Question

During the initial physical assessment on a client who is a Vietnamese immigrant, the nurse notices small, circular, ecchymotic areas on the client's knees. The best action for the nurse to take is to

A) Ask the client for more information about the nature of the bruises
B) Ask the client and then the family about the findings
C) Report the bruising to social services to follow-up
D) Document the findings on the admission sheet

Answer 1

The nurse should document the findings on the admission sheet.

Step-by-step explanation:

The best action for the nurse to take is to document the findings on the admission sheet.

The nurse should document the presence of small, circular, ecchymotic areas on the client's knees as part of the initial physical assessment. This is important for maintaining accurate and complete medical records.

By documenting the findings, the nurse ensures that the information is recorded and can be used for future reference and continuity of care.