Hair, Skin, Nails
Skin
Vital Signs plus
Documentation plus
100
The nurse notes loss of hair on the client's scalp during the physical examination.
What is alopecia?
100
Discoloration of the skin and mucous membranes; indicates a lack of oxygen in the blood
What is cyanosis?
100
This type of heart rate may occur in a client with a fever or experiencing stress.
What is tachycardia?
100
Blood pressure of 120/80 is obtained on the right upper extremity of an adult client.
What is normal blood pressure in an adult?
200
The circled area noted below
What is nasolabial fold?
200
The nurse assesses this by pinching a small fold of skin and observing how quickly the skin returns to its original position.
What is skin turgor?
200
A temperature between 35.5 -37.7 degrees Celsius.
What is normothermia?
200
The nurse assesses black and blue discoloration of the skin on the client's left antecubital space.
What is ecchymosis?
300
180-degree or greater nail base; typically noted in conditions with chronic hypoxia
What is clubbing?
300
The nurse assessed this finding by pressing for 5-10 seconds on the client's tibia to evaluate swelling of body tissues due to fluid accumulation.
What is edema?
300
An unlicensed assistive personnel documents an adult client's heart as 56.
What is bradycardia?
300
This mnemonic can be used to obtain information about a client’s symptoms.
What is COLDSPA?
400
Noted on this client's skin
What is petechiae?
400
Depicted in this photo
What is jaundice?
400
The nurse auscultates a respiratory rate of 8 in an adult client.
What is bradypnea?
400
Inspection
What is the first step in performing an assessment?
500
The opening between the upper and lower eyelids
What is palpebral fissure?
500
The client complains of itchiness on their arm.
What is pruritus?
500
A swishing sound caused by turbulent blood flow through a constricted vessel.
What is bruit?
500
The nurse notes an adult client's skin to be red and warm where a bug bite occurred.
What is erythema?