ATI RN
nclex practice questions 2023 health assessment Questions
Question 1 of 9
The primary purpose of the ciliated mucous membrane in the nose is to:
Correct Answer: B
Rationale: The correct answer is B: filter out dust and bacteria. The ciliated mucous membrane in the nose traps dust and bacteria present in the inhaled air through the mucus layer and then moves them towards the throat to be swallowed or expelled. This helps in protecting the respiratory system from harmful particles. Choice A is incorrect as the warming of inhaled air is primarily done by the nasal passages and sinuses, not the ciliated mucous membrane. Choice C is incorrect because the filtering of coarse particles is also done by the nasal hairs and the mucous membrane working together, not just the ciliated mucous membrane alone. Choice D is incorrect as the movement of air through the nares is mainly controlled by the size of the nostrils and is not the primary function of the ciliated mucous membrane.
Question 2 of 9
A woman in her second trimester of pregnancy mentions that since becoming pregnant she has had"more nosebleeds than ever." The nurse recognizes that this is due to:
Correct Answer: B
Rationale: The correct answer is B: increased vascularity in the upper respiratory tract as a result of the pregnancy. During pregnancy, hormonal changes lead to increased blood flow in the body, including the nasal passages, causing them to become more sensitive and prone to bleeding. This explains why the woman is experiencing more nosebleeds. Incorrect Choices: A: coagulation problems in the patient - This is incorrect as pregnancy is associated with hypercoagulability rather than coagulation problems. C: increased susceptibility to colds and nasal irritation - While pregnancy can lower immunity, this does not directly cause nosebleeds. D: inappropriate use of nasal sprays - This is not relevant to the situation described and does not explain the increased nosebleeds due to pregnancy.
Question 3 of 9
The primary purpose of the ciliated mucous membrane in the nose is to:
Correct Answer: B
Rationale: The correct answer is B: filter out dust and bacteria. The ciliated mucous membrane in the nose traps dust and bacteria present in the inhaled air through the mucus layer and then moves them towards the throat to be swallowed or expelled. This helps in protecting the respiratory system from harmful particles. Choice A is incorrect as the warming of inhaled air is primarily done by the nasal passages and sinuses, not the ciliated mucous membrane. Choice C is incorrect because the filtering of coarse particles is also done by the nasal hairs and the mucous membrane working together, not just the ciliated mucous membrane alone. Choice D is incorrect as the movement of air through the nares is mainly controlled by the size of the nostrils and is not the primary function of the ciliated mucous membrane.
Question 4 of 9
The nurse is performing an otoscopic examination on an adult. Which of the following is true?
Correct Answer: C
Rationale: The correct answer is C: Pull the pinna up and back before inserting the speculum. This is because pulling the pinna up and back straightens the auditory canal, allowing for easier and more accurate insertion of the speculum without causing discomfort or injury. Option A is incorrect as tilting the head forward may obstruct the view. Option B is incorrect as maintaining traction is essential for stability. Option D is incorrect as using the smallest speculum may not provide a clear view or proper insertion depth.
Question 5 of 9
The nurse is examining a patient's ears and notices cerumen in the external canal. Which of the following statements about cerumen is correct?
Correct Answer: C
Rationale: The correct answer is C: The purpose of cerumen is to protect and lubricate the ear. Cerumen, commonly known as earwax, acts as a natural barrier to prevent dust, debris, and microorganisms from entering the ear canal. It also helps to lubricate the skin in the ear canal and prevent dryness and itching. Choice A is incorrect because sticky, honey-colored cerumen is not necessarily a sign of infection; it can occur due to various factors. Choice B is incorrect as the presence of cerumen does not solely indicate poor hygiene; everyone produces earwax regardless of hygiene practices. Choice D is incorrect as cerumen can sometimes block the ear canal and impair sound transmission rather than aid it.
Question 6 of 9
The nurse is aware that all of the areas in the body where lymph nodes are accessible for examination are the:
Correct Answer: C
Rationale: The correct answer is C because lymph nodes are accessible for examination in the head and neck, arms, breasts, and axillae. Lymph nodes are present in these areas where they can be easily palpated and assessed for any signs of inflammation or abnormalities. The other choices are incorrect because they do not include all the areas where lymph nodes are accessible for examination. Choice A does not include the axillae, which is a crucial area for examining lymph nodes in the arms. Choice B does not include the axillae and breasts. Choice D does not include the breasts, which are important areas for lymph node examination in cases of breast cancer or other breast-related conditions.
Question 7 of 9
During an ophthalmoscopic examination of a patient, the examiner notes areas of exudate that look like"cotton wool" or fluffy grey-white cumulus clouds. Which of the possible problems below does this finding indicate?
Correct Answer: A
Rationale: The correct answer is A: Diabetes. The presence of "cotton wool" or fluffy grey-white cumulus clouds on ophthalmoscopic examination indicates retinal nerve fiber layer infarcts due to microvascular damage, which is a common finding in diabetic retinopathy. This occurs due to ischemia and subsequent axonal swelling. In diabetes, hyperglycemia can lead to damage in the blood vessels supplying the retina, resulting in microaneurysms, hemorrhages, exudates, and ultimately vision loss if left untreated. Summary of other choices: B: Hyperthyroidism - This condition primarily affects the thyroid gland and does not directly cause the characteristic retinal findings described. C: Glaucoma - Glaucoma is a condition characterized by increased intraocular pressure and optic nerve damage, which does not typically present with the specific retinal findings mentioned. D: Hypotension - Low blood pressure may lead to retinal artery occlusion or ischemic optic neuropathy,
Question 8 of 9
The nurse is assessing the skin of a patient who has acquired immunodeficiency syndrome (AIDS). Which of the following will the nurse most likely observe?
Correct Answer: C
Rationale: The correct answer is C: Erythematous scaly patch with sharp margins in the sacral area. In patients with AIDS, this presentation is most likely indicative of a common opportunistic infection called tinea corporis. This fungal infection often presents as erythematous scaly patches with well-defined borders. The location in the sacral area is also common due to the warm and moist environment. Choice A, tinea capitis, is a fungal infection of the scalp and is not typically associated with AIDS. Choice B describes a presentation more indicative of a condition like seborrheic dermatitis rather than an AIDS-related skin manifestation. Choice D describes a presentation more typical of tinea corporis, which is not commonly seen in the axilla region in patients with AIDS.
Question 9 of 9
A patient has had a"terrible itch" for several months that he has been scratching continuously. On examination, the nurse might expect to find:
Correct Answer: D
Rationale: The correct answer is D: lichenification. Lichenification is the thickening and hardening of the skin due to chronic scratching or rubbing. In this case, the patient's continuous scratching has led to lichenification. The term "terrible itch" indicates a persistent and severe itching sensation, which aligns with the chronic scratching behavior. Choices A, B, and C are not correct because a keloid is an overgrowth of scar tissue, a fissure is a small cut or crack in the skin, and keratosis is the thickening of the outer layer of the skin. These conditions are not directly related to chronic scratching behavior.