Signs Health Assessment

Question 28 of 61

The patient was found unresponsive in her apartment and is being brought to the emergency department. She has arm, hand, and leg edema, her temperature is 95.6Ã‚Â°F, and her hands are cold secondary to her history of peripheral vascular disease. It is reported that she has a latex allergy. To quickly measure the patient's oxygen saturation, what should the nurse do?

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ATI RN · Vital Signs Health Assessment

Question 29 of 61

The nurse is auscultating lung sounds and hears a fine crackling sound during inspiration. What condition is this most likely associated with?

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ATI RN · Vital Signs Health Assessment

Question 30 of 61

The nurse is performing a neurological assessment and asks the patient to squeeze their hands. Which aspect of neurological function is being tested?

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ATI RN · Vital Signs Health Assessment

Question 31 of 61

Before auscultating the patient's lungs, the nurse ensures which of the following?

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ATI RN · Vital Signs Health Assessment

Question 32 of 61

To encourage adequate nutritional intake for a client after a head injury that damaged the frontal lobe, the nurse should:

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ATI RN · Vital Signs Health Assessment

Question 33 of 61

Shoulder impingement may result from which of the following?

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ATI RN · Vital Signs Health Assessment

Question 34 of 61

A 65-year-old patient with a history of heart failure comes to the clinic with complaints of 'being awakened from sleep with shortness of breath.' Which action by the nurse is most appropriate?

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ATI RN · Vital Signs Health Assessment

Question 35 of 61

A finger locked in flexion, especially in the morning, is typical of which condition?

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ATI RN · Vital Signs Health Assessment

Question 36 of 61

The Achilles reflex assesses which nerve root?

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ATI RN · Vital Signs Health Assessment

Question 37 of 61

Which contraction generates the least force?

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ATI RN · Vital Signs Health Assessment

Question 38 of 61

During an examination, the nurse notes that a patient is exhibiting flight of ideas. Which statement by the patient is an example of flight of ideas?

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ATI RN · Vital Signs Health Assessment

Question 39 of 61

During a cardiovascular assessment, the nurse palpates an irregularly irregular pulse. What condition does this finding suggest?

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ATI RN · Vital Signs Health Assessment

Question 40 of 61

While measuring a patient's blood pressure, the nurse recalls that certain factors, such as _____, help determine blood pressure.

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ATI RN · Vital Signs Health Assessment

Question 41 of 61

During an examination, the nurse can assess mental status by which activity?

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ATI RN · Vital Signs Health Assessment

Question 42 of 61

A 47-year-old receptionist comes to your office, complaining of fever, shortness of breath, and a productive cough with golden sputum. On auscultation she has decreased air movement, and coarse crackles are heard over the left lower lobe. There is dullness on percussion, increased fremitus during palpation, and egophony and whispered pectoriloquy on auscultation.

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ATI RN · Vital Signs Health Assessment

Question 43 of 61

The nurse is assessing a patient's peripheral vision. Which test is most appropriate?

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ATI RN · Vital Signs Health Assessment

Question 44 of 61

The nurse is assessing an 8-year-old child whose growth rate measures below the third percentile for a child his age. He appears significantly younger than his stated age and is chubby with infantile facial features. Which condition does this child have?

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ATI RN · Vital Signs Health Assessment

Question 45 of 61

Which of the following is an average normal temperature in Centigrade for a healthy adult?

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ATI RN · Vital Signs Health Assessment

Question 46 of 61

The nurse is assessing a patient's abdomen and observes abdominal distension. Which additional assessment finding would most likely indicate a bowel obstruction?

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ATI RN · Vital Signs Health Assessment

Question 47 of 61

A patient presents for evaluation of a cough. Which of the following anatomic regions can be responsible for a cough?

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ATI RN · Vital Signs Health Assessment

Question 48 of 61

A nurse is assessing a client's oxygen saturation and obtains a reading of 92%. What action should the nurse take?

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ATI RN · Vital Signs Health Assessment

Question 49 of 61

A patient is assigned a visual acuity of 20/100 in her left eye. Which of the following is true?

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ATI RN · Vital Signs Health Assessment

Question 50 of 61

A nurse is assessing the blood pressure on an obese woman. What error might occur if the cuff used is too narrow?

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ATI RN · Vital Signs Health Assessment

Question 51 of 61

Which of the following findings during a musculoskeletal assessment indicates the need for immediate intervention?

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ATI RN · Vital Signs Health Assessment

Question 52 of 61

A 35-year-old stockbroker comes to your office, complaining of feeling tired and irritable. She also says she feels like nothing ever goes her way and that nothing good ever happens. When you ask her how long she has felt this way she laughs and says, "Since when have I not?" She relates that she has felt pessimistic about life in general since she was in high school. She denies any problems with sleep, appetite, or concentration, and states she hasn't thought about killing herself. She reports no recent illnesses or injuries. She is single. She smokes one pack of cigarettes a day, drinks occasionally, and hasn't taken any illegal drugs since college. Her mother suffers from depression and her father has high blood pressure. On examination her vital signs and physical examination are unremarkable. What mental health disorder best describes her symptoms?

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ATI RN · Vital Signs Health Assessment

Question 53 of 61

What step of the nursing process includes data collection by health history, physical examination, and interview?

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ATI RN · Vital Signs Health Assessment

Question 54 of 61

The patient is admitted with shortness of breath and chest discomfort. Which laboratory value could account for the patient's symptoms?

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ATI RN · Vital Signs Health Assessment

Question 55 of 61

The nurse is performing an abdominal assessment and notes a positive Murphy's sign. What condition is most likely associated with this finding?

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ATI RN · Vital Signs Health Assessment

Question 56 of 61

The nurse is assessing a patient's cranial nerve function and asks the patient to close their eyes and identify familiar smells. Which cranial nerve is being tested?

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ATI RN · Vital Signs Health Assessment

Question 57 of 61

Will you attend the Regional Nursing Meeting to obtain the Continuing Nursing Education (CNE) unit for this Health & Safety Alert?

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ATI RN · Vital Signs Health Assessment

Question 58 of 61

The component of the conduction system referred to as the pacemaker of the heart is the:

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ATI RN · Vital Signs Health Assessment

Question 59 of 61

During a health history interview, a female patient states that she has noticed a few drops of clear discharge from her right nipple. What should the nurse do next?

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ATI RN · Vital Signs Health Assessment

Question 60 of 61

The nurse is assessing the lungs of an older adult. Which of these changes are normal in the respiratory system of the older adult?

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ATI RN · Vital Signs Health Assessment

Question 61 of 61

A 40-year-old patient who has just finished chemotherapy for breast cancer tells the nurse that she is concerned about her mouth. During the assessment the nurse finds areas of buccal mucosa that are raw and red with some bleeding, as well as other areas that have a white, cheesy coating. The nurse recognizes that this abnormality is:

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