ATI RN
Assessing Vital Signs Questions
Question 1 of 5
The nurse recognizes that the bell of the stethoscope is used to detect which type of sounds?
Correct Answer: B
Rationale: The correct answer is B because low-pitched sounds like heart murmurs are best detected using the bell of the stethoscope. The bell is designed to pick up low-frequency sounds with more clarity and resonance due to its shape and size. Heart murmurs typically fall into the category of low-pitched sounds, making the bell ideal for their detection. Choice A is incorrect because high-pitched sounds like breath sounds are better detected using the diaphragm of the stethoscope, not the bell. Choice C is incorrect as sounds over a large surface area would be better detected using the diaphragm as well. Choice D is incorrect because the amplitude of the sound does not determine whether the bell or diaphragm is used; it is more about the frequency or pitch of the sound.
Question 2 of 5
A client who was trapped inside a car for hours after a head-on collision is rushed to the emergency department with multiple injuries. During the neurologic examination, the client responds to painful stimuli with decerebrate posturing. This finding indicates damage to which part of the brain?
Correct Answer: D
Rationale: The correct answer is D: Midbrain. Decerebrate posturing is a specific type of abnormal posturing that indicates damage to the midbrain. In decerebrate posturing, the arms are extended and pronated, and the legs are extended with plantar flexion. This posture is a result of the disruption of the neural pathways between the brain and spinal cord that pass through the midbrain. Damage to the cortex (choice A) would not result in decerebrate posturing. The diencephalon (choice B) is responsible for regulating many important functions, but it does not directly control motor responses like posturing. The medulla (choice C) is primarily involved in regulating vital functions like breathing and heart rate, not motor posturing. Therefore, the correct answer is D, midbrain, as damage to this area leads to decerebrate posturing.
Question 3 of 5
A physical therapist completes an examination on a five-year-old boy diagnosed with Duchenne muscular dystrophy. The referral indicates that the boy was diagnosed with the disease less than one year ago. Assuming a normal progression, which of the following would be expected?
Correct Answer: B
Rationale: The correct answer is B: Proximal muscle weakness. In Duchenne muscular dystrophy, proximal muscle weakness is typically one of the earliest signs due to the progressive degeneration of muscle fibers. This weakness starts in the pelvic girdle and lower extremities before affecting the upper extremities. Distal muscle weakness (choice A) occurs later in the disease progression. Impaired respiratory function (choice C) is also a common feature in Duchenne muscular dystrophy but usually develops later in the disease course. Inability to perform activities of daily living (choice D) may occur eventually, but proximal muscle weakness is the more immediate and expected outcome in a newly diagnosed five-year-old with Duchenne muscular dystrophy.
Question 4 of 5
A physical therapist observes a patient completing a treadmill exercise test. The patient's blood pressure rises significantly during exercise. The therapist should recognize this as:
Correct Answer: A
Rationale: The correct answer is A: A normal response to exercise. During exercise, it is common for blood pressure to increase as the body works harder to supply oxygen to the muscles. This is known as the exercise pressor response and is a normal physiological reaction to physical activity. It helps the body meet the increased demand for oxygen during exercise. Choices B, C, and D are incorrect because a rise in blood pressure during exercise is generally expected and not necessarily indicative of an issue that requires test termination, poor cardiovascular fitness, or a contraindication to exercise.
Question 5 of 5
The nurse is performing a physical assessment and observes that the patient has a barrel-shaped chest. This finding is most commonly associated with which condition?
Correct Answer: B
Rationale: Barrel-shaped chest is most commonly associated with COPD due to chronic air trapping and hyperinflation of the lungs. In COPD, the increased residual volume leads to a more rounded appearance of the chest. Asthma typically presents with wheezing and chest tightness, not barrel chest. Pneumonia is characterized by lung consolidation and pleural effusion by fluid accumulation in the pleural space, neither of which directly causes a barrel-shaped chest.