ATI Comprehensive physical assessment of an adult post test Questions and Answers | Latest Version | 2025/2026 | Correct & Verified

ATI Comprehensive physical assessment of an adult post test Questions and Answers | Latest Version | 2025/2026 | Correct & Verified A nurse is performing a head-to-toe assessment on an adult client. What is the first action the nurse should take during the assessment? Introduce yourself and explain the procedure to the client. When inspecting the client's skin, what does the nurse look for to identify any abnormal findings? The nurse checks for lesions, redness, discoloration, and skin integrity. During the assessment of the client's eyes, what does the nurse assess to check for pupil reaction? The nurse assesses for the direct and consensual response to light and accommodation. When palpating the client's abdomen, what should the nurse be cautious of? The nurse should be cautious of tenderness, rigidity, and abnormal masses. 2 When auscultating the heart, what sounds are the nurse expected to hear? The nurse should expect to hear S1 (lub) and S2 (dub), and any abnormal heart sounds such as murmurs or extra heart sounds. What is the most common finding when inspecting the client's neck for jugular venous distention? Jugular venous distention is commonly observed in clients with right-sided heart failure. What is a key assessment finding when evaluating a client's respiratory system? The nurse should listen for abnormal breath sounds, such as wheezing, crackles, or stridor, and assess the symmetry of the chest expansion. During the musculoskeletal assessment, how should the nurse evaluate the client’s joint function? The nurse should assess the range of motion, joint tenderness, swelling, and any limitations in movement. When assessing a client’s pulses, what should be noted in the documentation? 3 The nurse should note the pulse rate, rhythm, and quality, and any abnormal findings like weak or absent pulses. What is an appropriate way to assess a client’s neurological function during a physical exam? The nurse should assess the client’s mental status, motor function, reflexes, and sensation. When performing an assessment of the client's thoracic cage, what is the nurse looking for? The nurse should check for symmetry, deformities, and any abnormal expansion or retractions during respiration. What is the best way to assess a client's hydration status during the physical exam? The nurse should look for signs of dehydration, such as dry mucous membranes, decreased skin turgor, and concentrated urine. What should a nurse do to check for lymph node enlargement during a physical assessment? The nurse should palpate for lymph nodes in the neck, axillae, and inguinal area and note any tenderness or enlargement. 4 During a comprehensive physical assessment, what would an abnormal finding be when examining the client's extremities? Abnormal findings include cold, pale, or cyanotic extremities, as well as swelling or deformities. When inspecting a client’s mouth, what abnormal finding would indicate a need for further investigation? The nurse should be concerned if the client has lesions, white patches, or excessive dryness, which may indicate infection or disease. What should the nurse look for when assessing the