Practice Question
While performing an assessment, the nurse presses the client’s arm with the tip of her thumb, holds for a few seconds, and releases. The nurse observes the client as?
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Correct Answer:
Pitting edema
Rationale:
💠 Pressing the skin with the thumb and observing whether an indentation remains is the standard method of assessing for pitting edema.
💠 Pitting edema indicates fluid accumulation in the interstitial tissues, commonly seen in conditions such as heart failure, renal disease, or liver disease.
💠 The nurse grades the severity of edema based on depth and duration of the pit (e.g., +1 to +4 scale).
💠 This assessment is different from capillary refill, which checks circulation, or peripheral pulses, which assess arterial flow.
💠 It also does not evaluate skin temperature, which requires palpation for warmth or coolness.
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This question is from Health Assessment Exam 2- Examplify which contains 47 questions.
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Question Details
- Category: RN Nursing Exam(s)
- Subcategory: Examplify Exam(s)
- Domain: Health Assessment
- Answer Choices: 4