A nurse is collecting data from a client about pitting edema and notes an indentation of 6 mm (0.25 in) at the point of pressure. Which of the following numbers should the nurse document to indicate the intensity of the client's edema?

Answer and Explanation

The Correct Answer is B

A. 4+: 4+ pitting edema corresponds to an indentation of 8 mm or more, which is more severe than the 6 mm described in the question.

B. 3+: 3+ pitting edema is characterized by an indentation of 6 mm and indicates moderately severe fluid retention.

C. 2+: 2+ pitting edema corresponds to an indentation of 4 mm, which is less than the 6 mm described.

D. 1+: 1+ pitting edema corresponds to an indentation of 2 mm, which is mild and does not match the severity in the scenario.

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Correct Answer is C

Explanation

A. Denial of pruritus. Pruritus (itching) is a hallmark symptom of contact dermatitis, so its denial would be unusual.

B. Reports of joint discomfort. Joint pain is not a characteristic feature of contact dermatitis; it is more common in systemic inflammatory conditions such as arthritis.

C. Reports of exposure to a skin irritant. Contact dermatitis is caused by direct contact with an irritant or allergen, so a history of exposure is a key finding.

D. Elevated temperature. Fever is not typical of contact dermatitis unless an infection is present.

A. Bruising that covers the arms and legs B. Velvety texture or a gray frosty covering C. Large, raised patches that measure greater than 6mm D. Thin skin with little subcutaneous fat

Correct Answer is D

Explanation

A. Bruising that covers the arms and legs. While elderly clients may bruise easily due to fragile blood vessels, widespread bruising suggests coagulopathy, trauma, or abuse, not normal aging.

B. Velvety texture or a gray frosty covering. Velvety skin can indicate endocrine disorders (e.g., acanthosis nigricans), and a gray frost-like appearance suggests uremia (kidney failure), which is not part of normal aging.

C. Large, raised patches that measure greater than 6mm. Skin lesions greater than 6mm should be evaluated for malignancy (e.g., melanoma, seborrheic keratosis).

D. Thin skin with little subcutaneous fat. Aging causes loss of collagen and subcutaneous fat, making the skin thin, fragile, and prone to injury.

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A nurse is collecting data from a client about pitting edema and notes an indentation of 6 mm (0.25 in) at the point of pressure. Which of the following numbers should the nurse document to indicate the intensity of the client's edema?

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Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a client who has contact dermatitis of the neck and upper chest. Which of the following findings should the nurse expect?

Correct Answer is C

Explanation

As clients age. skin goes through several changes. Which of the following identifies a change you may see in an elderly client's skin?

Correct Answer is D

Explanation

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A nurse is collecting data from a client about pitting edema and notes an indentation of 6 mm (0.25 in) at the point of pressure. Which of the following numbers should the nurse document to indicate the intensity of the client's edema?

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