ATI RN
Vital Signs Assessment for Nurses Questions
Question 1 of 5
Mrs. Patton, a 48-year-old woman, comes to your office with a complaint of a breast mass. Without any other information, what is the risk of this mass being cancerous?
Correct Answer: A
Rationale: The correct answer is A: About 10%. The risk of a breast mass being cancerous in a 48-year-old woman without any other information is approximately 10%. This estimate is based on epidemiological data and risk assessment tools that consider age, family history, and other risk factors. It is important to note that the risk could vary based on individual factors, but in general, the likelihood of a breast mass being cancerous is lower in younger women. Choices B, C, and D are incorrect as they overestimate the risk without considering the specific patient's characteristics.
Question 2 of 5
Which of these individuals would the nurse consider at highest risk for a suicide attempt?
Correct Answer: D
Rationale: The correct answer is D because the older adult man's statement about joining his wife in heaven and planning to use a gun indicates specific intent and means for suicide. This combination of intent and method poses the highest risk for an imminent suicide attempt. Choice A is incorrect because joking about death does not necessarily indicate a high risk for suicide. Choice B, while concerning, refers to a past suicide attempt and does not provide current information to suggest an imminent risk. Choice C, although expressing suicidal ideation, lacks a clear plan or intent.
Question 3 of 5
A woman is discussing the problems she is having with her 2-year-old son. She says, 'He won't go to sleep at night, and during the day he has several fits. I get so upset when that happens.' The nurse's best verbal response would be:
Correct Answer: B
Rationale: The correct answer is B: "Fits? Tell me what you mean by this." This response shows active listening and seeks clarification, allowing the nurse to gather more information to better understand the situation and provide appropriate support. It demonstrates empathy and encourages the woman to express her concerns further. Choices A and C are less effective because they do not address the specific issue of the fits the child is having. Choice D is incorrect as it dismisses the woman's emotions and fails to address the underlying problem. Overall, choice B is the best response as it promotes effective communication and understanding between the nurse and the woman.
Question 4 of 5
Before auscultating the abdomen for bowel sounds, the nurse should:
Correct Answer: D
Rationale: The correct answer is D because checking the room temperature and ensuring patient comfort is crucial before auscultating the abdomen to prevent any environmental factors from affecting the patient's comfort or bowel sounds. A, warming the stethoscope, is unnecessary and could potentially be uncomfortable for the patient. B, leaving the gown on, may interfere with the ability to properly listen to bowel sounds. C, ensuring the bell side of the stethoscope is on, is important but not the primary consideration before auscultating the abdomen.
Question 5 of 5
During auscultation, the nurse hears an unfamiliar sound. The best action is to:
Correct Answer: B
Rationale: The correct answer is B because asking another nurse to double-check the finding is crucial for validation and ensuring accuracy in assessment. This step helps in confirming the unfamiliar sound and ruling out any potential errors or misinterpretations. It promotes patient safety and effective communication among healthcare providers. Ignoring the sound (Choice A) can lead to overlooking a significant finding that may impact the patient's condition. Documenting and continuing the assessment (Choice C) without validation may result in incomplete information and potential misdiagnosis. Repositioning the patient and listening again (Choice D) may not address the need for confirmation from another healthcare provider.