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Ati nurs220 health assessment exam
Total Questions : 40
Showing 10 questions, Sign in for morePeripheral Vascular
A 65-year-old patient is experiencing pain in his left calf when he exercises that disappears after resting for a few minutes.
Choose the correct answer in the drop down menu to fill in the blank.
The nurse recognizes that this description is most consistent with
Explanation
Claudication due to arterial abnormalities in
Rationale: Intermittent claudication is a hallmark symptom of peripheral arterial disease (PAD). It is characterized by muscle pain or cramping in the lower extremities, typically triggered by exercise and relieved by rest. The pain occurs due to ischemia, or reduced blood flow, resulting from partial arterial obstruction.
A patient is reporting sharp pain along the costovertebral angles. What does this symptom most often indicate?
A nurse is precepting a new graduate nurse on the telemetry unit. The new graduate nurse is preparing to perform an abdominal assessment on a hospitalized client without a history of gastrointestinal abnormalities. Click to indicate the corresponding number for each of the following assessment techniques in order of performance.
Explanation
|
Assessment Technique |
1 |
2 |
3 |
4 |
|
Percussion |
✅ |
|||
|
Inspection |
✅ |
|||
|
Palpation |
✅ |
|||
|
Auscultation |
✅ |
Rationale:
Begin with inspection to visually assess the abdomen for abnormalities. Auscultate before palpation and percussion to avoid altering bowel sounds. Determine areas of pain to avoid causing discomfort during palpation and percussion. Palpate to assess for tenderness or masses. Percuss last to evaluate organ size and detect abnormal fluid or gas.
A patient comes into the clinic complaining of pain in her right eye. On examination, the nurse sees a pustule at the lid margin that is painful to touch, red, and swollen. The nurse recognizes that this is a:
A 70-year-old patient tells the nurse that he has noticed that he is having trouble hearing, especially in large groups. He says that he "can't always tell where the sound is coming from" and the words often sound "mixed up." What might the nurse suspect as the cause for this change?
A nurse is precepting a new graduate nurse on the telemetry unit. The new graduate nurse is preparing to perform an abdominal assessment on a hospitalized client without a history of gastrointestinal abnormalities.
The nurse preceptor reminds the new graduate nurse of normal and abnormal findings.
Click to indicate whether the findings listed below are normal or abnormal.
Explanation
Each category must have at least 1 response option selected
|
Finding |
Normal |
Abnormal |
|
Tympany to percussion over the intestines |
✅ |
|
|
Loose, watery stool |
✅ |
|
|
Suprapubic tenderness |
✅ |
|
|
A non-palpable spleen |
✅ |
|
|
Aortic pulsation in the epigastric area |
✅ |
|
|
Decreased bowel sounds |
✅ |
Rationale:
Tympany to percussion over the intestines (Normal):
Tympany is expected due to the presence of gas in the intestines.
Loose, watery stool (Abnormal):
This is indicative of diarrhea, which may point to gastrointestinal upset or infection.
Suprapubic tenderness (Abnormal):
Tenderness in this area may indicate bladder infection, inflammation, or pelvic issues.
A non-palpable spleen (Normal):
The spleen is generally not palpable in healthy individuals unless it is enlarged (splenomegaly).
Aortic pulsation in the epigastric area (Normal):
Mild pulsations may be felt in thin or normal-weight individuals. However, a widened or strong pulsation could suggest an abdominal aortic aneurysm.
Decreased bowel sounds (Abnormal):
Hypoactive or absent bowel sounds may indicate decreased intestinal motility, such as in ileus or peritonitis.
A patient had abdominal surgery yesterday when auscultating his abdomen, you would expect to hear:
The nurse is describing how to perform a testicular self-examination to a patient. Which statement is most appropriate?
A nurse performs the Weber test on a healthy adult client. The nurse would expect which of the following normal finding?
The nurse is performing an assessment on an adult. The adult's vital signs are normal, and capillary refill time is 5 seconds. What should the nurse do next?
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