ATI LPN
Study Guide for Fundamentals of Nursing Care: Concepts, Connections & Skills
Chapter 21 : Physical Assessment Questions
Question 1 of 5
Which of the following assessment findings is not within the textbook normal range?
Correct Answer: B,D
Rationale: Capillary refill of 5 seconds (normal is <2-3 seconds) and systolic pressure of 86 mm Hg (normal is 90-120 mm Hg) are outside normal ranges.
Question 2 of 5
You know that it is important to foster rapport and communication with all of your patients. Which of the following actions and interventions would be helpful to increase the effectiveness of your communication and increase nurse-patient rapport?
Correct Answer: B,D,E,F,G
Rationale: Smiling, spending time, being genuine, explaining actions, being nonjudgmental, and respecting cultural differences foster rapport and effective communication.
Question 3 of 5
Your instructor has asked you to come to the patient's room to hear a good example of a murmur and a bruit. You know that there are specific instances when you use the bell versus the diaphragm side on your stethoscope and when you use light pressure as opposed to pressing to make a firm seal against the patient's skin. Which of the following correctly describes how to use the bell and diaphragm chest piece of your stethoscope?
Correct Answer: B,D
Rationale: The bell is used for low-pitched sounds with light pressure, while the diaphragm is pressed firmly for high-pitched sounds like murmurs and bruits.
Question 4 of 5
During examination of the eyes, you check something known as consensual reflex. How is this done?
Correct Answer: A
Rationale: Consensual reflex is tested by shining a light into one eye, causing constriction in both the illuminated and opposite pupil.
Question 5 of 5
Percussion of a patient's abdomen and chest provides you with what information about the patient?
Correct Answer: D
Rationale: Percussion reveals density, fluid, air, and organ size/position through sound differences (e.g., dullness, tympany).