ATI RN
Assess Vital Signs Rationale Questions
Question 1 of 5
How can cardiac rehabilitation benefit a patient with angina pectoris?
Correct Answer: D
Rationale: The correct answer is D: Improve efficiency. Cardiac rehabilitation can benefit a patient with angina pectoris by improving the efficiency of the heart muscle, leading to better circulation and reduced workload on the heart. This helps in managing angina symptoms and improving overall cardiovascular health. A: Increasing myocardial oxygen consumption would worsen angina symptoms by putting more strain on the heart. B: Decreasing the maximum heart rate could limit the patient's ability to exercise and improve cardiovascular health. C: Changing the angina threshold does not directly address the underlying issue of heart efficiency and may not provide long-term benefits.
Question 2 of 5
A patient is brought by ambulance to the emergency department with multiple traumas received in an automobile accident. He is alert and cooperative, but his injuries are quite severe. How would the nurse proceed with data collection?
Correct Answer: B
Rationale: The correct answer is B. In this scenario, the nurse should prioritize immediate actions to ensure the patient's survival. By simultaneously asking history questions, performing the examination, and initiating life-saving measures, the nurse can quickly gather essential information while addressing the patient's critical needs. This approach allows for efficient data collection without compromising the patient's well-being. Choices A, C, and D are incorrect because they do not prioritize the patient's immediate needs. A delays life-saving measures by collecting history first, which can be detrimental in a critical situation. C focuses on detailed history information that is not essential for immediate care. D delays gathering any history information, which is crucial for understanding the patient's condition and providing appropriate care.
Question 3 of 5
A young woman undergoes cranial nerve testing. On touching the soft palate, her uvula deviates to the left. Which of the following is likely?
Correct Answer: D
Rationale: The correct answer is D: CN X lesion on the right. When the uvula deviates to the left upon touching the soft palate, it indicates a lesion of the right vagus nerve (CN X). The uvula is innervated by the vagus nerve, and when there is a lesion on the right side, the uvula will deviate away from the affected side due to the unopposed action of the intact left vagus nerve. Choices A and B are incorrect because cranial nerve IX (glossopharyngeal nerve) does not innervate the uvula. Choice C is incorrect as a lesion of the left vagus nerve would cause the uvula to deviate to the right, not the left.
Question 4 of 5
An elderly woman with a history of coronary bypass comes in with severe, diffuse, abdominal pain. Strangely, during your examination, the pain is not made worse by pressing on the abdomen. What do you suspect?
Correct Answer: C
Rationale: The correct answer is C: Ischemia. The elderly woman's history of coronary bypass surgery suggests a higher risk for vascular issues like mesenteric ischemia. The severe, diffuse abdominal pain that is not exacerbated by palpation is a classic presentation of mesenteric ischemia. This condition results from inadequate blood supply to the intestines and can lead to severe abdominal pain. Malingering (A) is unlikely as there is a legitimate medical history. Neuropathy (B) typically presents with different symptoms such as numbness or tingling rather than severe abdominal pain. Physical abuse (D) does not align with the clinical presentation and medical history.
Question 5 of 5
When assessing a patient with bacterial meningitis, the nurse obtains the following data. Which finding should be reported immediately to the health care provider?
Correct Answer: D
Rationale: The correct answer is D. A blood pressure of 92/42 mm Hg indicates hypotension, which can be a sign of septic shock in a patient with bacterial meningitis. This finding requires immediate attention as it can lead to serious complications and requires prompt intervention to stabilize the patient's hemodynamic status. A: A positive Kernig's sign and complaints of a stiff neck are common findings in patients with bacterial meningitis but do not require immediate reporting as they are expected symptoms. C: A temperature of 101°F is slightly elevated but not a critical finding that necessitates immediate reporting compared to hypotension.