While assessing a child, the nurse pinches up a small section of the child's skin between the thumb and forefinger, and then quickly releases it. The nurse is assessing for:
a. hydration c. excess fat
b. skin tension d. pain tracks
A
Feedback
A Correct. Skin turgor or elasticity reflects the child's state of hydration. It is assessed by pinching a small section of the child's skin between your thumb and forefinger and quickly releasing it.
B Incorrect. The nurse is not assessing for skin tension.
C Incorrect. The nurse is not assessing for excess fat.
D Incorrect. The nurse is not assessing for pain tracks.
You might also like to view...
Approval of a practical or vocational nursing program is mandatory; accreditation of a program is voluntary
Indicate whether the statement is true or false
The home care nurse is caring for a patient newly prescribed a nonselective beta-blocking agent. What would the nurse include in the teaching plan related to this drug? (Select all that apply.)
A) Take with meals. B) Change position slowly. C) Avoid driving or operating hazardous machinery. D) Warn of possible increase in libido. E) Increase activity levels as much as possible.
An adult client has just received morphine sulfate for severe pain. What would indicate that the pain medication was effective?
a. Client lies very still in bed b. Reduction of the respiratory rate to 8 breaths per minute c. Facial grimacing and verbalization of relief of pain d. Lowering of tachycardia to within normal limits
In planning to teach an older adult client, the nurse should incorporate which of the following teaching methods or principles into the plan?
a. Keeping teaching sessions short b. Teaching in the early morning or late evening c. Putting as much as possible into each teaching session d. Focusing on teaching a family member instead