ATI RN
Assess Vital Signs Questions
Question 1 of 5
When assessing an older adult, which vital sign changes occur with aging?
Correct Answer: B
Rationale: The correct answer is B: Widened pulse pressure. As people age, their blood vessels become less elastic, leading to an increase in systolic blood pressure and a decrease in diastolic blood pressure. This results in a widened pulse pressure. A: Increase in pulse rate is not a typical vital sign change with aging. C: Increase in body temperature is not a common vital sign change in older adults. D: Decrease in diastolic blood pressure is true but does not fully capture the overall vital sign changes that occur with aging.
Question 2 of 5
The nurse educator is preparing an education module for the nursing staff on the dermis layer of skin. Which of these statements would be included in the module? The dermis:
Correct Answer: D
Rationale: The correct answer is D. The dermis layer of the skin contains sensory receptors, such as Meissner's corpuscles and Pacinian corpuscles, which are responsible for detecting touch, pressure, temperature, and pain. This information is crucial for the nursing staff to understand as it impacts patient care and assessment. Choice A is incorrect because fat cells are predominantly found in the subcutaneous tissue, not in the dermis layer. Choice B is incorrect because keratin is primarily found in the epidermis, not the dermis. Choice C is incorrect because the dermis is not replaced every 4 weeks; it is a relatively stable layer compared to the epidermis, which undergoes continuous renewal.
Question 3 of 5
A newborn infant has Down syndrome. During the skin assessment, the nurse notices a transient mottling in the trunk and extremities in response to the cool temperature in the examination room. The infant's mother also notices the mottling and asks what it is. The nurse knows that this mottling is called:
Correct Answer: D
Rationale: The correct answer is D: Cutis marmorata. Cutis marmorata is a transient mottling of the skin that occurs in response to cold temperatures, common in newborns with Down syndrome. This occurs due to immature vasomotor control and resolves with warmth. Choice A, Café au lait, refers to light brown skin pigmentation and is not related to mottling. Choice B, Carotenemia, is yellow-orange discoloration of the skin from excessive carotene intake, not related to mottling. Choice C, Acrocyanosis, is bluish discoloration of the extremities due to poor circulation, not mottling.
Question 4 of 5
A patient has been admitted for severe psoriasis. The nurse expects to see what finding in the patient's fingernails?
Correct Answer: C
Rationale: The correct answer is C: Pitting. Pitting of the fingernails is a common finding in patients with severe psoriasis due to the involvement of nail matrix. It presents as small depressions or holes on the nail surface. This occurs as a result of abnormal keratinization in the nail matrix. Splinter hemorrhages (choice A) are seen in conditions like infective endocarditis, not psoriasis. Paronychia (choice B) is an infection around the nail fold. Beau lines (choice D) are transverse depressions in the nail plate caused by temporary disruption in nail growth, often due to systemic illness.
Question 5 of 5
In performing an examination of a 3-year-old child with a suspected ear infection, the nurse would:
Correct Answer: D
Rationale: The correct answer is D because performing the otoscopic examination at the end of the assessment allows the nurse to build rapport with the child first, reducing anxiety and increasing cooperation. This approach also prevents the child from becoming upset or uncooperative due to discomfort during the examination. Additionally, it ensures that the child's comfort and trust are prioritized during the assessment process. Choice A is incorrect because omitting the otoscopic examination based on the child having a fever can lead to missing important diagnostic information. Choice B is incorrect as pulling the ear up and back before inserting the speculum is not recommended practice and can cause discomfort to the child. Choice C is incorrect as it is important for the mother to be present to provide comfort and support to the child during the examination.