ATI RN
Vital Signs Assessment Chapter 7 Questions
Question 1 of 5
Which of the following is true of human papilloma virus (HPV) infection?
Correct Answer: B
Rationale: HPV is the most common STI in the United States and is by far the most common cause of cervical cancers. The sensitivity of the liquid-based cytology is between 61% and 95% and specificity is from 78% to 82%. While HPV affects almost 50% of the population at some point, many of these infections resolve spontaneously.
Question 2 of 5
A patient with longstanding COPD was told by another practitioner that his liver was enlarged and this needed to be assessed. Which of the following would be reasonable to do next?
Correct Answer: B
Rationale: In this scenario, the correct answer is B) Measure the span of the liver. This is the most reasonable next step because an enlarged liver can be indicative of various conditions, including COPD-related complications or comorbidities. Measuring the span of the liver can provide valuable information about its size and potential enlargement, helping to confirm the initial observation and guide further diagnostic investigations or treatment plans. Option A) Percuss the lower border of the liver may not provide as accurate or comprehensive information about the size of the liver compared to actually measuring its span. Percussion alone may not be sufficient to confirm the extent of liver enlargement. Option C) Ordering a hepatitis panel would not be the next immediate step in this case unless there were specific clinical indications or risk factors suggesting hepatitis as a likely cause of liver enlargement. It is important to prioritize investigations based on the patient's presentation and relevant findings. Option D) Obtaining an ultrasound of the liver may be a valuable diagnostic tool, but measuring the liver span is a less invasive and more cost-effective initial step to assess liver enlargement before proceeding to imaging studies. Educationally, this question emphasizes the importance of systematic and logical clinical reasoning in assessing patients with suspected liver abnormalities. It highlights the significance of choosing the most appropriate initial diagnostic steps based on the clinical context, patient history, and physical examination findings. Understanding the rationale behind selecting the correct next step in this scenario is crucial for healthcare providers to enhance their diagnostic skills and improve patient care outcomes.
Question 3 of 5
A patient has had a cerebrovascular accident (stroke). He is trying very hard to communicate. He seems driven to speak and says, 'I buy obie get spirding and take my train.' What is the best description of this patient's problem?
Correct Answer: D
Rationale: In this scenario, the correct answer is D) Wernicke's aphasia. Wernicke's aphasia is characterized by fluent but nonsensical speech, where individuals have difficulty understanding language and may produce sentences that lack meaning or contain invented words. The patient's speech, "I buy obie get spirding and take my train," reflects this symptomatology as it lacks coherence and contains words that do not fit the context. Regarding why the other options are incorrect: - A) Global aphasia typically involves both receptive and expressive language deficits, resulting in significant impairments in both understanding and producing language. The patient in the question is producing speech, albeit nonsensical, indicating it's not a complete absence of language function. - B) Broca's aphasia is characterized by non-fluent speech, where individuals have difficulty with speech production but relatively preserved understanding. The patient's speech, although effortful, is fluent and lacks the characteristic telegraphic speech seen in Broca's aphasia. - C) Echolalia refers to the repetition of words or phrases spoken by others, which is not demonstrated in the patient's speech. Educationally, understanding different types of aphasia is crucial for healthcare providers to appropriately assess and support patients with communication impairments. Recognizing the distinct features of each type of aphasia aids in accurate diagnosis and tailored intervention strategies to improve communication and quality of life for individuals affected by stroke or other conditions impacting language processing.
Question 4 of 5
A pregnant woman states, 'I just know labor will be so painful that I won't be able to stand it. I know it sounds awful, but I really dread going into labor.' The nurse responds by stating, 'Oh, don't worry about labor so much. I have been through it, and although it is painful, many good medications are available to decrease the pain.' Which statement is true regarding this response? The nurse's reply was a:
Correct Answer: B
Rationale: By providing false assurance or reassurance, this courage builder relieves the woman's anxiety and gives the nurse the false sense of having provided comfort. However, for the woman, providing false assurance or reassurance actually closes off communication, trivializes her anxiety, and effectively denies any further talk of it.
Question 5 of 5
The nurse is preparing to assess a hospitalized patient with significant shortness of breath. How should the nurse proceed?
Correct Answer: D
Rationale: In this scenario, option D, which is to focus on areas related to the problem and finish later, is the correct approach for the nurse to take when assessing a hospitalized patient with significant shortness of breath. This option is the most appropriate because addressing the immediate concern of shortness of breath is crucial for the patient's well-being. By focusing on areas related to the problem first, the nurse can quickly gather essential information to initiate appropriate interventions to alleviate the patient's distress. Option A, laying the patient flat for accurate cardiac and respiratory assessments, is incorrect in this case because it can worsen the patient's shortness of breath due to increased pressure on the chest and lungs. This action could further compromise the patient's respiratory status. Option B, obtaining a detailed history from a family member, is not the priority when a patient is experiencing significant shortness of breath. While obtaining a thorough history is important, addressing the immediate physiological needs of the patient takes precedence in this situation. Option C, performing a complete physical assessment immediately, is also not the best course of action because it may be overwhelming for the patient and could delay the prompt intervention needed for the shortness of breath. In an educational context, it is essential for healthcare providers to prioritize and manage acute symptoms effectively. By focusing on the problem at hand, nurses can provide timely and appropriate care to address the patient's immediate needs while still maintaining a comprehensive approach to care. This approach ensures that critical issues are addressed promptly, leading to better patient outcomes.