NURS250: Chapter 3 - Techniques, Safety, and Infection Control PrepU

A client with scabies visits the health care facility for a follow-up appointment. Which preparation by the nurse is of greatest priority for the physical examination of this client?

Adequate lighting.

The nurse understands that the preferred method of hand hygiene when hands are not visibly soiled is what?

Alcohol-based rub.

When performing a physical assessment on an older adult client, what should the nurse consider offering this client?

An extra blanket.

After the physical examination of a client, a nurse disposes of the used gloves. The nurse has not come in contact with any body fluids or excretion, mucous membranes, non-intact skin, or wound dressings. The nurse's hands do not appear to be visibly soiled. What hand hygiene should the nurse perform?

Application of antiseptic hand rub.

The nurse is planning to assess for the presence of lower pitch sounds when examining a client's heart. Which item of equipment would the nurse use to make this assessment?

Bell of stethoscope.

When assessing the temperature of the feet of an older client with diabetes, the nurse would use which part of the hand to obtain the most accurate information?

Dorsal hand surface.

While examining a client, the nurse plans to palpate temperature of the skin by using the?

Dorsal surface of the hand.

A nurse is preparing to perform auscultation on a client. Which guideline is most important for the nurse to keep in mind while performing this technique?

Eliminate distracting noises from the environment.

The nurse is using a Wood's light for a client who has complaints of itching, burning, and peeling of the skin between his toes. The nurse is assessing for what etiology of the client's symptoms?

Fungal infection.

A nurse performs an admission assessment on a client admitted with chest pain. The nurse knows that using the bell of the stethoscope is appropriate to auscultate for which type of sounds?

Heart murmurs.

In the course of performing a client's physical assessment, the nurse has changed from using the diaphragm of the stethoscope to using the bell. The nurse is most likely assessing which of the following?

Heart sounds.

The student nurse is caring for a client with emphysema. What sound would the student nurse expect to hear when percussing the client's lungs?

Hyperresonance.

Which of the following techniques are used in a physical assessment?

Inspection, palpation, auscultation.

During a comprehensive assessment, the primary technique used by the nurse throughout the examination is?

Inspection.

The nurse is assessing a client with unexplained lesions noted on the client's back. The nurse is going to palpate the area of the lesions. What type of palpation should the nurse use?

Light palpations.

During the physical examination of your client you auscultate the sound of the client's breathing. What area of the client are you assessing?

Lungs.

The nurse selects a tuning fork to use when assessing a client. Which body system is the nurse most likely assessing?

Peripheral vascular.

The nurse is using the finger pads of the hand to palpate a body part. The nurse would best be able to detect which finding?

Pulses.

The nurse is preparing to auscultate sounds that have a lower pitch. Which equipment should be used to complete this assessment?

Stethoscope bell.

Which illustrates the nurse using the technique of inspection?

The nurse detects a fruity odor of the client's breath.

Which describes the nurse using the technique of auscultation?

The nurse detects gurgling throughout the abdomen.

Which describes the nurse using the technique of percussion?

The nurse notes resonance over the individual's thorax.

The nurse wears gloves for which of the following purposes?

To prevent the spread of flora from client to client and limit exposure to body fluids and secretions.

A nurse performing percussion over the area of the stomach should anticipate hearing which type of sound?

Tympany.

The nurse prepares to use mediate percussion to assess lung tissue. Which action will the nurse take when using this assessment technique?

Use the middle finger to deliver two taps.

Before beginning a physical assessment of a client, the nurse should first?

Wash both hands with soap and water.

Identify the steps in order of priority the nurse takes for performing hand hygiene, from first step to last.

Wet the hands. Apply soap. Scrub the hands together vigorously for 15 seconds. Rinse the hands. Dry hands Turn off faucet with paper towel.