ATI RN
Assess Vital Signs Questions
Question 1 of 5
A patient has been admitted for severe psoriasis. The nurse expects to see what finding in the patient's fingernails?
Correct Answer: C
Rationale: The correct answer is C: Pitting. Pitting of the fingernails is a common finding in patients with severe psoriasis due to the involvement of nail matrix. It presents as small depressions or holes on the nail surface. This occurs as a result of abnormal keratinization in the nail matrix. Splinter hemorrhages (choice A) are seen in conditions like infective endocarditis, not psoriasis. Paronychia (choice B) is an infection around the nail fold. Beau lines (choice D) are transverse depressions in the nail plate caused by temporary disruption in nail growth, often due to systemic illness.
Question 2 of 5
A 92-year-old patient has had a stroke. The right side of his face is drooping. The nurse might also suspect which of these assessment findings?
Correct Answer: C
Rationale: The correct answer is C: Dysphagia. Dysphagia is the difficulty or discomfort in swallowing, which can occur after a stroke due to facial muscle weakness. In this case, the right-sided facial drooping indicates a stroke affecting the left side of the brain, which can lead to dysphagia. Epistaxis (nosebleed) and rhinorrhea (runny nose) are not typically associated with facial drooping after a stroke. Xerostomia (dry mouth) is more related to salivary gland dysfunction and is not directly related to facial muscle weakness.
Question 3 of 5
When examining the mouth of an older patient, the nurse recognizes which finding is due to the aging process?
Correct Answer: B
Rationale: The correct answer is B because as individuals age, the papillae on the tongue tend to flatten, resulting in a smoother appearance. This is a normal part of the aging process. Choice A is incorrect as teeth appearing shorter is more likely due to wear and tear or dental issues. Choice C, beefy red buccal mucosa, may indicate inflammation or infection, not necessarily related to aging. Choice D, a painless lump on the dorsum of the tongue, should be further investigated as it could be a sign of a more serious condition.
Question 4 of 5
When auscultating the lungs of an adult patient, the nurse notes that low-pitched, soft breath sounds are heard over the posterior lower lobes, with inspiration being longer than expiration. The nurse interprets that these sounds are:
Correct Answer: C
Rationale: The correct answer is C: Vesicular breath sounds and normal in that location. Vesicular breath sounds are low-pitched, soft sounds heard over most of the lung fields. In this case, they are heard over the posterior lower lobes, which is a normal location for vesicular sounds. The longer inspiration than expiration is also characteristic of vesicular breath sounds. A: Normally auscultated over the trachea - This is incorrect as breath sounds over the trachea are typically harsh and high-pitched. B: Bronchial breath sounds and normal in that location - Bronchial breath sounds are harsh, loud sounds heard over the trachea and are not normal in the posterior lower lobes. D: Bronchovesicular breath sounds and normal in that location - Bronchovesicular breath sounds are a mix of bronchial and vesicular sounds, and they are not normally auscultated in the posterior lower lobes.
Question 5 of 5
Which of the following statements is true regarding the internal structures of the breast? The breast is made up of:
Correct Answer: B
Rationale: Rationale: 1. The breast is composed of fibrous tissue, which provides structural support. 2. Glandular tissue is present for milk production. 3. Adipose tissue is essential for storing energy and padding. 4. Option A is incorrect as the breast contains minimal muscle tissue. 5. Option C is incorrect as lactiferous ducts are part of the milk delivery system, not the entire breast. 6. Option D is incorrect as glandular tissue does not attach to the chest wall.