A 48-year-old high school librarian comes to your clinic, complaining of 1 week of heavy discharge causing severe itching. She is not presently sexually active and has had no burning with urination. The symptoms started several days after her last period. She just finished a course of antibiotics for a sinus infection. Her past medical history consists of type 2 diabetes and high blood pressure. She is widowed and has three children. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died of diabetes complications. On examination you see a healthy-appearing woman. Her blood pressure is 130/80 and her pulse is 70. Her head, eyes, ears, nose, throat, cardiac, lung, and abdominal examinations are unremarkable. Palpation of the inguinal lymph nodes is unremarkable. On visualization of the vulva, a thick, white, curdy discharge is seen at the introitus. On speculum examination there is a copious amount of this discharge. The pH of the discharge is 4.1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding hyphae. What vaginitis does this patient most likely have?

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ATI Vital Signs Assessment Questions

Question 1 of 5

A 48-year-old high school librarian comes to your clinic, complaining of 1 week of heavy discharge causing severe itching. She is not presently sexually active and has had no burning with urination. The symptoms started several days after her last period. She just finished a course of antibiotics for a sinus infection. Her past medical history consists of type 2 diabetes and high blood pressure. She is widowed and has three children. She denies tobacco, alcohol, or drug use. Her mother has high blood pressure and her father died of diabetes complications. On examination you see a healthy-appearing woman. Her blood pressure is 130/80 and her pulse is 70. Her head, eyes, ears, nose, throat, cardiac, lung, and abdominal examinations are unremarkable. Palpation of the inguinal lymph nodes is unremarkable. On visualization of the vulva, a thick, white, curdy discharge is seen at the introitus. On speculum examination there is a copious amount of this discharge. The pH of the discharge is 4.1 and the KOH whiff test is negative, with no unusual smell. Wet prep shows budding hyphae. What vaginitis does this patient most likely have?

Correct Answer: B

Rationale: The correct answer is B: Candida vaginitis. In this case, the patient's symptoms of heavy discharge, severe itching, and thick, white, curdy discharge at the introitus are indicative of a yeast infection, which is commonly caused by Candida species. The presence of budding hyphae on wet prep further supports this diagnosis, as Candida typically presents with this characteristic. The negative KOH whiff test and pH of 4.1 are consistent with Candida vaginitis, as opposed to Trichomonas vaginitis or bacterial vaginosis, which would have different pH levels and odors. Atrophic vaginitis is unlikely given the patient's age and absence of hormonal changes. Therefore, based on the clinical presentation and laboratory findings, Candida vaginitis is the most likely diagnosis for this patient.

Question 2 of 5

A grandmother brings her 13-year-old grandson for evaluation of a collapsed breastbone that has been present for quite awhile. He has no symptoms but is embarrassed about his appearance.

Correct Answer: B

Rationale: The correct answer is B: Funnel chest (pectus excavatum). Pectus excavatum is characterized by a depression or concave appearance of the breastbone (sternum). In this case, the 13-year-old grandson has a collapsed breastbone, which aligns with the description of pectus excavatum. This condition is often asymptomatic but can cause embarrassment due to the appearance. Barrel chest (choice A) refers to an increase in the anteroposterior diameter of the chest often seen in conditions like COPD, not related to a collapsed breastbone. Pigeon chest (choice C) is the opposite of pectus excavatum, where the sternum protrudes outward. Thoracic kyphoscoliosis (choice D) involves a combination of kyphosis (excessive outward curvature of the spine) and scoliosis (sideways curvature of the spine), not directly related to a collapsed breastbone.

Question 3 of 5

A 19-year-old woman comes to the clinic at the insistence of her brother. She is wearing black combat boots and a black lace nightgown over the top of her other clothes. Her hair is dyed pink with black streaks throughout. She has several pierced holes in her nares and ears and is wearing an earring through her eyebrow and heavy black makeup. The nurse concludes that:

Correct Answer: D

Rationale: The correct answer is D because it is important to gather more information before making assumptions or conclusions about the woman's appearance. Without a comprehensive assessment of her mental health, personal preferences, cultural background, and any potential underlying issues, it would be inappropriate to jump to conclusions about her attire. Choice A is incorrect because judging solely based on appearance is not a valid way to assess someone's well-being. Choice B is incorrect as dismissing her appearance as a mere attempt to shock overlooks the potential reasons behind her choices. Choice C is incorrect because associating her appearance with a manic syndrome without proper evaluation is premature and stigmatizing.

Question 4 of 5

The nurse asks, 'I would like to ask you some questions about your health and your usual daily activities so that we can better plan your stay here.' This question is found at the _____ phase of the interview process.

Correct Answer: D

Rationale: The correct answer is D: Opening or introduction. In the given question, the nurse is initiating the conversation by introducing the purpose of the interview and setting the stage for gathering information. This phase is crucial as it helps establish rapport and build trust with the patient. The opening phase allows the nurse to start the conversation in a structured and organized manner. Summary: This choice is incorrect because the summary phase comes at the end of the interview where the nurse would recap important points discussed. Closing: This choice is incorrect as the closing phase involves wrapping up the interview and discussing next steps or providing closure. Body: This choice is incorrect as the body phase is where the main discussion and information gathering take place.

Question 5 of 5

Which of these techniques uses the sense of touch to assess texture, temperature, moisture, and swelling?

Correct Answer: A

Rationale: The correct answer is A: Palpation. Palpation is the technique of using the sense of touch to assess various aspects such as texture, temperature, moisture, and swelling. It involves feeling the body with the hands to gather information about the underlying structures. Inspection (B) is the visual examination, not tactile. Percussion (C) is tapping on the body to listen for sounds, not assessing through touch. Auscultation (D) is listening to sounds within the body using a stethoscope, not related to touch assessment.

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