ATI RN
health assessment practice questions nursing Questions
Question 1 of 9
The mother of a 2-year-old is concerned because her son has had three ear infections in the past year. Which of the following would be an appropriate response by the nurse?
Correct Answer: D
Rationale: The correct answer is D because it provides an accurate explanation for the frequent ear infections in the 2-year-old. The eustachian tube in children is indeed shorter and wider compared to adults, making it easier for infections to develop. This anatomical difference predisposes young children to ear infections. Choice A is incorrect because it falsely implies that frequent ear infections in small children are unusual only if something else is wrong. Choice B is incorrect as checking the immune system is not typically the first step in addressing recurrent ear infections. Choice C is incorrect as cerumen (earwax) does not directly contribute to ear infections in the middle ear.
Question 2 of 9
A very concerned mother is at the clinic with her infant who has a large, soft lump on the side of his head. She tells the nurse that she noticed the lump about 8 hours after her baby's birth and that it seems to be getting bigger. One possible explanation for this is:
Correct Answer: C
Rationale: The correct answer is C: cephalhematoma. A cephalhematoma is a collection of blood between a baby's skull and the periosteum, typically occurring due to trauma during birth. In this case, the lump appeared 8 hours after birth, which aligns with the timeline for cephalhematoma development. It is soft because it consists of blood, and it can increase in size as the blood accumulates. Incorrect Choices: A: Hydrocephalus is an abnormal accumulation of cerebrospinal fluid within the brain, not a collection of blood. B: Craniosynostosis is the premature fusion of skull bones, leading to an abnormal head shape, not a collection of blood. D: Caput succedaneum is swelling of the soft tissues of a newborn's scalp due to pressure during delivery, not a collection of blood.
Question 3 of 9
When a light is directed across the iris of the eye from the temporal side, the examiner is assessing for:
Correct Answer: C
Rationale: The correct answer is C: the presence of shadows, which may indicate glaucoma. When a light is directed across the iris from the temporal side, it helps in evaluating the presence of shadows in the anterior chamber angle, which can suggest a narrow or closed angle glaucoma. This technique is known as transillumination test and is important in detecting potential glaucoma cases. A: Drainage from dacryocystitis is incorrect as it is typically assessed by pressing on the lacrimal sac area to observe for discharge. B: Conjunctivitis over the iris is incorrect as conjunctivitis is an inflammation of the conjunctiva, not the iris. D: A scattered light reflex indicative of cataracts is incorrect as cataracts cause clouding of the lens, not scattering of light across the iris.
Question 4 of 9
During history-taking, a patient tells the nurse that he has frequent nosebleeds and asks about the best way to prevent them. What would be the nurse's best response?
Correct Answer: B
Rationale: The correct answer is B. When a patient experiences nosebleeds, the best way to stop it is by sitting straight with the head tilted slightly forward and pinching the nose firmly for about 10-15 minutes. This position helps reduce blood flow to the nose and promotes clotting. It is important not to tilt the head back as it can lead to blood going down the throat and potentially causing choking or vomiting. Cold compresses can also be applied to help constrict blood vessels. Choices A, C, and D are incorrect as they do not follow the proper technique for managing nosebleeds and can potentially worsen the situation.
Question 5 of 9
A physician has diagnosed a patient with purpura. After leaving the room, a nursing student asks the nurse what the physician saw that led to that diagnosis. The nurse should say:
Correct Answer: C
Rationale: The correct answer is C because purpura is characterized by the presence of confluent and extensive patches of petechiae and ecchymoses. Petechiae are small, pinpoint hemorrhages less than 2mm in size, and ecchymoses are larger bruises. This presentation is indicative of a more severe underlying condition, such as a bleeding disorder or vasculitis. Choice A is incorrect as it describes spider veins or telangiectasias, not purpura. Choice B describes a birthmark, not purpura. Choice D is incorrect as it describes petechiae, not purpura, which involves larger areas of bleeding.
Question 6 of 9
When examining the ear with an otoscope, the nurse would expect to find that the tympanic membrane is:
Correct Answer: B
Rationale: The correct answer is B: pearly grey and slightly concave. This is because a healthy tympanic membrane should appear pearly grey in color and slightly concave in shape. The pearly grey color indicates normal transparency and reflection of light, while the slightly concave shape is indicative of a normal eardrum. Choice A is incorrect as a light pink color and slight bulge are not characteristic of a healthy tympanic membrane. Choice C is incorrect because a pulled-in appearance at the base of the cone of light suggests retraction, which is abnormal. Choice D is incorrect as a whitish color with a small fleck of light is not a typical presentation of a healthy tympanic membrane.
Question 7 of 9
While assessing the tonsils of a 30-year-old, the nurse notes that they look involuted and granular, and appear to have deep crypts. What is the correct follow-up to these findings?
Correct Answer: B
Rationale: The correct answer is B: Nothing, this is the appearance of normal tonsils. In a 30-year-old, tonsils commonly appear involuted, granular, and have deep crypts due to natural aging and exposure to infections. This is considered a normal variant and does not typically require further intervention. Referral to a specialist (Option A) is unnecessary as these findings are within the normal range. Continuing the assessment (Option C) may not yield significant abnormal findings related to the tonsils. Throat culture for strep (Option D) is not indicated unless there are specific symptoms or signs of infection.
Question 8 of 9
The nurse is teaching a health class to high school boys. One of the topics is the use of smokeless tobacco (SLT). Which of the following statements about SLT are accurate? (Select all that apply.)
Correct Answer: A
Rationale: The correct answer is A because one pinch of smokeless tobacco (SLT) in the mouth for 30 minutes can indeed deliver a similar amount of nicotine as smoking one cigarette. This is because the nicotine in SLT is absorbed through the oral mucosa directly into the bloodstream, providing a quick effect. This statement is accurate and reflects the pharmacokinetics of SLT use. Option B is incorrect because smoking carries a higher risk of oral cancer compared to SLT use. Option C is incorrect as pain is not always an early sign of oral cancer, and other symptoms such as non-healing sores or lumps may indicate oral cancer. Option D is incorrect as pain can sometimes be an early sign of oral cancer, especially in advanced stages.
Question 9 of 9
When examining children with Down's syndrome (trisomy 21), the nurse looks for the possible presence of:
Correct Answer: C
Rationale: Step 1: Down's syndrome is associated with characteristic physical features. Step 2: One common physical feature is a protruding tongue due to a small oral cavity. Step 3: This is known as macroglossia and is seen in individuals with Down's syndrome. Step 4: Therefore, the nurse looks for a protruding thin tongue in children with Down's syndrome. Summary: A is incorrect because ear dysplasia is not a common feature. B is incorrect as a long, thin neck is not a typical characteristic. D is incorrect because a narrow and raised nasal bridge is not a key feature of Down's syndrome.