ATI RN
RN Vital Signs Assessment ATI Questions
Question 1 of 5
The arterial blood gases for a patient in shock demonstrate increased carbon dioxide and decreased oxygen. What type of respirations would the nurse expect to assess based on these findings?
Correct Answer: C
Rationale: Rapid and deep respirations compensate for high CO2 and low O2 in shock, per the answer key, as the body attempts to correct acid-base imbalance (Kussmaul breathing). Absent or slow contradict this. Noisy isn't specific. Nurses recognize this pattern to address respiratory distress urgently.
Question 2 of 5
A nurse performing physical assessments of residents in a long-term care facility describes to the student nurse common head and neck variations in the older adult. Which of the following accurately defines these variations? Select all that apply.
Correct Answer: A
Rationale: Decreased vision , entropion/ectropion , and hearing loss are common in older adults, per the answer key (A, D, E). Arcus senilis is true but not selected here. Adaptation decreases. Nurses, per Taylor, note these aging changes.
Question 3 of 5
Jean has just given birth 6 months ago and is breast-feeding her child. She has not had a period since giving birth. What does this most likely represent?
Correct Answer: B
Rationale: The correct answer is B: Secondary amenorrhea. After childbirth, it is common for women who are breastfeeding to experience a temporary absence of menstruation, known as lactational amenorrhea. This is a type of secondary amenorrhea, where menstruation ceases temporarily due to factors like breastfeeding. Primary amenorrhea refers to the absence of menstruation by age 16 without any previous periods. Oligomenorrhea is infrequent or irregular periods, not the total absence of periods. Dysmenorrhea is severe menstrual pain, not the absence of menstruation.
Question 4 of 5
Which of the following is most likely benign on breast examination?
Correct Answer: B
Rationale: The correct answer is B: One breast larger than the other. This is most likely benign because breast asymmetry is common and often not a sign of serious health issues. Other choices are incorrect: A - dimpling resembling an orange peel is concerning for breast cancer, C - inverted nipple can be a sign of underlying breast pathology, D - dimpling in a breast when leaning forward could indicate an underlying mass or tumor.
Question 5 of 5
Which lung sound possesses the characteristics of being louder and higher in pitch, with a short silence between inspiration and expiration and with expiration being longer than inspiration?
Correct Answer: C
Rationale: The correct answer is C: Bronchial. Bronchial sounds are louder and higher in pitch compared to vesicular and bronchovesicular sounds. There is a short silence between inspiration and expiration, characteristic of bronchial sounds. Additionally, expiration is longer than inspiration in bronchial sounds. Bronchovesicular sounds have equal inspiration and expiration phases, vesicular sounds are softer and lower in pitch, and tracheal sounds are harsh and heard over the trachea.