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
During ocular examinations, the nurse keeps in mind that movement of the extraocular muscles is:
Correct Answer: D
Rationale: The correct answer is D because the movement of extraocular muscles is primarily controlled by cranial nerves III, IV, and VI. CN III controls most of the eye movements, CN IV controls the superior oblique muscle, and CN VI controls the lateral rectus muscle. These nerves work together to coordinate eye movements in all directions. Choices A and B are incorrect because age or cataracts do not directly impact the stimulation of extraocular muscles. Choice C is incorrect as CNs I and II are not involved in controlling extraocular muscle movement.
Question 3 of 9
During the assessment of a 26-year-old, she states,"I have a spot on my lip I think is cancer." The nurse notes the following: a cluster of clear vesicles with an erythematous base around them located at the lip"“ skin border. The patient mentions that she just returned from Hawaii. What would be the most appropriate response by the nurse?
Correct Answer: C
Rationale: The correct answer is C because the presentation of clear vesicles with an erythematous base around them at the lip-skin border is characteristic of herpes simplex virus 1 infection, commonly known as cold sores. Given the patient's recent travel to Hawaii, exposure to the virus is likely. This infection is self-limiting and typically heals in 4 to 10 days without the need for specific treatment. Choice A is incorrect because seeing a skin specialist may not be necessary for a self-limiting viral infection. Choice B is incorrect as a biopsy is not typically indicated for a clear clinical diagnosis of herpes simplex virus infection. Choice D is incorrect as riboflavin deficiency does not present with clear vesicles and erythema at the lip-skin border.
Question 4 of 9
During an otoscopic examination, the nurse notes an area of black and white dots on the tympanic membrane and ear canal wall. What does this finding suggest?
Correct Answer: D
Rationale: The presence of black and white dots on the tympanic membrane and ear canal wall during an otoscopic examination suggests a yeast or fungal infection. This is because yeast or fungal infections commonly present as white or black dots in the ear canal. Malignancy would typically manifest as abnormal growths or masses, not dots. Viral infections usually do not present as specific dots on the tympanic membrane. Blood in the middle ear would appear as red or pinkish fluid behind the eardrum, not as black and white dots. Therefore, the correct answer is D: Yeast or fungal infection.
Question 5 of 9
Which of the following cranial nerves (CNs) is responsible for conducting nerve impulses to the brain from the organ of Corti?
Correct Answer: C
Rationale: The correct answer is C: CN VIII. The vestibulocochlear nerve (CN VIII) is responsible for conducting nerve impulses from the organ of Corti in the inner ear to the brain. This nerve specifically carries auditory information to the brainstem and auditory cortex for processing. Choice A (CN I) is incorrect as it is the olfactory nerve responsible for smell. Choice B (CN III) is incorrect as it is the oculomotor nerve responsible for eye movement. Choice D (CN XI) is incorrect as it is the accessory nerve responsible for neck and shoulder movements.
Question 6 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 7 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 8 of 9
A patient complains of pain in her right eye. On examination, the nurse sees a pustule at the lid margin that is painful to touch, red, and swollen. The nurse recognizes that this is:
Correct Answer: B
Rationale: The correct answer is B: a hordeolum (stye). A hordeolum is a localized infection in the eyelid, typically caused by bacterial infection of the oil glands. In this case, the presence of a painful pustule at the lid margin, along with redness and swelling, is characteristic of a hordeolum. The pain on touch is also indicative of an infection. Choice A, a chalazion, is an inflammatory lesion caused by a blocked oil gland, but it is usually painless and not typically associated with redness or tenderness. Choice C, dacryocystitis, is an infection of the lacrimal sac, which presents with different symptoms such as tenderness over the inner corner of the eye and tearing. Choice D, blepharitis, is inflammation of the eyelid margins, but it does not typically present with a painful pustule at the lid margin.
Question 9 of 9
During an admission assessment, the nurse notices that a male patient has an enlarged and rather thick skull. The nurse suspects acromegaly and would further assess for:
Correct Answer: C
Rationale: Step 1: The nurse notices an enlarged and thick skull, which are common signs of acromegaly. Step 2: Acromegaly results from excess growth hormone, leading to changes in facial features. Step 3: Coarse facial features such as enlarged nose, lips, and jaw are classic signs of acromegaly. Step 4: Therefore, assessing for coarse facial features is crucial in confirming acromegaly. Summary: A: Exophthalmos is associated with hyperthyroidism, not acromegaly. B: Bowed long bones are seen in conditions like rickets, not acromegaly. D: An acorn-shaped cranium is not a typical feature of acromegaly.