ATI RN
ATI Vital Signs Assessment Questions
Question 1 of 5
The nurse notices that a patient has a solid, elevated, circumscribed lesion that is less than 1 cm in diameter. When documenting this finding, the nurse reports this as a:
Correct Answer: D
Rationale: Step-by-step rationale: 1. A papule is a solid, elevated lesion less than 1 cm in diameter, fitting the description. 2. A bulla is a large vesicle greater than 1 cm, not fitting the size criteria in the question. 3. A wheal is a raised, erythematous, edematous papule or plaque, not solid as described. 4. A nodule is a solid, raised lesion larger than 1 cm, not fitting the size criteria in the question. In summary, the correct answer is D (Papule) because it accurately describes the size and characteristics of the lesion in question, while the other options do not match the given description.
Question 2 of 5
The nurse is performing an ear examination of an 80-year-old patient. Which of these findings would be considered normal?
Correct Answer: A
Rationale: The correct answer is A: High-tone frequency loss. In older adults, age-related hearing loss affects high-tone frequencies first due to changes in the inner ear structures. This is considered a normal age-related change. Increased elasticity of the pinna (B) is not related to aging but rather a congenital or acquired condition. A thin, translucent membrane (C) or a shiny, pink tympanic membrane (D) may indicate issues like infection or inflammation, not normal aging changes in the ear.
Question 3 of 5
The nurse is using an otoscope to assess the nasal cavity. Which of these techniques is correct?
Correct Answer: B
Rationale: The correct technique when using an otoscope to assess the nasal cavity is to avoid touching the nasal septum with the speculum. This is important because the nasal septum is a sensitive area that can be easily irritated or damaged. By avoiding contact with the septum, the nurse can prevent discomfort or potential injury to the patient. Choice A is incorrect because inserting the speculum 3 cm into the vestibule is unnecessary and may cause discomfort to the patient. Choice C is incorrect as displacing the nose can distort the anatomy and make it difficult to assess the nasal cavity accurately. Choice D is incorrect as keeping the speculum tip medial to avoid touching the floor of the nares is not a standard technique and may not provide an optimal view of the nasal cavity.
Question 4 of 5
The nurse is performing an assessment. Which of these findings would cause the greatest concern?
Correct Answer: D
Rationale: The correct answer is D because an ulceration on the side of the tongue with rolled edges could indicate a potential malignancy like oral cancer. This finding is concerning due to its location and characteristics, which warrant further investigation and prompt intervention. Explanation for incorrect choices: A: A painful vesicle inside the cheek for 2 days is likely a benign condition like a canker sore. B: Presence of moist, nontender Stensen's ducts is a normal finding related to salivary gland function. C: Stippled gingival margins that snugly adhere to the teeth indicate healthy gum tissue and proper attachment.
Question 5 of 5
During auscultation of the lungs, the nurse expects decreased breath sounds to be heard in which situation?
Correct Answer: A
Rationale: The correct answer is A: When the bronchial tree is obstructed. Decreased breath sounds are expected in situations where airflow is obstructed, leading to diminished sound transmission. When there is an obstruction in the bronchial tree, such as in asthma or bronchitis, breath sounds become decreased due to the restricted airflow. The other choices are incorrect because: B: When adventitious sounds are present - Adventitious sounds like crackles or wheezes indicate abnormal lung sounds but do not necessarily result in decreased breath sounds. C: In conjunction with whispered pectoriloquy - Whispered pectoriloquy is a finding where whispering is heard clearly through the stethoscope, indicating lung consolidation rather than decreased breath sounds. D: In conditions of consolidation, such as pneumonia - Consolidation leads to increased breath sounds due to the denser lung tissue, not decreased breath sounds.