ATI RN
health assessment practice questions Questions
Question 1 of 9
During the examination of a patient in her third trimester of pregnancy, the nurse notices that the patient's thyroid gland is slightly enlarged. No enlargement had been noted previously. The nurse suspects that:
Correct Answer: C
Rationale: Step-by-step rationale for why choice C is correct: 1. Enlargement of the thyroid gland during pregnancy is a normal finding due to hormonal changes. 2. The thyroid gland enlarges to meet the increased demands of thyroid hormone production. 3. This condition is known as gestational thyrotoxicosis and is usually benign. 4. No further testing is needed for thyroid cancer unless other concerning symptoms are present. Summary: A: Not relevant as iodine deficiency is not typically associated with thyroid enlargement in pregnancy. B: Incorrect as early signs of goitre would involve more pronounced symptoms than just slight enlargement. D: Unnecessary as thyroid cancer is not a common concern in this scenario of a slightly enlarged thyroid in the third trimester of pregnancy.
Question 2 of 9
The nurse is preparing to do an otoscopic examination on a 2-year-old child. Which of the following reflects correct procedure?
Correct Answer: C
Rationale: The correct answer is C: Tilt the child's head slightly toward the examiner. This position straightens the ear canal, facilitating visualization. Pulling the pinna down (A) can cause discomfort and obstruct the view. Pulling the pinna up and back (B) is incorrect for a child under 3 years old as it straightens the ear canal in adults. Having the child touch his chin to his chest (D) is unnecessary and may lead to improper examination positioning.
Question 3 of 9
A 60-year-old man is at the clinic for an eye examination. The nurse suspects that he has ptosis of one eye. Ptosis is:
Correct Answer: C
Rationale: The correct answer is C: drooping of the upper eyelid. Ptosis refers to the drooping of the upper eyelid, which may occur due to weakened eyelid muscles or nerve damage. In this case, the nurse suspects ptosis in the 60-year-old man, which is likely due to age-related muscle weakness. Choice A, a cloudy cornea, is incorrect as it refers to a different eye condition. Choice B, an unequal red reflex, is incorrect as it is related to abnormalities in the retina. Choice D, protruding and bulging eyes, is incorrect as it indicates exophthalmos, a condition typically seen in thyroid eye disease.
Question 4 of 9
A patient has a normal pupillary light reflex. The nurse recognizes this to indicate that:
Correct Answer: D
Rationale: The correct answer is D because a normal pupillary light reflex involves the constriction of both pupils in response to bright light. This reflex is controlled by the autonomic nervous system, specifically the parasympathetic nervous system. When light is detected by the retina, signals are sent to the brain which then triggers the constriction of both pupils to reduce the amount of light entering the eye. Choices A, B, and C are incorrect because they do not accurately describe the pupillary light reflex. Vision convergence, light reflection, and focusing the image at the center of the pupil are not directly related to the pupillary light reflex.
Question 5 of 9
An 85-year-old female patient is complaining about the fact that the bones in her face have become more noticeable. What explanation should the nurse provide?
Correct Answer: C
Rationale: The correct answer is C because as individuals age, there is a natural decrease in skin elasticity, subcutaneous fat, and moisture content in the skin. These factors contribute to the bones becoming more noticeable in the face. Choice A is incorrect because diets low in protein and high in carbohydrates do not directly cause enlargement of facial bones. Choice B is incorrect as the use of a specific moisturizer does not directly impact the visibility of facial bones. Choice D is incorrect because facial skin actually loses elasticity with age, leading to less taut skin and more prominent bones.
Question 6 of 9
The nurse suspects that a patient has hyperthyroidism, and laboratory data also indicate that the patient's T and T hormone levels are elevated. Which of the following would the nurse most likely find on 4 3 examination?
Correct Answer: A
Rationale: Step-by-step rationale for why choice A (Tachycardia) is correct: 1. Hyperthyroidism leads to increased production of thyroid hormones. 2. Thyroid hormones can increase metabolic rate and heart rate. 3. Tachycardia is a common symptom of hyperthyroidism due to increased metabolic demand. 4. Therefore, the nurse would most likely find tachycardia on examination in a patient with hyperthyroidism. Summary of why other choices are incorrect: B: Constipation - Constipation is more commonly associated with hypothyroidism, not hyperthyroidism. C: Rapid dyspnea - Dyspnea (shortness of breath) is not a typical symptom of hyperthyroidism. D: Atrophied, nodular thyroid - Hyperthyroidism often presents with an enlarged, not atrophied, thyroid gland due to overactivity. Nodules may be present in conditions like thyroid cancer, but not specific to hyper
Question 7 of 9
A 31-year-old patient tells the nurse that he is experiencing a progressive loss of hearing. He says that it does seem to help when people speak more loudly or if he turns up the volume. The most likely cause of his hearing loss is:
Correct Answer: A
Rationale: The correct answer is A: otosclerosis. Otosclerosis is a condition where abnormal bone growth in the middle ear causes hearing loss. In this case, the patient's symptoms of progressive hearing loss improving with louder sounds suggest conductive hearing loss, which is commonly seen in otosclerosis. Other choices are incorrect because presbycusis is age-related hearing loss, trauma to the bones would typically result in sudden hearing loss, and frequent ear infections are more likely to cause temporary hearing loss rather than progressive loss.
Question 8 of 9
When examining a patient's eyes, the nurse knows that stimulation of the sympathetic branch of the autonomic nervous system:
Correct Answer: C
Rationale: The correct answer is C because stimulation of the sympathetic branch of the autonomic nervous system results in the elevation of the eyelid (ptosis) and dilation of the pupil (mydriasis). This is due to the action of the dilator pupillae muscle and the superior tarsal muscle. Pupillary constriction (choice A) is controlled by the parasympathetic branch via the sphincter pupillae muscle. Adjusting the eye for near vision (choice B) is controlled by the ciliary muscle, which is under parasympathetic control, not sympathetic. Contraction of the ciliary body (choice D) is also controlled by the parasympathetic system for accommodation of near vision, not the sympathetic system.
Question 9 of 9
A mother who has brought her newborn infant for assessment tells the nurse that she has noticed that whenever her newborn's head is turned to the right side, the baby straightens out the arm and leg on the same side and flexes the opposite arm and leg. After confirming this on examination, the nurse would tell the mother that this is:
Correct Answer: C
Rationale: Step 1: The described behavior is known as the asymmetric tonic neck reflex (ATNR), a normal infantile reflex. Step 2: The ATNR typically emerges around birth and should disappear between 3 and 4 months of age. Step 3: The reflex helps with hand-eye coordination and development of body awareness. Step 4: Choice A is incorrect as the behavior is not abnormal or related to atonic neck reflex. Step 5: Choice B is incorrect as the reflex typically disappears by 3-4 months, not by the first year of life. Step 6: Choice D is incorrect as it describes a different pattern of movement than what is observed in the ATNR. Summary: The correct answer is C because the behavior described is a normal infantile reflex that typically disappears between 3-4 months of age, aiding in the baby's development.