ATI RN
ATI RN Fundamentals Exam 2 Questions
Extract:
Question 1 of 5
The nurse examines a client's auditory canal and tympanic membrane with an otoscope. The nurse recognizes that which of the following is considered an abnormal finding?
Correct Answer: D
Rationale: A yellow or amber tympanic membrane suggests fluid or infection behind the eardrum, such as in otitis media, which is abnormal. A shiny, pearly white tympanic membrane, cerumen, and a cone of light are normal findings during an otoscopic exam.
Question 2 of 5
A group of nursing students are studying the conduction system of the heart. The nursing students should recognize that the pacemaker of the heart is known as
Correct Answer: A
Rationale: The sinoatrial (S
A) node is the heart's natural pacemaker, located in the right atrium. It generates electrical impulses that initiate each heartbeat and set the rhythm for the entire heart. This is a fundamental concept in cardiac physiology.
Question 3 of 5
A client diagnosed with pleuritis has been admitted to the hospital and complains of pain with breathing. Which of the following assessment findings should the nurse expect when auscultating a client with pleuritis?
Correct Answer: B
Rationale: Pleuritis causes a friction rub due to inflamed pleural layers rubbing during breathing. Wheezing, stridor, and crackles are associated with other conditions like asthma, upper airway obstruction, and fluid in the lungs, respectively.
Question 4 of 5
The nurse is assessing a client diagnosed with fluid overload. The nurse should implement priority interventions for which of the following assessment findings? (Select all that apply.)
Correct Answer: C,D
Rationale: Blood pressure of 180/100 and respiratory rate of 32 indicate severe fluid overload, potentially leading to hypertension and pulmonary edema, requiring immediate intervention. Increased temperature and hematocrit are not typical, and heart rate of 120 bpm alone is less specific.
Question 5 of 5
The nurse is caring for an older adult client who has recently had a stroke. The nurse assesses that the right side of the client's face is drooping. The nurse might also expect which of the following assessment findings?
Correct Answer: C
Rationale: Dysphagia, or difficulty swallowing, is commonly associated with stroke due to muscle weakness, including facial muscles. Facial drooping on one side, as seen in this client, indicates neurological impairment that can affect swallowing muscles. Xerostomia (dry mouth), epistaxis (nosebleed), and rhinorrhea (runny nose) are not directly related to stroke-induced facial drooping.