A patient tells the nurse that he is very nervous, nauseous, and “feels hot.” What type of assessment data is this?

NURS330 Individual Assessment

Chapter 1 Quiz

Question 1A patient tells the nurse that he is very nervous, nauseous, and “feels hot.” What type of assessment data is this?

 

  Objective

 

  Reflective

 

  Subjective

 

  Introspective

 

Question 2A patient is brought by ambulance to the emergency department with multiple injuries received in an automobile accident. He is alert and cooperative, but his injuries are quite severe. How would the nurse proceed with data collection?

 

  Collect history information first, then perform the physical examination and institute lifesaving measures.

 

  Simultaneously ask history questions while performing the examination and initiating lifesaving measures.

 

  Collect all information on the history form, including social support patterns, strengths, and coping patterns.

 

  Perform lifesaving measures and delay asking any history questions until the patient is transferred to the intensive care unit.

 

Question 3Which statement best describes a proficient nurse?

 

  Has little experience with a specified population and uses rules to guide performance.

 

  Has an intuitive grasp of a clinical situation and quickly identifies the accurate solution.

 

  Sees actions in the context of daily plans for patients.

 

  Understands a patient situation as a whole rather than a list of tasks and recognizes the long-term goals for the patient.

 

Question 4During a staff meeting, nurses discuss the problems with accessing research studies to incorporate evidence-based clinical decision making into their practice. Which suggestion by the nurse manager would best help these problems?

 

  Form a committee to conduct research studies.

 

  Post published research studies on the unit’s bulletin boards.

 

  Encourage the nurses to visit the library to review studies.

 

  Teach the nurses how to conduct electronic searches for research studies.

 

Question 5The nurse is performing a physical assessment on a newly admitted patient. Which is an example of objective information obtained during the physical assessment?

 

  Patient’s history of allergies

 

  Patient’s use of medications at home

 

  Last menstrual period 1 month ago

 

  2 × 5 cm scar on the right lower forearm

 

Question 6The clinic nurse is caring for a patient who has been coming to the clinic weekly for blood pressure checks since she changed medications 2 months ago. Which is the most appropriate action for the nurse to take?

 

  Collect a follow-up database and then check the patient’s blood pressure.

 

  Ask the patient to read her health record and indicate any changes since her last visit.

 

  Check the patient’s blood pressure.

 

  Obtain a complete health history on the patient before checking her blood pressure.

 

Question 7The nursing process is a sequential method of problem solving that nurses use and includes which steps?

 

  Assessment, treatment, planning, evaluation, discharge, and follow-up

 

  Admission, assessment, diagnosis, treatment, and discharge planning

 

  Admission, diagnosis, treatment, evaluation, and discharge planning

 

  Assessment, diagnosis, outcome identification, planning, implementation, and evaluation

 

Question 8The nurse recognizes that which concept of prevention is essential in describing health?

 

  Disease can be prevented by treating the external environment.

 

  The majority of deaths among Americans under age 65 years are not preventable.

 

  Prevention places the emphasis on the link between health and personal behavior.

 

  The means to prevention is through treatment provided by primary health care practitioners.

 

Question 9The nurse is reviewing data collected after an assessment. Of the data listed below, which would be considered related cues that would be clustered together during data analysis? (Select all that apply.)

 

  Inspiratory wheezes noted in left lower lobes

 

  Hypoactive bowel sounds

 

  Nonproductive cough

 

  Edema, +2, noted on left hand

 

  Patient reports dyspnea upon exertion

 

  Rate of respirations 16 breaths per minute

 

Question 10A newly admitted patient is in acute pain, has not been sleeping well lately, and is having difficulty breathing. How should the nurse prioritize these problems?

 

  Breathing, pain, and sleep

 

  Breathing, sleep, and pain

 

  Sleep, breathing, and pain

  Sleep, pain, and breathing

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