ATI RN
Assessing Vital Signs ATI Questions
Question 1 of 5
A 44-year-old female comes to your clinic, complaining of severe dry skin in the area over her right nipple. She denies any trauma to the area. She noticed the skin change during a self-examination 2 months ago. She also admits that she had felt a lump under the nipple but kept putting off making an appointment. She does admit to 6 months of fatigue but no weight loss, weight gain, fever, or night sweats. Her past medical history is significant for hypothyroidism. She does not have a history of eczema or allergies. She denies any tobacco, alcohol, or drug use. On examination you find a middle-aged woman appearing her stated age. Inspection of her right breast reveals a scaly eczema-like crust around her nipple. Underneath you palpate a nontender 2-cm mass. The axilla contains only soft, moveable nodes. The left breast and axilla examination findings are unremarkable. What visible skin change of the breast does she have?
Correct Answer: B
Rationale: The correct answer is B: Paget's disease. Paget's disease of the breast presents with eczema-like skin changes around the nipple and is often associated with an underlying breast mass, which can be palpated. In this case, the patient's symptoms of severe dry skin over the right nipple, along with the presence of a mass underneath, are consistent with Paget's disease. The other choices are incorrect because nipple retraction (choice A) typically presents as a pulled-in appearance of the nipple, not eczema-like crusts. Peau d'orange sign (choice C) is characterized by skin dimpling resembling an orange peel, which is not described in the patient's presentation. Option D is not provided as a choice.
Question 2 of 5
The nurse is assessing the mental status of a child. Which statement about children and mental status is true?
Correct Answer: A
Rationale: The correct answer is A because all aspects of mental status in children are indeed interdependent. This means that cognitive, emotional, and behavioral domains of mental status are interconnected and influence each other. It is crucial to assess all aspects together to gain a comprehensive understanding of a child's mental well-being. Choice B is incorrect because children are not necessarily highly labile and unstable until the age of 2 years. While children may exhibit rapid changes in behavior due to developmental milestones, it is not accurate to generalize them as highly labile. Choice C is incorrect as children's mental status is not solely a function of their parents' level of functioning. While parental influence plays a significant role, children's mental status is also influenced by various other factors such as genetics, environment, and individual experiences. Choice D is incorrect as it is possible to assess a child's mental status even before they develop the ability to concentrate. Assessment tools and techniques exist to evaluate different aspects of mental status in children, even at a
Question 3 of 5
A patient describes feeling an unreasonable, irrational fear of snakes. His fear is so persistent that he can no longer comfortably look at even pictures of snakes and has made an effort to identify all the places he might encounter a snake and avoids them. The nurse recognizes that he:
Correct Answer: A
Rationale: The correct answer is A: Has a snake phobia. The patient's persistent and irrational fear of snakes that interferes with his daily life indicates a phobia. Phobias are characterized by an intense fear of a specific object or situation, leading to avoidance behaviors. In this case, the patient's fear of snakes is excessive and unreasonable, causing significant distress. It is not a hypochondriac (B) because the fear is specific to snakes and not related to health concerns. It is not an obsession (C) because the fear of snakes is not driven by intrusive thoughts or compulsive behaviors. It is not a delusion (D) because the fear is not based on a false belief, but rather an irrational fear.
Question 4 of 5
A nurse is taking complete health histories on all of the patients attending a wellness workshop. On the history form, one of the written questions asks, 'You don't smoke, drink, or take drugs, do you?' This question is an example of:
Correct Answer: C
Rationale: The correct answer is C: Using biased or leading questions. This question is leading because it assumes that the patients don't smoke, drink, or take drugs. It may influence the patients to answer in a certain way to please the nurse. This can result in inaccurate information being provided. Talking too much (A), using confrontation (B), and using blunt language (D) do not accurately describe the nature of the question being asked.
Question 5 of 5
When examining an older adult, the nurse should:
Correct Answer: D
Rationale: The correct answer is D because older adults may have mobility issues, so minimizing position changes during the exam helps prevent discomfort or falls. This approach promotes patient safety and comfort. Choice A is incorrect as appropriate touch is essential for a thorough assessment. Choice B is incorrect as older adults may tire easily, so breaking up the exam into manageable parts is preferable. Choice C is incorrect as speaking loudly and slowly may be perceived as patronizing and is not necessary unless the patient has hearing difficulties.