ATI RN
CNS Vital Signs Assessment Questions
Question 1 of 5
A 60-year-old male patient has been treated for pneumonia for the past 6 weeks. He is seen today in the clinic for an "unexplained" weight loss of 10 pounds over the last 6 weeks. The nurse knows that:
Correct Answer: C
Rationale: The correct answer is C: Unexplained weight loss often accompanies short-term illnesses. In this case, the patient has been treated for pneumonia for the past 6 weeks, which is a short-term illness. Weight loss in this context could be due to factors like increased metabolic rate or decreased appetite related to the illness. Choice A is incorrect because the weight loss is unexplained, not necessarily due to unhealthy eating habits. Choice B is incorrect as hypertension is not typically associated with significant weight loss. Choice D is incorrect as there is no indication in the scenario provided that the weight loss is due to a mental health dysfunction.
Question 2 of 5
During the aging process, the hair can look gray or white and begin to feel thin and fine. The nurse knows that this occurs because of a decrease in the number of functioning:
Correct Answer: D
Rationale: The correct answer is D: Melanocytes. Melanocytes are responsible for producing melanin, the pigment that gives hair its color. As individuals age, the number of functioning melanocytes decreases, leading to a loss of pigment in the hair, resulting in gray or white hair. Metrocytes (A), Fungacytes (B), and Phagocytes (C) are not involved in hair pigmentation, making them incorrect choices in this context.
Question 3 of 5
The nurse just noted from the medical record that the patient has a lesion that is confluent in nature. On examination, the nurse expects to find:
Correct Answer: A
Rationale: The correct answer is A: Lesions that run together. Confluent lesions refer to individual lesions that merge or run together to form a larger, continuous area of involvement. This term is commonly used to describe skin lesions that have coalesced. The other choices are incorrect because B refers to lesions forming a ring shape, C describes lesions following a nerve pathway, and D implies lesions grouped closely together but not necessarily merging. Thus, A is the best choice based on the description of confluent lesions.
Question 4 of 5
The nurse is reviewing the structures of the ear. Which of these statements concerning the eustachian tube is true?
Correct Answer: D
Rationale: The correct answer is D because the eustachian tube helps equalize air pressure on both sides of the tympanic membrane. This is important for maintaining proper function of the middle ear. The other choices are incorrect because: A) Cerumen is produced by the ceruminous glands, not the eustachian tube. B) The eustachian tube normally remains closed and only opens during swallowing, yawning, or sneezing to equalize pressure. C) The eustachian tube connects the middle ear to the nasopharynx, not the outer ear.
Question 5 of 5
An assessment of a 23-year-old patient reveals the following: an auricle that is tender and reddish-blue in color with small vesicles. The nurse would need to know additional information that includes which of these?
Correct Answer: D
Rationale: The correct answer is D because the presentation of a tender, reddish-blue auricle with vesicles suggests frostbite, which is caused by prolonged exposure to extreme cold. Understanding the patient's exposure to cold is crucial for proper treatment. A: Change in ability to hear is not directly related to the physical findings described. B: Recent drainage from the ear is not typically associated with the described symptoms. C: While trauma may cause similar symptoms, the presentation of vesicles is more indicative of frostbite rather than trauma.