ATI RN
Health Assessment Vital Signs Quizlet Questions
Question 1 of 5
A 55-year-old smoker complains of chest pain and gestures with a closed fist over her sternum to describe it. Which of the following diagnoses should you consider because of her gesture?
Correct Answer: D
Rationale: The correct answer is D: Angina pectoris. The gesture of a closed fist over the sternum is a classic description of angina pectoris, which is chest pain or discomfort due to coronary artery disease. The patient's age, smoking history, and location of pain all point towards a cardiac origin. Bronchitis (A) typically presents with cough and respiratory symptoms, not chest pain. Costochondritis (B) is inflammation of the cartilage that connects the ribs to the sternum, causing localized chest pain worsened by movement or palpation. Pericarditis (C) is inflammation of the sac surrounding the heart, leading to sharp chest pain worsened by breathing or lying down. Angina pectoris (D) is the most likely diagnosis given the patient's presentation and risk factors.
Question 2 of 5
During an interview, the nurse states, 'You mentioned having shortness of breath. Tell me more about that.' Which verbal skill is used with this statement?
Correct Answer: D
Rationale: The correct answer is D: Open-ended question. This type of question encourages the interviewee to provide detailed and descriptive responses, allowing them to freely express their thoughts and feelings. In this scenario, the nurse's question prompts the interviewee to elaborate on their experience with shortness of breath, leading to a more in-depth conversation. Reflection (A) involves restating the interviewee's words, Facilitation (B) involves encouraging the interviewee to continue talking, and Direct question (C) is closed-ended and limits the response to a specific answer, unlike the open-ended question used in this situation.
Question 3 of 5
The nurse is reviewing percussion techniques with a newly graduated nurse. Which technique indicates that more review is needed?
Correct Answer: A
Rationale: Correct Answer: A Rationale: 1. Percussing once over each area is incorrect because percussion should involve multiple strikes to accurately assess underlying structures. 2. Percussion requires a series of light and rapid strikes to elicit different sounds based on tissue density. 3. By percussing only once, the nurse may miss subtle differences in sound pitch and quality, leading to inaccurate assessments. 4. Therefore, more review is needed to ensure the nurse understands the importance of multiple percussion strikes for proper assessment. Summary of other choices: B. Quickly lifting the striking finger after each stroke is a correct technique to enhance the accuracy of percussion. C. Striking with the fingertip, not the finger pad, is important to produce clear sounds during percussion. D. Using the wrist to make the strikes, not the arm, is the correct technique to achieve controlled and precise percussion strikes.
Question 4 of 5
When auscultating for bowel sounds, the nurse should:
Correct Answer: C
Rationale: The correct answer is C: Use the diaphragm of the stethoscope. The diaphragm is the appropriate part of the stethoscope for listening to bowel sounds due to its ability to pick up higher frequency sounds. Bowel sounds are best heard with a higher frequency range, which the diaphragm is designed to capture. Using the bell of the stethoscope (choice A) is not ideal for bowel sounds as it is better suited for low-frequency sounds like heart murmurs. Ensuring the patient is standing upright (choice B) is unnecessary for auscultating bowel sounds. Avoiding pressing the stethoscope too firmly (choice D) is a good practice to prevent unnecessary noise interference, but it is not directly related to the optimal choice of stethoscope component for bowel sounds.
Question 5 of 5
When assessing a 75-year-old patient who has asthma, the nurse notes that he assumes a tripod position, leaning forward with arms braced on the chair. On the basis of this observation, the nurse should:
Correct Answer: D
Rationale: The correct answer is D. A tripod position, where a patient leans forward with arms braced on a chair, is often used when a patient is having respiratory difficulties, such as in asthma exacerbation. This position helps improve airflow by allowing better expansion of the chest. The patient is likely trying to relieve breathing difficulty by maximizing lung expansion. Choosing option D is appropriate as it acknowledges the significance of the tripod position in respiratory distress. A: This choice is incorrect because assuming the patient is eager and interested in participating in the interview does not relate to the observation of the tripod position in a patient with asthma. B: Evaluating the patient for abdominal pain is not the priority in this scenario where respiratory distress is suspected. C: This option is incorrect as moving the patient to a supine position may worsen breathing difficulties.