The nurse notices the client's physical appearance, behavior, mobility, and neurological status when they enter the room.
Which of the following is the nurse assessing?

General survey.

Medical history.

Biographical data.

Social history.

Answer and Explanation

The Correct Answer is A

Choice A rationale

The general survey is an overall assessment of a client's physical appearance, behavior, mobility, and neurological status. It provides a comprehensive overview of the client's health and well-being, making it the focus of the nurse's observations in this scenario.

Choice B rationale

Medical history includes past and current health conditions, surgeries, medications, and family health history. While important, it is not the focus of the nurse's immediate observations in this scenario.

Choice C rationale

Biographical data involves personal information such as age, gender, occupation, and marital status. While relevant to the client's health, it is not the primary focus of the nurse's observations in this scenario.

Choice D rationale

Social history includes information about the client's lifestyle, habits, and social environment. While valuable for understanding the client's overall health context, it is not the focus of the nurse's immediate observations in this scenario. .

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Correct Answer is B

Explanation

Choice A rationale

An elliptical chest describes the typical shape of a healthy chest with a lateral dimension greater than the anteroposterior dimension. This shape allows for normal expansion and contraction of the lungs during breathing. An elliptical chest does not indicate any deformity or abnormality in the sternum or costal cartilage.

Choice B rationale

Pectus excavatum, also known as funnel chest, is a congenital deformity where the sternum and costal cartilage are sunken inward, creating a concave appearance of the chest. This condition can range in severity and may affect respiratory function and exercise tolerance in some individuals. Surgical correction may be considered for severe cases.

Choice C rationale

A standard chest describes a chest without any deformities or abnormalities, typically with a normal elliptical shape. This term does not denote any specific condition or configuration and implies a healthy, non-deformed chest.

Choice D rationale

Barrel chest is characterized by an increased anteroposterior diameter of the chest, giving it a round or barrel-like appearance. This condition is often seen in individuals with chronic obstructive pulmonary disease (COPD) or emphysema, where the lungs are chronically overinflated, causing the chest to expand and lose its normal shape.

A. Fibrocystic lesions. B. A normal finding of the breast. C. Carcinoma of the breast. D. Fibroadenoma.

Correct Answer is C

Explanation

Choice A rationale

Fibrocystic lesions in the breast are benign changes that involve the formation of cysts and fibrous tissue. These do not typically cause an orange-peel appearance of the skin.

Choice B rationale

A normal finding of the breast would not include an orange-peel or "peau d'orange" appearance, as this is considered an abnormal change often associated with underlying pathology.

Choice C rationale

Carcinoma of the breast can lead to an orange-peel appearance of the skin due to lymphatic obstruction. This dimpling effect is caused by the cancerous infiltration and thickening of the skin, making this the correct answer.

Choice D rationale

Fibroadenoma is a benign tumor of the breast and does not usually cause the skin changes described as orange-peel appearance. This condition is generally not associated with skin texture changes.

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The nurse notices the client's physical appearance, behavior, mobility, and neurological status when they enter the room.Which of the following is the nurse assessing?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is assessing the chest shape of a patient.Which chest configuration describes a sunken in sternum and costal cartilage?

Correct Answer is B

Explanation

During the breast examination of a client, the nurse notes an orange-peel or "peau d'orange" appearance of the skin of the breast.The nurse understands that this appearance of the skin is due to what type of breast condition?

Correct Answer is C

Explanation

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The nurse notices the client's physical appearance, behavior, mobility, and neurological status when they enter the room.
Which of the following is the nurse assessing?