A nurse is completing a client assessment for admission to the medical unit. Which of the following abdominal assessment findings require further investigation by the nurse?

Bilateral bowel sounds in lower quadrants

Symmetrical convex sphere shape

Ecchymosis

Concave umbilicus

Answer and Explanation

The Correct Answer is C

A. Bilateral bowel sounds in the lower quadrants are normal and do not require further investigation unless they are abnormal in frequency or tone.

B. A symmetrical convex sphere shape of the abdomen can be a normal finding, especially in a well-nourished individual.

C. Ecchymosis (bruising) may be a sign of trauma, bleeding disorders, or other underlying health conditions that require further investigation.

D. A concave umbilicus may be normal or could indicate a past surgical history or conditions like malnutrition, but it doesn't inherently require investigation unless associated with other symptoms.

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Correct Answer is B

Explanation

A. Asking "Would it help to discuss your feelings about this hospitalization?" is more closed and may not effectively promote discussion about the client's health history.

B. Asking "What brought you to the hospital?" is an open-ended question that allows the client to provide a comprehensive answer and facilitates a meaningful discussion about their health and hospitalization.

C. "Would you tell me about all of your medical issues?" is too broad and could overwhelm the client. A more specific question would be more effective.

D. "Do you want to talk about your health concerns?" is a yes/no question and may not encourage open communication.

A. Dorsal surface of the foot B. Conjunctivae C. Dorsal surface of the hand D. Pinnae of the ears

Correct Answer is B

Explanation

A. The dorsal surface of the foot and the dorsal surface of the hand are less reliable areas to assess for cyanosis in dark-skinned individuals.

B. Cyanosis in clients with dark skin can be more difficult to detect in the skin but is often visible in the conjunctivae of the eyes, as it reflects the oxygenation status of the blood.

C. The dorsal surface of the hand is also not an ideal area for assessing cyanosis in dark skin.

D. The pinnae of the ears can show signs of cyanosis but may not be as reliable as the conjunctivae, especially in dark-skinned individuals.

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A nurse is completing a client assessment for admission to the medical unit. Which of the following abdominal assessment findings require further investigation by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to collect health history data during a client's admission. Which of the following questions should the nurse use to promote this discussion?

Correct Answer is B

Explanation

A nurse is assessing for cyanosis in a client who has dark skin. Which of the following sites should the nurse examine to identify cyanosis in this client?

Correct Answer is B

Explanation

A nurse is teaching a new group of assistive personnel (AP) about the importance of hand hygiene. Which of the following statements should the nurse include?

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