ATI RN
Chapter 12 Vital Signs Assessment Questions
Question 1 of 5
The nurse is observing the auscultation technique of another nurse. The correct method to use when progressing from one auscultatory site on the thorax to another is _____ comparison.
Correct Answer: A
Rationale: The correct method is side-to-side comparison. This allows for a systematic approach by ensuring all areas are examined equally. Moving side-to-side helps to maintain consistency and accuracy in assessing lung sounds. Top-to-bottom, posterior-to-anterior, and interspace-by-interspace methods may lead to missed areas or confusion in tracking progress. Side-to-side comparison is the most effective technique for thorough auscultation.
Question 2 of 5
During an interview, a patient reveals that she is pregnant. She states that she is not sure whether she will breastfeed her baby and asks for some information about this. Which of these statements by the nurse is accurate?
Correct Answer: B
Rationale: The correct answer is B because breastfeeding provides the perfect nutrition and antibodies for the baby, promoting optimal growth and immunity. It is essential for the baby's health and development. Incorrect answers: A: Breastfed babies are not necessarily more colicky; this statement is misleading. C: Breastfed babies may feed more frequently initially but not necessarily throughout infancy. D: Breastfeeding may not come naturally to every woman, as it can be challenging for some due to various reasons.
Question 3 of 5
A 25-year-old woman in her fifth month of pregnancy has a blood pressure of 100/70 mm Hg. In reviewing her previous examination, the nurse notes that her blood pressure in her second month was 124/80 mm Hg. In evaluating this change, what does the nurse know to be true?
Correct Answer: A
Rationale: Step-by-step rationale: 1. During pregnancy, blood pressure tends to decrease due to hormonal and physiological changes. 2. The decline in blood pressure is attributed to peripheral vasodilatation, allowing for increased blood flow to the placenta. 3. This vasodilatation is a normal adaptive response to support the growing fetus. 4. The parasympathetic effect of pregnancy hormones contributes to the vasodilatation and helps regulate blood pressure. 5. Therefore, choice A is correct as it aligns with the physiological changes expected during pregnancy. Summary of other choices: - Choice B incorrectly attributes the decline solely to the parasympathetic effect, ignoring the role of vasodilatation. - Choice C is incorrect as a decrease in blood pressure does not necessarily mean a decrease in cardiac output during pregnancy. - Choice D is incorrect as a decrease in blood pressure does not always indicate a dangerous decrease in blood volume for the fetus.
Question 4 of 5
A patient reports severe abdominal pain. The nurse begins with:
Correct Answer: C
Rationale: The correct answer is C: Inspection to note visible abnormalities. Inspection is the initial assessment technique used to observe visible signs such as distention, discoloration, or scars. This helps in gathering important information about the patient's condition before proceeding to palpation or percussion. Light palpation (choice A) and deep palpation (choice B) involve touching the abdomen, which may worsen the pain or miss important visual clues. Percussion (choice D) is typically used after inspection and palpation to assess organ density, not as the initial step in assessing abdominal pain.
Question 5 of 5
Which statement is true regarding the arterial system?
Correct Answer: B
Rationale: The correct answer is B: The arterial system is a high-pressure system. Arteries carry blood away from the heart to various parts of the body, and they experience high pressure due to the force exerted by the pumping heart. This pressure is essential for delivering oxygen and nutrients efficiently throughout the body. Therefore, choice B is correct. Choices A, C, and D are incorrect because arteries are not always large in diameter, the walls of arteries are thicker than veins for maintaining higher pressure, and arteries do not greatly expand like veins to accommodate large blood volume increases.