The nurse is preparing to perform a physical assessment. The correct action by the nurse is reflected by which statement? The nurse:

Performs the examination from the left side of the bed.

Follows the same examination sequence, regardless of the patient's age or condition.

Examines tender or painful areas first to help relieve the patient's anxiety.

Organizes the assessment to ensure that the patient does not change positions too often.

Answer and Explanation

The Correct Answer is D

A. Performs the examination from the left side of the bed:
The standard is to approach from the right side of the bed for consistency in technique.

B. Follows the same examination sequence, regardless of the patient's age or condition:
The sequence may need to be adjusted depending on patient needs (e.g., very ill or pediatric clients).

C. Examines tender or painful areas first to help relieve the patient's anxiety:
Painful areas should be examined last to avoid unnecessary discomfort or guarding.

D. Organizes the assessment to ensure that the patient does not change positions too often:
Promotes comfort and efficiency during the exam.

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Correct Answer is A

Explanation

A. Peripheral vasoconstriction:
In response to cold, the body constricts peripheral vessels to preserve core temperature, leading to pale, cool skin.

B. Peripheral vasodilation:
Causes warm, flushed skin, not pale and cool.

C. Venous pooling:
Would lead to reddish-blue discoloration and possibly swelling-not pallor and coolness.

D. Decreased arterial perfusion:
Could cause pale and cool skin chronically, but in this case, it's an acute environmental response, not pathological.

A. Bronchial sounds B. Wheezes C. Bronchophony D. Whispered pectoriloquy

Correct Answer is B

Explanation

A. Bronchial sounds:
Normal over the trachea; not an adventitious sound.

B. Wheezes:
High-pitched musical sounds caused by air flowing through narrowed airways, typical in asthma.

C. Bronchophony:
A vocal resonance test, not a breath sound.

D. Whispered pectoriloquy:
Another voice transmission test-indicates consolidation but is not a breath sound.

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The nurse is preparing to perform a physical assessment. The correct action by the nurse is reflected by which statement? The nurse:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient comes in for a physical examination and complains that she was "freezing to death" while waiting for her examination. The nurse notes that her skin is pale and cool, and attributes this finding to:

Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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