A nurse is caring for a client who has contact dermatitis of the neck and upper chest. Which assessment data is an expected finding?

Report of generalized joint discomfort

Systemic symptoms including elevated temperature

Denial of pruritus

Report of exposure to a skin irritant

Answer and Explanation

The Correct Answer is D

A. Generalized joint discomfort is not commonly associated with contact dermatitis; this condition typically affects the skin locally rather than causing systemic joint symptoms.

B. Systemic symptoms such as elevated temperature are generally not expected with contact dermatitis, as it is usually a localized skin reaction.

C. Pruritus (itching) is a common symptom of contact dermatitis, so denial of pruritus would not be expected.

D. Contact dermatitis often occurs due to exposure to a skin irritant, making a report of such exposure a typical finding in the assessment.

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Correct Answer is D

Explanation

A. Petechiae are small, pinpoint hemorrhages and are considered objective data that can be observed and documented by the nurse.

B. Blood pressure is a vital sign and objective data that can be measured using a sphygmomanometer.

C. Cyanosis is a physical sign indicating low oxygenation in the blood and is objective data that can be observed.

D. Nausea is a subjective symptom reported by the client, reflecting their internal experience and cannot be measured or observed directly.

A. Use the bell of the stethoscope B. Palpate the chest wall to feel the intensity of the murmur C. Use a Doppler ultrasound device D. Percuss the thorax cavity

Correct Answer is A

Explanation

A. The bell of the stethoscope is best used to listen for low-pitched sounds, including some types of murmurs, and can help assess the quality and intensity of a cardiac murmur.

B. While palpation can provide some information about the heart's function (such as thrills), it is not the primary method for assessing the quality of a murmur.

C. A Doppler ultrasound device is used for measuring blood flow and can help in assessing murmurs but does not provide the quality assessment needed for characterizing a murmur.

D. Percussion is not typically used to evaluate murmurs; it is more useful for assessing the size and borders of organs.

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A nurse is caring for a client who has contact dermatitis of the neck and upper chest. Which assessment data is an expected finding?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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