ATI RN
Health Assessment Practice Questions Questions
Question 1 of 9
A nurse is assessing a patient with a history of stroke. The nurse should monitor for signs of which of the following complications?
Correct Answer: B
Rationale: The correct answer is B: Deep vein thrombosis (DVT). Patients with a history of stroke are at increased risk for DVT due to immobility and potential damage to blood vessels. The nurse should monitor for signs such as swelling, pain, and redness in the extremities. Pneumonia (A) can occur post-stroke but is not the most common complication. Hypoglycemia (C) is more relevant for diabetic patients. Hypertension (D) is a common comorbidity in stroke patients but monitoring for DVT is crucial due to its immediate life-threatening implications.
Question 2 of 9
What is the most important assessment for a client with diabetes and newly diagnosed hypertension?
Correct Answer: B
Rationale: The correct answer is B: Perform a comprehensive physical exam. This is important because it helps assess the overall health status of the client, including cardiovascular risk factors that can affect both diabetes and hypertension. Monitoring blood glucose (A) is important for diabetes management but not specific to newly diagnosed hypertension. Checking for protein in the urine (C) is important for assessing kidney function in diabetes, but not the most crucial assessment for newly diagnosed hypertension. Assessing for urinary retention (D) is not directly related to managing diabetes and hypertension.
Question 3 of 9
A nurse is caring for a patient who is post-operative following abdominal surgery. Which of the following signs and symptoms would the nurse consider as an early indicator of infection?
Correct Answer: A
Rationale: The correct answer is A: Fever. Fever is an early indicator of infection as it is the body's natural response to fighting off pathogens. When the body detects an infection, it raises its temperature to create an inhospitable environment for the pathogens. Pain at the surgical site (B) is common post-operatively but may not necessarily indicate infection. Redness at the incision site (C) can be a sign of inflammation but is not specific to infection. Increased heart rate (D) can occur due to various reasons post-operatively, not just infection. Fever is a systemic response and a more reliable early indicator of infection in this context.
Question 4 of 9
The patient's record, laboratory studies, objective data, and subjective data together form the:
Correct Answer: A
Rationale: The correct answer is A: database. The patient's record, laboratory studies, objective data, and subjective data collectively form the database in healthcare. This term refers to a comprehensive collection of all pertinent information about a patient that is used for analysis, diagnosis, and treatment planning. The other choices are incorrect because B: admitting data specifically refers to information gathered at the time of admission, C: financial statement pertains to financial information, and D: discharge summary summarizes the patient's care and treatment at the time of discharge, not the entire patient record.
Question 5 of 9
A patient asks the nurse, "Why do I have to stop smoking before my surgery?" What is the most appropriate response by the nurse?
Correct Answer: A
Rationale: The correct answer is A: "Smoking increases the risk of complications during surgery." Smoking constricts blood vessels, reduces oxygen levels, and impairs the body's ability to heal. This can lead to increased risks of infections, delayed wound healing, and other complications during and after surgery. Choice B is vague and does not address the specific risks associated with smoking. Choice C is too general and does not emphasize the immediate risks related to surgery. Choice D implies a benefit after surgery rather than focusing on the risks associated with smoking before surgery.
Question 6 of 9
What should the nurse do when a client develops severe shortness of breath after surgery?
Correct Answer: A
Rationale: The correct answer is A: Administer oxygen. This is the priority intervention to address severe shortness of breath, ensuring the client receives adequate oxygenation. Administering oxygen helps improve oxygen saturation levels and supports respiratory function. Encouraging deep breathing (B) may exacerbate the client's distress. Elevating the head of the bed (C) can help improve breathing but does not address the immediate need for oxygen. Administering antibiotics (D) is not indicated for shortness of breath unless there is an underlying infection causing it.
Question 7 of 9
In using the ophthalmoscope to assess a patient's eyes, the nurse notes a red glow in the patient's pupils. On the basis of this finding, the nurse would:
Correct Answer: C
Rationale: Rationale for Correct Answer (C): 1. Red glow in pupils indicates a normal reflection off the inner retina known as the red reflex. 2. The red reflex helps to visualize the internal structures of the eye, including the retina. 3. This finding is expected during an ophthalmoscopic examination. 4. No abnormality is suggested by the presence of a red glow in the pupils. Summary of Other Choices: A: Incorrect. Red glow does not indicate an opacity in the lens or cornea. B: Incorrect. Checking the light source is unnecessary as red glow is a normal finding. D: Incorrect. Referral is not needed as red reflex is a normal part of an ophthalmoscopic exam.
Question 8 of 9
A 31-year-old patient tells the nurse that he has noticed pain in his left ear when people speak loudly to him. The nurse knows that this finding:
Correct Answer: C
Rationale: The correct answer is C because pain in the ear when people speak loudly can be a sign of a middle ear infection. This is due to increased pressure in the middle ear caused by inflammation or fluid buildup. Recruitment (B) is a phenomenon related to hearing loss, not ear pain. Cerumen impaction (D) would not typically cause pain in response to loud sounds. It is not normal for a person of that age to experience ear pain when people speak loudly (A).
Question 9 of 9
What is the primary goal for a client with newly diagnosed diabetes?
Correct Answer: B
Rationale: The primary goal for a client with newly diagnosed diabetes is to monitor their blood glucose levels (Answer B). This is essential to understand how their body responds to different foods, activities, and medications. Monitoring blood glucose levels helps in determining the effectiveness of the treatment plan and making necessary adjustments. Teaching the client how to manage their blood glucose levels (Answer A) is important, but monitoring comes first. Monitoring urine output (Answer C) is not as relevant for diabetes management. Administering insulin (Answer D) may be necessary in some cases, but it is not the primary goal initially.