ATI RN
Vital Signs Assessment Chapter 7 Questions
Question 1 of 9
A nurse is assessing a client's pulse rate and observes an irregular rhythm with skipped beats. What action should the nurse take?
Correct Answer: C
Rationale: Irregular rhythm with skipped beats suggests a potential arrhythmia, requiring provider notification for evaluation. It's not normal . Waiting an hour delays care. Deep breathing doesn't address cardiac issues. Choice C is correct, per the explanation, reflecting nursing's duty to escalate abnormal findings promptly for patient safety.
Question 2 of 9
What is the most common cause of posterior cruciate ligament (PCL) injury?
Correct Answer: D
Rationale: A dashboard injury, where the tibia is forced posteriorly, is the most common cause of PCL injury.
Question 3 of 9
During an assessment, the nurse uses the profile sign to detect:
Correct Answer: B
Rationale: The nurse should use the profile sign (viewing the finger from the side) to detect early clubbing.
Question 4 of 9
During an assessment of a 20-year-old Asian patient, the nurse notices that he has dry, flaky cerumen in his canal. What is the significance of this finding? This finding:
Correct Answer: C
Rationale: Asians and Native Americans are more likely to have dry cerumen, whereas Blacks and Whites usually have wet cerumen.
Question 5 of 9
A 50-year-old woman presents with a history of sudden-onset leg pain and swelling. She has a recent history of prolonged immobility due to a recent surgery. What is the most likely diagnosis?
Correct Answer: A
Rationale: Sudden-onset leg pain, swelling, and a history of recent immobility are consistent with deep vein thrombosis (DVT).
Question 6 of 9
Which of the following is true of human papilloma virus (HPV) infection?
Correct Answer: B
Rationale: HPV is the most common STI in the United States and is by far the most common cause of cervical cancers. The sensitivity of the liquid-based cytology is between 61% and 95% and specificity is from 78% to 82%. While HPV affects almost 50% of the population at some point, many of these infections resolve spontaneously.
Question 7 of 9
A pregnant woman states, 'I just know labor will be so painful that I won't be able to stand it. I know it sounds awful, but I really dread going into labor.' The nurse responds by stating, 'Oh, don't worry about labor so much. I have been through it, and although it is painful, many good medications are available to decrease the pain.' Which statement is true regarding this response? The nurse's reply was a:
Correct Answer: B
Rationale: By providing false assurance or reassurance, this courage builder relieves the woman's anxiety and gives the nurse the false sense of having provided comfort. However, for the woman, providing false assurance or reassurance actually closes off communication, trivializes her anxiety, and effectively denies any further talk of it.
Question 8 of 9
The nurse is assessing a patient's peripheral pulses. Which pulse is located on the top of the foot?
Correct Answer: A
Rationale: The dorsalis pedis pulse is located on the top of the foot and is an important indicator of peripheral circulation.
Question 9 of 9
The nurse is performing a musculoskeletal assessment and notes that the patient has a decreased range of motion in the knee joint. What is the most likely cause of this finding?
Correct Answer: A
Rationale: Decreased range of motion in the knee joint is often a result of osteoarthritis, a condition characterized by the degeneration of joint cartilage.