ATI RN
health assessment practice questions nursing Questions
Question 1 of 9
A very concerned mother is at the clinic with her infant who has a large, soft lump on the side of his head. She tells the nurse that she noticed the lump about 8 hours after her baby's birth and that it seems to be getting bigger. One possible explanation for this is:
Correct Answer: C
Rationale: The correct answer is C: cephalhematoma. A cephalhematoma is a collection of blood between a baby's skull and the periosteum, typically occurring due to trauma during birth. In this case, the lump appeared 8 hours after birth, which aligns with the timeline for cephalhematoma development. It is soft because it consists of blood, and it can increase in size as the blood accumulates. Incorrect Choices: A: Hydrocephalus is an abnormal accumulation of cerebrospinal fluid within the brain, not a collection of blood. B: Craniosynostosis is the premature fusion of skull bones, leading to an abnormal head shape, not a collection of blood. D: Caput succedaneum is swelling of the soft tissues of a newborn's scalp due to pressure during delivery, not a collection of blood.
Question 2 of 9
The nurse has just completed a lymph assessment on a 60-year-old healthy female patient. The nurse knows that most lymph nodes in healthy adults are normally:
Correct Answer: B
Rationale: The correct answer is B: not palpable. In healthy adults, most lymph nodes are not palpable as they are typically small and not easily detectable through touch. This indicates normal lymphatic function and absence of significant inflammation or infection. Choices A, C, and D describe characteristics of abnormal lymph nodes, such as being shotty, large/firm/fixed, or rubbery/discrete/mobile, respectively, which are indicative of pathological conditions like infection, malignancy, or inflammation. Therefore, the absence of palpable lymph nodes in a healthy individual is the expected norm.
Question 3 of 9
A 68-year-old woman is in the eye clinic for a checkup. She tells the nurse that she has been having trouble reading the paper, sewing, and even seeing the faces of her grandchildren. On examination, the nurse notes that she has some loss of central vision but her peripheral vision is normal. These findings suggest that:
Correct Answer: A
Rationale: The correct answer is A: she may have macular degeneration. Macular degeneration is characterized by loss of central vision while peripheral vision remains intact. In this case, the woman's difficulty with tasks that require central vision, such as reading and recognizing faces, points towards macular degeneration. The other choices are incorrect because: B: Her symptoms indicate a specific vision problem, not just age-related changes. C: Cataracts typically cause blurred vision, not loss of central vision. D: Glaucoma typically affects peripheral vision first before progressing to central vision loss.
Question 4 of 9
During the assessment of a 20-year-old patient with a 3-day history of nausea and vomiting, the nurse notes the following: dry mucosa and deep fissures in the tongue. This finding is indicative of:
Correct Answer: A
Rationale: The dry mucosa and deep fissures in the tongue indicate dehydration in the patient. Dehydration causes decreased saliva production, leading to dry mouth and tongue fissures. This is a common symptom of dehydration. The lack of moisture in the oral cavity can result in these physical signs. The other choices are incorrect because irritation by gastric juices typically presents with other symptoms, a normal oral condition would not show these specific findings, and side effects of nausea medication would not directly cause dry mucosa and deep fissures in the tongue. Therefore, the correct answer is A: dehydration.
Question 5 of 9
The nurse is teaching a health class to high school boys. One of the topics is the use of smokeless tobacco (SLT). Which of the following statements about SLT are accurate? (Select all that apply.)
Correct Answer: A
Rationale: The correct answer is A because one pinch of smokeless tobacco (SLT) in the mouth for 30 minutes can indeed deliver a similar amount of nicotine as smoking one cigarette. This is because the nicotine in SLT is absorbed through the oral mucosa directly into the bloodstream, providing a quick effect. This statement is accurate and reflects the pharmacokinetics of SLT use. Option B is incorrect because smoking carries a higher risk of oral cancer compared to SLT use. Option C is incorrect as pain is not always an early sign of oral cancer, and other symptoms such as non-healing sores or lumps may indicate oral cancer. Option D is incorrect as pain can sometimes be an early sign of oral cancer, especially in advanced stages.
Question 6 of 9
When examining children with Down's syndrome (trisomy 21), the nurse looks for the possible presence of:
Correct Answer: C
Rationale: Step 1: Down's syndrome is associated with characteristic physical features. Step 2: One common physical feature is a protruding tongue due to a small oral cavity. Step 3: This is known as macroglossia and is seen in individuals with Down's syndrome. Step 4: Therefore, the nurse looks for a protruding thin tongue in children with Down's syndrome. Summary: A is incorrect because ear dysplasia is not a common feature. B is incorrect as a long, thin neck is not a typical characteristic. D is incorrect because a narrow and raised nasal bridge is not a key feature of Down's syndrome.
Question 7 of 9
A 17-year-old student is a swimmer on her high school's swim team. She has had three bouts of otitis externa so far this season and wants to know how to prevent it. The nurse instructs her to:
Correct Answer: B
Rationale: Correct Answer: B Rationale: 1. Rubbing alcohol or 2% acetic acid eardrops help to maintain the pH balance in the ear canal, making it less conducive to bacterial growth. 2. These eardrops also help to dry out excess moisture, reducing the risk of otitis externa. 3. By using these eardrops after every swim, the student can prevent the recurrence of otitis externa. Summary of other choices: A: Using a cotton-tipped swab can push wax deeper into the ear canal, increasing the risk of infection. C: Irrigating the ears can introduce water into the ear canal, potentially worsening the condition. D: Mineral oil and hydrogen peroxide can be harsh on the delicate skin of the ear canal, causing irritation.
Question 8 of 9
A 40-year-old woman reports a change in mole size, accompanied by colour changes, itching, burning, and bleeding over the past month. She has a dark complexion and has no family history of skin cancer, but she has had many blistering sunburns in the past. The nurse would:
Correct Answer: B
Rationale: The correct answer is B because the patient's symptoms (change in mole size, color changes, itching, burning, bleeding) are concerning for melanoma, a type of skin cancer. Given her history of blistering sunburns, early evaluation and referral are crucial for timely intervention. Option A is incorrect as it delays necessary evaluation. Option C is irrelevant as the symptoms suggest a serious condition, not environmental irritants. Option D is incorrect as compound nevi typically do not present with the described symptoms and are not common in this age group.
Question 9 of 9
During a physical education class, a student is hit in the eye with the end of a baseball bat. When examined in the emergency department, the nurse notes the presence of blood in the anterior chamber of the eye. This finding indicates the presence of:
Correct Answer: B
Rationale: The correct answer is B: hyphema. Hyphema is the presence of blood in the anterior chamber of the eye, which can occur due to trauma like being hit with a baseball bat. This indicates bleeding inside the eye, specifically in the space between the cornea and iris. Hypopyon (A) is the accumulation of white blood cells in the anterior chamber. Corneal abrasion (C) is a scratch on the cornea, not related to blood in the anterior chamber. Iritis (D) is inflammation of the iris, which does not necessarily involve blood in the anterior chamber.