ATI RN
Vital Signs Physical Assessment Techniques Questions
Question 1 of 5
During a physical examination, which action is most important for preventing infection?
Correct Answer: B
Rationale: The correct answer is B: Washing hands before and after patient contact. This is crucial for preventing infection as it reduces the spread of pathogens. Washing hands removes dirt and microbes that may be present on the hands, preventing their transfer to the patient or from the patient to the healthcare provider. Wearing gloves (choice A) is important but should not replace proper handwashing. Disinfecting equipment (choice C) is essential but not as critical as hand hygiene. Avoiding contact with the patient's skin (choice D) is unrealistic and not practical in a physical examination.
Question 2 of 5
A student is late for his appointment and has rushed across campus to the health clinic. The nurse should:
Correct Answer: A
Rationale: The correct answer is A because allowing the student 5 minutes to relax and rest before checking his vital signs is important for obtaining accurate readings. When someone rushes across campus, their heart rate and blood pressure are likely elevated, which can lead to inaccurate readings if taken immediately. Allowing the student to relax will help stabilize their vital signs and provide a more accurate baseline measurement. Choice B is incorrect because checking blood pressure in both arms expecting a difference due to recent exercise is not necessary in this scenario. Choice C is incorrect as immediate monitoring may not provide accurate readings due to the student's rushed state. Choice D is incorrect as checking blood pressure in the supine position is not necessary and may not accurately reflect the student's true vital signs in this situation.
Question 3 of 5
During an examination, the nurse notices that a female patient has a round "moon" face, central trunk obesity, and a cervical hump. Her skin is fragile with bruises. The nurse determines that the patient has which condition?
Correct Answer: C
Rationale: The correct answer is C: Cushing syndrome. This condition is characterized by the symptoms described - "moon" face, central trunk obesity, cervical hump, fragile skin with bruises - due to excessive cortisol production. Marfan syndrome (A) is a genetic disorder affecting connective tissue, leading to tall stature and long limbs. Gigantism (B) is caused by excess growth hormone before puberty, resulting in abnormal growth. Acromegaly (D) is similar to gigantism but occurs after growth plates have closed, causing enlargement of bones and tissues. The symptoms described in the question are indicative of Cushing syndrome, thus making it the correct answer.
Question 4 of 5
A 42-year-old woman complains that she has noticed several small, slightly raised, bright red dots on her chest. On examination, the nurse expects that the spots are probably:
Correct Answer: C
Rationale: The correct answer is C: Senile angiomas. Senile angiomas are common benign vascular growths that appear as small, bright red dots on the skin, often found in older individuals. In this case, the patient is a 42-year-old woman, which fits the age range for senile angiomas. Anasarca (A) is generalized edema, not related to the described skin findings. Scleroderma (B) is a connective tissue disorder characterized by skin thickening and not typically presenting as bright red dots. Latent myeloma (D) is a type of blood cancer and not associated with the described skin lesions.
Question 5 of 5
A father brings in his 2-month-old infant to the clinic because the infant has had diarrhea for the last 24 hours. He says his baby has not been able to keep any formula down and that the diarrhea has been at least every 2 hours. The nurse suspects dehydration. The nurse should test skin mobility and turgor over the infant's:
Correct Answer: D
Rationale: The correct answer is D: Abdomen. The nurse should test skin mobility and turgor over the infant's abdomen because it is a reliable indicator of dehydration in infants. Dehydration can lead to decreased skin turgor, meaning that the skin will not bounce back quickly when pinched. The abdomen provides a larger surface area for assessment compared to the other options, making it easier to evaluate skin mobility and turgor accurately. Testing on the sternum, forehead, or forearms may not provide a clear assessment of dehydration in infants. Therefore, choosing the abdomen for skin mobility and turgor assessment is the most appropriate and reliable option in this scenario.