Vital Signs Physical Assessment Techniques

ATI RN · Vital Signs Physical Assessment Techniques

Question 1 of 63

What is the primary purpose of performing percussion during a physical examination?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 2 of 63

A nurse is assessing a client's pain and notes that the client has dilated pupils, increased blood pressure, and increased heart rate. Which type of pain is the client likely experiencing?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 3 of 63

During a musculoskeletal assessment, the nurse notes that the patient has a tender, swollen joint with decreased range of motion. What is the most likely diagnosis?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 4 of 63

During reporting, the nurse hears that a patient is experiencing hallucinations. Which is an example of a hallucination?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 5 of 63

A 70-year-old man presents with a complaint of severe, crushing chest pain that radiates to his left arm. He has a history of hypertension and diabetes mellitus. What is the most likely diagnosis?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 6 of 63

Conducting a health assessment involves collecting, validating, and analyzing subjective data and objective data. Which of the following is an example of subjective data?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 7 of 63

A 36-year-old teacher presents with sharp, knifelike pain on the left side of her chest for 2 days. Breathing and lying down make the pain worse, while sitting forward helps. A scratching noise is heard at the lower left sternal border, coincident with systole.

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ATI RN · Vital Signs Physical Assessment Techniques

Question 8 of 63

A mother brings her 4-month-old infant to the clinic with concerns regarding a small pad in the middle of the upper lip that has been there since 1 month of age. The infant has no health problems. On physical examination, the nurse notices a 0.5-cm, fleshy, elevated area in the middle of the upper lip. No evidence of inflammation or drainage is observed. What would the nurse tell this mother?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 9 of 63

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

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ATI RN · Vital Signs Physical Assessment Techniques

Question 10 of 63

The nurse is caring for an elderly patient and notes that his temperature is 96.8Ã‚Â°F (36Ã‚Â°C). She understands that this patient is

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ATI RN · Vital Signs Physical Assessment Techniques

Question 11 of 63

The nurse is preparing to assess the blood pressure of a 3 year old. How should the nurse proceed?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 12 of 63

A nurse is assessing a client's pulse rate using a stethoscope. Where should the nurse place the stethoscope to auscultate the pulse?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 13 of 63

During a cardiovascular assessment, the nurse notes that the patient has a jugular vein distension (JVD) when positioned at 45 degrees. What does this finding suggest?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 14 of 63

The nurse is conducting a class on priority setting for new graduate nurses. Which is an example of a first-level priority problem?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 15 of 63

During a cardiac assessment, the nurse notes a grade 3/6 systolic murmur at the left sternal border. What is the appropriate documentation for this finding?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 16 of 63

A 28-year-old woman presents with a complaint of chronic headaches that are worse in the morning and are associated with nausea and vomiting. She also reports blurred vision. Neurological examination reveals papilledema. What is the most likely diagnosis?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 17 of 63

The nurse is assessing a patient with suspected pneumonia. Which finding is most consistent with this condition?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 18 of 63

When assessing a newborn infant who is 5 minutes old, the nurse knows which of these statements to be true?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 19 of 63

A patient is examined with the ophthalmoscope and found to have red reflexes bilaterally. Which of the following have you essentially excluded from your differential?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 20 of 63

Weakness of which muscle would correlate with compression of the C5 nerve root?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 21 of 63

The nurse recognizes that the concept of prevention in describing health is essential because:

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ATI RN · Vital Signs Physical Assessment Techniques

Question 22 of 63

Mr. Kruger is an 84-year-old who presents with a smooth lower abdominal mass in the midline which is minimally tender. There is dullness to percussion up to 6 centimeters above the symphysis pubis. What does this most likely represent?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 23 of 63

S.Q. was just admitted because of cellulitis of her lower extremity due to a cat scratch. She was previously treated outpatient but missed multiple appointments and did not take her medication. As you complete the health history, she shares that she is sleeping on her sister's couch because she lost her job. She lives in an area of town considered a food desert and often eats whatever she can find from a local gas station or fast-food restaurant. She missed her last two follow-up visits for her leg due to inadequate transportation and could not afford to purchase the expensive medication. Which of the following statements best describes the impact of social determinants of health on S.Q.'s well-being?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 24 of 63

The nurse is performing an abdominal examination and notes that the patient has tympany over the entire abdomen. What is the most likely cause of this finding?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 25 of 63

A 52-year-old woman is admitted with dyspnea and discomfort in her left chest with deep breaths. She has smoked for 35 years and recently lost over 10 pounds. Her vital signs on admission are: HR 112, BP 138/82, RR 22, tympanic temperature 36.8Ã‚Â°C (98.2Ã‚Â°F), and oxygen saturation 94%. She is receiving oxygen at 2 L/min via a nasal cannula. Which vital sign reflects a positive outcome of the oxygen therapy?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 26 of 63

Cyanosis is ...

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ATI RN · Vital Signs Physical Assessment Techniques

Question 27 of 63

Which one of the following physical examination descriptions would be most consistent with the diagnosis of cholecystitis?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 28 of 63

Frank is a 24-year-old man who presents with multiple burning erosions on the shaft of his penis and some tender inguinal adenopathy. Which of the following is most likely?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 29 of 63

Evaluation of scoliosis involves the Adams test and measuring the Cobb angle. What does the Cobb angle measure?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 30 of 63

Core body temperature is ___ surface body temperature.

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ATI RN · Vital Signs Physical Assessment Techniques

Question 31 of 63

Adam is a very successful 15-year-old student and athlete. His mother brings him in today because he no longer studies, works out, or sees his friends. This has gone on for a month and a half. When you speak with him alone in the room, he states it "would be better if he were not here." What would you do next?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 32 of 63

A 70-year-old patient is being seen in the clinic for severe exacerbation of his heart failure. Which of these findings is the nurse most likely to observe in this patient?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 33 of 63

During an annual physical examination, a 43-year-old patient states that she does not perform monthly breast self-examinations (BSEs). She tells the nurse that she believes that mammograms "do a much better job than I ever could to find a lump." The nurse should explain to her that:

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ATI RN · Vital Signs Physical Assessment Techniques

Question 34 of 63

During an examination, the nurse notices that a female patient has a round "moon" face, central trunk obesity, and a cervical hump. Her skin is fragile with bruises. The nurse determines that the patient has which condition?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 35 of 63

During a physical examination, which action is most important for preventing infection?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 36 of 63

During percussion, the nurse knows that a dull percussion note elicited over a lung lobe most likely results from:

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ATI RN · Vital Signs Physical Assessment Techniques

Question 37 of 63

The nurse is assessing a patient's gait and observes shuffling and difficulty initiating movement. What condition is most likely associated with these findings?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 38 of 63

The following information is recorded in the health history: 'I feel really tired.' Which category does it belong to?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 39 of 63

The nurse is assessing a 16-year-old patient who has suffered head injuries from a recent motor vehicle accident. Which of these statements indicates the most important reason for assessing for any drainage from the ear canal?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 40 of 63

The nurse is preparing to measure the length, weight, chest, and head circumference of a 6-month-old infant. Which measurement technique is correct?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 41 of 63

A 42-year-old woman complains that she has noticed several small, slightly raised, bright red dots on her chest. On examination, the nurse expects that the spots are probably:

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ATI RN · Vital Signs Physical Assessment Techniques

Question 42 of 63

When conducting a physical assessment, what should the nurse assess and document about size and shape of body parts?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 43 of 63

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

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ATI RN · Vital Signs Physical Assessment Techniques

Question 44 of 63

Which of the following is the most appropriate action when the nurse encounters an area of tenderness during abdominal palpation?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 45 of 63

A 70-year-old man with a history of hypertension presents with shortness of breath and orthopnea. His physical examination reveals bilateral pedal edema, crackles at the lung bases, and jugular venous distention. What is the most likely diagnosis?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 46 of 63

Which of the following is a contraindication for the use of contrast baths?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 47 of 63

A father brings in his 2-month-old infant to the clinic because the infant has had diarrhea for the last 24 hours. He says his baby has not been able to keep any formula down and that the diarrhea has been at least every 2 hours. The nurse suspects dehydration. The nurse should test skin mobility and turgor over the infant's:

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ATI RN · Vital Signs Physical Assessment Techniques

Question 48 of 63

What is a Bankart lesion?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 49 of 63

The nurse is preparing to perform a modified Allen test. Which is an appropriate reason for this test?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 50 of 63

The nurse is performing an oral assessment on a 40-year-old Black patient and notices the presence of a 1 cm, nontender, grayish-white lesion on the left buccal mucosa. Which one of these statements is true? This lesion is:

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ATI RN · Vital Signs Physical Assessment Techniques

Question 51 of 63

During an interview, a parent of a hospitalized child is sitting in an open position. As the interviewer begins to discuss his son's treatment, however, he suddenly crosses his arms against his chest and crosses his legs. This changed posture would suggest that the parent is:

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ATI RN · Vital Signs Physical Assessment Techniques

Question 52 of 63

Before auscultating the abdomen for the presence of bowel sounds on a patient, the nurse should:

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ATI RN · Vital Signs Physical Assessment Techniques

Question 53 of 63

The nurse is teaching a patient about the use of the diaphragm of a stethoscope. It is best used to detect:

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ATI RN · Vital Signs Physical Assessment Techniques

Question 54 of 63

The patient has a temperature of 105.2Ã‚Â°F. The nurse is attempting to lower temperature by providing tepid sponge baths and placing cool compresses in strategic body locations. Which technique is the nurse using to lower the patient's temperature?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 55 of 63

When assessing aging adults, the nurse knows that one of the first things that should be assessed before making judgments about their mental status is:

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ATI RN · Vital Signs Physical Assessment Techniques

Question 56 of 63

A student is late for his appointment and has rushed across campus to the health clinic. The nurse should:

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ATI RN · Vital Signs Physical Assessment Techniques

Question 57 of 63

The nurse is assessing a patient's abdomen and hears high-pitched, tinkling bowel sounds. What do these sounds indicate?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 58 of 63

A student is reading the medical record of an assigned patient and notes the patient has been afebrile for the past 12 hours. What does the term afebrile indicate?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 59 of 63

A patient has intravenous fluids infusing in the right arm. How should the nurse obtain the blood pressure on this patient?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 60 of 63

Which finding during a lung assessment indicates the presence of fluid in the alveoli?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 61 of 63

The nurse is assessing a patient's peripheral pulses and notes that the pulse is weak and thready. What is the most likely cause of this finding?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 62 of 63

What does the anterior drawer test assess in the ankle?

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ATI RN · Vital Signs Physical Assessment Techniques

Question 63 of 63

During an eye assessment, the nurse uses the Snellen chart to test the patient's visual acuity. Which result is considered normal?

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