The nurse is performing an assessment of the skin. Which ...

[swpotter12]

The nurse is performing an assessment of the skin. Which statements regarding this assessment are correct?
 
  Select all that apply.
  1. Assessment of the skin involves inspection, palpation, and auscultation.
  2. Assessment of the skin involves using the sense of smell.
  3. The nurse assesses the client for edema.
  4. The nurse may assess the client's nails and hair while assessing the skin.
  5. When assessing the skin, the nurse recognizes the effect of developmental stage on findings.

Question 2

The nurse is assessing the client's cardiorespiratory system. Which tool will the nurse require to perform these examinations?
 
  1. Stethoscope
  2. Percussion hammer
  3. Nasal speculum
  4. Lubricant

[Sammyo]

Answer to Question 1

Correct Answer: 2,3,4,5

Assessment of the skin involves using the sense of smell to note any unusual odors or the presence of body odor frequently related to poor hygiene. The nurse will note any edema that makes skin look swollen, shiny, and taut. The nurse can assess the nails and hair while performing the skin assessment. The client's developmental stage will impact the findings, and must be taken into consideration when the nurse assesses the client's skin. Assessment of the skin involves inspection and palpation, but auscultation is generally not required, because there is nothing to listen to during this exam.

Answer to Question 2

Correct Answer: 1

The nurse will require a stethoscope to auscultate the breath and heart sounds. A light source and nasal speculum will be required to examine the client's nares, but not for the cardiorespiratory system. A percussion hammer will not be required.

[swpotter12]

TYSM

[Alyson.hiatt@yahoo.com]

Gracias!