ATI RN
Vital Signs in Nursing Assessment Questions
Question 1 of 5
Various sounds are heard when assessing a blood pressure. What does the first sound heard through the stethoscope represent?
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Question 2 of 5
Older adults have an increase in systolic pressure related to what?
Correct Answer: B
Rationale: Decreased vessel elasticity, is correct because aging reduces arterial elasticity due to stiffening from collagen buildup and calcification. This increases systolic pressure as vessels resist expansion during heart contraction. Increased vessel flexibility, is false; flexibility decreases with age. Enlarged vessel dexterity, is nonsensical in this context. Diminished vessel porosity, isnt a primary factor in blood pressure. As arteries stiffen, systolic pressure rises (e.g., >140 mm Hg), a common hypertension pattern in older adults. This physiological change explains why systolic hypertension is prevalent in this group, making B the accurate answer based on cardiovascular aging principles.
Question 3 of 5
A nurse assesses orthostatic hypotension in an older adult. What would be an appropriate intervention for this patient?
Correct Answer: B
Rationale: Orthostatic hypotension involves a blood pressure drop upon standing, common in older adults. Allowing the patient to dangle stabilizes blood flow by gradually transitioning from sitting to standing, reducing dizziness risk. Rising quickly worsens hypotension by rushing blood redistribution. Returning to bed in Fowlers position is reactive, not preventive, and supine is preferred over Fowlers. Beta-blockers lower, not raise, blood pressure, making it inappropriate. Choice B is correct as it proactively prevents falls and symptoms, aligning with geriatric nursing strategies for safe mobility.
Question 4 of 5
Which of the following accurately reflects a recommended guideline when assessing blood pressure?
Correct Answer: C
Rationale: Initial bilateral arm measurement uses the higher reading, not lower, for consistency. Electronic devices struggle with irregularities, favoring manual methods. Raising the arm overhead isn't standard but may amplify sounds in congestion, though context is unclear; key says C. Newborn arm-leg checks detect coarctation. Choice C is correct per key, though unconventional, possibly situational for sound clarity in specific cases.
Question 5 of 5
The nurse is providing a blood pressure clinic for the community. Which group will the nurse most likely address?
Correct Answer: C
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.