ATI RN
Vital Signs Assessment Questions
Question 1 of 5
Which of the following findings is most concerning during a peripheral vascular assessment?
Correct Answer: C
Rationale: The correct answer is C, unilateral edema. This finding is most concerning as it may indicate a blockage or dysfunction in the lymphatic or venous system, potentially leading to serious conditions like deep vein thrombosis. In contrast, A and D are normal findings indicating good peripheral circulation, while B is also normal and indicates balanced blood flow.
Question 2 of 5
Which of the following findings during a cardiovascular assessment indicates poor oxygenation?
Correct Answer: B
Rationale: The correct answer is B: Cyanosis of the lips and nail beds. Cyanosis indicates poor oxygenation due to the bluish discoloration of the lips and nail beds, suggesting insufficient oxygen in the blood. Capillary refill time less than 2 seconds (A) is a normal finding indicating good perfusion. Warm and pink extremities (C) also suggest good circulation. Bounding peripheral pulses (D) can be associated with increased cardiac output but do not directly indicate poor oxygenation.
Question 3 of 5
The nurse is conducting a pain assessment. Which question best evaluates the quality of the patient's pain?
Correct Answer: B
Rationale: The correct answer is B: What does the pain feel like? This question is best for evaluating the quality of pain because it helps determine the characteristics and nature of the pain, such as sharp, dull, throbbing, burning, etc. Understanding the specific qualities of pain can provide valuable insights into possible causes and appropriate interventions. A: When did the pain start? This question assesses the onset of pain, not its quality. C: What makes the pain better or worse? This question evaluates exacerbating or alleviating factors, not the quality of pain. D: Where is the pain located? This question assesses the location of pain, not its quality.
Question 4 of 5
The nurse is auscultating heart sounds and notes a split S2 during inspiration. What does this finding indicate?
Correct Answer: A
Rationale: The correct answer is A: A normal finding. During inspiration, the intrathoracic pressure decreases, causing the pulmonary artery to fill more slowly than the aorta, resulting in a split S2. This is a physiological phenomenon known as a respiratory split, which is considered normal. Choices B, C, and D are incorrect because they do not correlate with the specific finding of a split S2 during inspiration. Mitral valve regurgitation and aortic stenosis typically present with different auscultatory findings, while heart failure may manifest with additional signs and symptoms beyond just a split S2.
Question 5 of 5
The following information is best placed in which category? 'The patient had a stent placed in the left anterior descending artery (LAD) in 1999.'
Correct Answer: A
Rationale: The correct answer is A: Adult illnesses. The information about a stent placed in an artery relates to a medical procedure for a cardiovascular condition, which falls under adult illnesses. This category encompasses conditions and treatments related to the health of adults. Surgeries (B) would be too broad and not specific to the medical context provided. Obstetrics/gynecology (C) focuses on women's reproductive health and pregnancy-related issues, which are not relevant here. Psychiatric (D) pertains to mental health and psychological disorders, which is also not applicable to the given information.