ATI RN
jarvis physical examination and health assessment 9th edition test bank Questions
Question 1 of 9
A nurse is caring for a patient with chronic kidney disease. The nurse should monitor for which of the following signs of fluid overload?
Correct Answer: A
Rationale: The correct answer is A, shortness of breath and weight gain, because fluid overload in patients with chronic kidney disease can lead to pulmonary edema and weight gain due to retained fluid. Shortness of breath occurs as the excess fluid accumulates in the lungs. Increased urine output and fatigue (B) are more indicative of dehydration. Dizziness and hypotension (C) are symptoms of hypovolemia, not fluid overload. Nausea and vomiting (D) are nonspecific symptoms and not typically associated with fluid overload.
Question 2 of 9
A patient with diabetes is being discharged after a prolonged hospitalization. Which of the following should the nurse include in discharge instructions?
Correct Answer: A
Rationale: The correct answer is A. Regularly checking blood glucose levels is crucial for diabetic patients to monitor their condition and adjust treatment as needed. This helps in managing blood sugar levels effectively and preventing complications. Choice B is incorrect because stopping insulin abruptly can lead to dangerous fluctuations in blood sugar levels. Choice C is incorrect because while exercise is important for diabetic patients, vigorous exercise every day may not be suitable for everyone and should be discussed with healthcare providers. Choice D is incorrect as carbohydrates are an essential source of energy and nutrients for the body. Diabetic patients can still consume carbohydrates in controlled portions as part of a balanced diet.
Question 3 of 9
When performing a physical assessment, the first technique the nurse will use is:
Correct Answer: B
Rationale: The correct answer is B: Inspection. This is because visual observation is typically the initial step in a physical assessment to gather information about the patient's overall appearance, skin color, posture, and any obvious abnormalities. Palpation (A) involves touching and feeling for abnormalities, which usually follows inspection. Percussion (C) is the technique of tapping on the body to assess underlying structures, and auscultation (D) is listening to sounds produced by the body, both of which typically come after inspection and palpation. Inspecting the patient first allows the nurse to establish a baseline before moving on to more detailed assessment techniques.
Question 4 of 9
A nurse is caring for a patient who has a history of hypertension and reports a new onset of headaches, nausea, and dizziness. The nurse should be most concerned about which of the following?
Correct Answer: A
Rationale: The correct answer is A: Hypertensive crisis. The nurse should be most concerned about this option because the patient has a history of hypertension and is experiencing new onset symptoms such as headaches, nausea, and dizziness, which could indicate a sudden and severe increase in blood pressure. This condition, if left untreated, can lead to serious complications such as stroke or heart attack. Summary: - B: Migraine headache is unlikely as the symptoms described are not typical of a migraine. - C: Benign positional vertigo is unlikely as it does not explain the presence of headaches and nausea. - D: Tension headache is less concerning compared to hypertensive crisis, given the patient's history of hypertension and the severity of symptoms.
Question 5 of 9
A 40-year-old woman presents to the clinic with complaints of fatigue and weight gain. On assessment, the nurse finds that the patient has cold intolerance, dry skin, and a slow heart rate. The nurse suspects:
Correct Answer: B
Rationale: The correct answer is B: Hypothyroidism. In this case, the patient's symptoms of fatigue, weight gain, cold intolerance, dry skin, and slow heart rate are indicative of hypothyroidism. The thyroid gland is underactive, leading to decreased production of thyroid hormones, which regulate metabolism. These symptoms align with the typical clinical presentation of hypothyroidism. Other choices are incorrect because hyperthyroidism (choice A) would present with symptoms like weight loss, heat intolerance, and a fast heart rate. Cushing's syndrome (choice C) and Addison's disease (choice D) are both conditions related to the adrenal glands and would have different symptom presentations compared to what is described in the case scenario.
Question 6 of 9
A nurse is caring for a patient with a history of asthma. The nurse should monitor for which of the following signs of an asthma exacerbation?
Correct Answer: B
Rationale: The correct answer is B: Increased wheezing and shortness of breath. During an asthma exacerbation, bronchial airways become inflamed and narrowed, leading to increased wheezing and shortness of breath. This is a classic sign of worsening asthma. Other choices are incorrect because: A) Decreased work of breathing is not expected in an asthma exacerbation as the patient usually struggles to breathe. C) Improved oxygen saturation is unlikely as airway obstruction can lead to decreased oxygen levels. D) Decreased sputum production is not a typical sign of asthma exacerbation; in fact, increased sputum production may occur due to airway inflammation.
Question 7 of 9
A nurse is caring for a patient with a history of hypertension. The nurse should educate the patient to prioritize which of the following?
Correct Answer: A
Rationale: The correct answer is A: Limiting sodium intake. This is crucial for a patient with hypertension as excess sodium can lead to increased blood pressure. Sodium intake should be limited to lower the risk of cardiovascular complications. B: Increasing potassium intake is beneficial, but not as critical as limiting sodium for hypertension management. C: Increasing fluid intake may or may not be necessary depending on the patient's condition, but it is not as crucial as limiting sodium for hypertension management. D: Consuming more caffeine can actually elevate blood pressure, so it is not recommended for patients with hypertension.
Question 8 of 9
A nurse is caring for a patient with diabetes. Which of the following symptoms should the nurse recognize as a sign of hypoglycemia?
Correct Answer: C
Rationale: The correct answer is C: Tremors and dizziness. Hypoglycemia is characterized by low blood sugar levels. Tremors and dizziness are common symptoms due to the brain not receiving enough glucose for energy. Tachycardia and nausea (choice A) are more indicative of hyperglycemia. Polyuria and polydipsia (choice B) are classic symptoms of hyperglycemia in diabetes. Weight loss and fatigue (choice D) are not specific symptoms of hypoglycemia.
Question 9 of 9
A nurse is teaching a patient with diabetes about blood glucose management. Which of the following statements by the patient indicates proper understanding?
Correct Answer: A
Rationale: Correct Answer: A Rationale: 1. Regular blood glucose monitoring helps in understanding patterns and making informed decisions. 2. Adjusting insulin based on blood glucose levels is crucial for effective diabetes management. 3. This statement shows the patient's understanding of the need for personalized insulin adjustments. 4. It promotes self-management and proactive approach to blood sugar control. Summary: B: Stopping insulin abruptly can lead to dangerous complications. C: Skipping meals can disrupt blood sugar levels and is not recommended. D: Waiting for high blood sugar to use insulin can result in uncontrolled levels and complications.