A nurse is assessing a dark-skinned client for pallor. What action is best?

a. Assess the conjunctiva of the eye.
b. Have the client open the hand widely.
c. Look at the roof of the client's mouth.
d. Palpate for areas of mild swelling.


ANS: A
To assess pallor in dark-skinned people, assess the conjunctiva of the eye or the mucous membranes. Looking at the roof of the mouth can reveal jaundice. Opening the hand widely is not related to pallor, nor is palpating for mild swelling.

Nursing

You might also like to view...

The nurse is explaining factors that affect an individual's body alignment, mobility, and daily activity level. Examples of client factors that might decrease mobility and activity include: Standard Text: Select all that apply

1. Vestibular disorder. 2. Spina bifida. 3. Anemia. 4. Overnutrition. 5. Ear canal infection.

Nursing

Which of the following is true of interrater reliability?

a. It is the relationship between ratings by the same person done at two separate times. b. It is the relationship between two or more data collectors' ratings of the same event. c. There is little the researcher can do to increase this type of reliability because numerous data collectors are involved. d. This type of reliability is applicable only to psychosocial instruments.

Nursing

A nurse is reviewing information about a psychiatric medication that describes the amount of the drug that actually reaches systemic circulation unchanged. The nurse identifies this as which of the following?

A) First-pass effect B) Bioavailability C) Solubility D) Biotransformation

Nursing

The nurse differentiates the humoral response from the cell-mediated response. Which statement about cell-mediated response is true?

a. The sensitized lymphocytes attack the cell for which they were sensitized. b. Cells produce new antibodies. c. The response does not occur until the white blood cell (WBC) count rises. d. There is a systemic response of fever and malaise.

Nursing