The nurse is assessing a client with an injury to the knee. What should the nurse do during this assessment?
1. Extend the knee joint to determine injury.
2. Check the client's gait.
3. Check capillary proximal to the injury.
4. Move the joint to the point of pain.
Answer: 4
1. The nurse would determine the ability to move the joint but not past the point of pain.
2. The nurse should not have the client walk on the injury.
3. Capillary refill is assessed distal to the injury.
4. The nurse moves the joint but stops as soon as the client indicates pain to prevent further injury.
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