ATI RN
Vital Signs Assessment ATI Quizlet Questions
Question 1 of 5
The nurse is assessing a patient with a history of chronic obstructive pulmonary disease (COPD). Which finding is expected?
Correct Answer: A
Rationale: The correct answer is A: Barrel-shaped chest. In COPD, air trapping leads to hyperinflation of the lungs, causing the chest to become barrel-shaped. This is due to the increase in the anteroposterior diameter. Tracheal deviation (B) suggests a mediastinal shift, not common in COPD. Asymmetrical chest expansion (C) may indicate conditions like pleural effusion or pneumothorax, not typical in COPD. Decreased tactile fremitus (D) is seen in conditions with increased air content like emphysema, not always in COPD.
Question 2 of 5
Which of the following findings during a respiratory assessment is considered abnormal?
Correct Answer: C
Rationale: The correct answer is C because wheezing during auscultation is considered abnormal in a respiratory assessment. Wheezing indicates narrowed airways, which can be a sign of conditions such as asthma or COPD. Resonance on percussion (A) and symmetrical chest expansion (B) are normal findings. A respiratory rate of 16 breaths per minute (D) falls within the normal range of 12-20 breaths per minute. Therefore, wheezing is the only abnormal finding among the choices provided.
Question 3 of 5
Which of the following assessment findings is most concerning in a patient with a head injury?
Correct Answer: B
Rationale: The correct answer is B: Decreased level of consciousness. This is the most concerning assessment finding in a patient with a head injury because it indicates potential brain damage or swelling, which can lead to serious complications. Decreased consciousness may suggest increased intracranial pressure, requiring immediate medical intervention to prevent further damage. A: Reactive pupils are generally a positive sign and indicate normal brain function. C: Mild headache is a common symptom after a head injury and may not necessarily indicate a serious issue. D: Nausea and vomiting can be common symptoms in head injuries, but they are not as concerning as a decreased level of consciousness, as they can also be caused by other factors such as pain or anxiety.
Question 4 of 5
Which technique is used to assess for tactile fremitus during a respiratory examination?
Correct Answer: C
Rationale: The correct answer is C: Palpating the chest while the patient speaks. Tactile fremitus is assessed by palpating the chest while the patient speaks to feel for vibrations caused by the passage of air through the lungs. This technique helps to identify abnormalities in lung tissue density and air content. Percussing the lung fields (A) is used to assess for resonance and dullness, not tactile fremitus. Auscultating for breath sounds (B) is used to assess lung sounds, not tactile fremitus. Inspecting chest wall movement during inspiration (D) is used to assess for respiratory effort and symmetry, not tactile fremitus.
Question 5 of 5
The nurse is performing an otoscopic examination of a patient's ear. Which finding is considered normal?
Correct Answer: C
Rationale: The correct answer is C: Pearly gray tympanic membrane. A normal tympanic membrane appears pearly gray in color due to its translucency. This indicates a healthy and intact eardrum. Red, bulging tympanic membrane (A) suggests inflammation or infection. Yellow, thickened tympanic membrane (B) may indicate fluid accumulation or pus behind the eardrum. A perforated tympanic membrane (D) means there is a hole in the eardrum, which is not considered normal.