ATI RN
ATI Nurse 142 Final Questions
Extract:
Question 1 of 5
When assessing the abdomen, the nurse would expect to auscultate which sounds?
Correct Answer: A
Rationale: When assessing the abdomen, the nurse would expect to auscultate bowel sounds, which are the sounds made by the movement of gas and fluid through the intestines. The normal bowel sounds are characterized as high-pitched, gurgling, and occurring at a rate of 5-30 sounds per minute. Bruits are abnormal sounds indicating turbulent blood flow and are usually assessed in other areas of the body, such as the epigastric and renal arteries, as well as in the aorta. Friction rubs are also abnormal sounds, but they are typically heard during auscultation of the heart and lungs. Low-pitched sonorous sounds are not typical sounds that are expected to be heard during an abdominal assessment.
Question 2 of 5
The nurse would use which of the following skills first when examining the cardiovascular system of a patient?
Correct Answer: D
Rationale: Inspection is the first skill used when examining the cardiovascular system. It involves observing the patient's physical appearance, skin color, and breathing pattern. This provides initial clues about the patient's cardiovascular status before proceeding to palpation, percussion, and auscultation.
Question 3 of 5
When assessing the heart, the nurse inspects and palpitates which of the following?
Correct Answer: B
Rationale: When assessing the heart, the nurse inspects and palpates the precordium, the area of the chest overlying the heart, and the point of maximal impulse (PMI), where the heartbeat is strongest. This helps evaluate the heart's size, shape, and any abnormalities. The peritoneum is unrelated to heart assessment.
Question 4 of 5
The nurse is assessing the patient's ear. The correct procedure for straightening the ear canal of an adult is to pull the pinna…
Correct Answer: B
Rationale: For an adult, the correct method to straighten the ear canal during examination is to pull the pinna up and back. This maneuver aligns the ear canal for better visualization of the tympanic membrane and inner structures. Pulling down and back is appropriate for children under 3, while the other options do not correctly align the canal.
Question 5 of 5
A 58-year-old patient is going home today. The nurse does her final assessment of the patient. Which of the following would be considered a normal finding?
Correct Answer: C
Rationale: A respiratory rate of 25 is slightly above the normal range (12-20 breaths per minute) but can be normal for some individuals. Bowel sounds of 5-30 per minute are normal but not sufficient alone for discharge. Capillary refill >3 seconds and a heart rate of 10 are abnormal, indicating poor perfusion and severe bradycardia, respectively.