Health Assessment ATI
A nurse has performed preoperative care on a client and is transferring the client to the surgical holding area when the client states, "I have changed my mind. I do not want to have this surgery." Which of the following ethical principles is the client using?
Autonomy
A nurse is performing a pre admission assessment on a client and employs the use of nonverbal and verbal communication. Which of the following actions demonstrates the use of a nonverbal communication technique by the nurse?
Maintain an arms length between self and client.
A nurse is performing auscultation during a clients physical assessment. Which of the following tools should the nurse use for this part of the assessment?
Stethoscope
A nurse is documenting their assessment and documents that the client states, "I have a dry cough every morning when I wake up." Which of the following types of data is the nurse documenting?
Subjective
The nurse is completing documentation in a clients medical record. Which of the following entries display proper documentation by the nurse?
The clients abdomen is soft and nondistended.
A nurse is preparing to perform a physical exam on a client. Which of the following interventions should the nurse perform to ensure client privacy?
Do not expose any more of the clients body than required at a time
A nurse is preparing to perform palpation on a client during a physical assessment. Which of the following findings is the nurse assessing during palpation?
Skin temperature, moisture, and abnormalities
A nurse is preparing to assess a newly admitted client. Which of the following pieces of equipment does the nurse need to begin the inspection part of the physical examination?
penlight, tape measure, tongue depressor