ATI RN
ATI Vital Signs Assessment Questions
Question 1 of 5
When evaluating the temperature of older adults, the nurse should remember which aspect about an older adult's body temperature?
Correct Answer: A
Rationale: The correct answer is A because older adults tend to have a lower baseline body temperature compared to younger adults. This is due to age-related changes in metabolism and decreased efficiency of thermoregulation. As people age, their metabolic rate decreases, leading to less heat production. Additionally, older adults may have impaired ability to adapt to temperature changes. Choice B is incorrect because young children typically have higher body temperatures than older adults. Choice C is incorrect as body temperature may vary slightly with different types of thermometers but the overall trend of lower temperature in older adults remains. Choice D is incorrect as while older adults may have decreased heat control mechanisms, their body temperature still tends to be lower rather than widely varying.
Question 2 of 5
The nurse is bathing an 80-year-old man and notices that his skin is wrinkled, thin, lax, and dry. This finding would be related to which factor in the older adult?
Correct Answer: D
Rationale: The correct answer is D because as individuals age, there is a natural decline in elastin production and a reduction in subcutaneous fat, leading to thin, lax, and dry skin. Increased vascularity (choice A) would not cause the described skin changes. Increased sweat and sebaceous glands (choice B) typically occur during puberty, not in older adults. An increase in elastin and a decrease in subcutaneous fat (choice C) would not result in the specific skin characteristics mentioned. Therefore, choice D is the most appropriate explanation for the observed skin changes in the elderly man.
Question 3 of 5
The nurse notices that a patient has a solid, elevated, circumscribed lesion that is less than 1 cm in diameter. When documenting this finding, the nurse reports this as a:
Correct Answer: D
Rationale: Step-by-step rationale: 1. A papule is a solid, elevated lesion less than 1 cm in diameter, fitting the description. 2. A bulla is a large vesicle greater than 1 cm, not fitting the size criteria in the question. 3. A wheal is a raised, erythematous, edematous papule or plaque, not solid as described. 4. A nodule is a solid, raised lesion larger than 1 cm, not fitting the size criteria in the question. In summary, the correct answer is D (Papule) because it accurately describes the size and characteristics of the lesion in question, while the other options do not match the given description.
Question 4 of 5
When examining the ear with an otoscope, the nurse notes that the tympanic membrane should appear:
Correct Answer: B
Rationale: The correct answer is B: Pearly gray and slightly concave. The tympanic membrane should appear pearly gray because it is composed of thin tissue. It should also appear slightly concave due to the shape and position within the ear. This indicates normal and healthy appearance. Incorrect choices: A: Light pink with a slight bulge - The tympanic membrane should not be pink, as it may indicate inflammation. A bulge could suggest fluid behind the membrane. C: Pulled in at the base of the cone of light - This could indicate negative pressure in the middle ear. D: Whitish with a small fleck of light in the superior portion - A whitish appearance may suggest infection or scarring, and a small fleck of light is not a typical finding.
Question 5 of 5
The nurse is performing an ear examination of an 80-year-old patient. Which of these findings would be considered normal?
Correct Answer: A
Rationale: The correct answer is A: High-tone frequency loss. In older adults, age-related hearing loss affects high-tone frequencies first due to changes in the inner ear structures. This is considered a normal age-related change. Increased elasticity of the pinna (B) is not related to aging but rather a congenital or acquired condition. A thin, translucent membrane (C) or a shiny, pink tympanic membrane (D) may indicate issues like infection or inflammation, not normal aging changes in the ear.