General Survey 3.0 Test
A nurse is caring for a client who is experiencing severe pain. Which of the following client statements indicates that the client is experiencing chronic pain? Select all that apply.
"The pain isn't always in the same place" "I have had this pain for 9 months." "The pain has been off and on for about a year now"
A nurse is documenting information in a client's medical record. Which of the following information did the nurse collect during the general survey? Select all that apply.
- Height and weight - Behavior and mood - Use of assistive devices
A nurse is providing teaching to a client who asks, "What are things that can affect my blood pressure?" Which of the following information should the nurse include as factors that affect blood pressure? Select all that apply.
- Obesity - Diuretic medication - Time of day - Smoking
A nurse is planning to obtain orthostatic blood pressures from a client who has syncope. In what order should the nurse complete the steps?
1. Place the client in a supine position and allow them to rest 2. Take the client's blood pressure in the supine position 3. Keep the cuff in place and assist the client to a seated position 4. Take the client's blood pressure in a seated position 5. Assist the client to stand and then obtain their blood pressure
A nurse is preparing to conduct a general survey and assessment on a newly admitted client. Which of the following actions should the nurse plan to take?
Engage in active listening with the client and allow the client to express concerns early in the assessment process.
A nurse is preparing to obtain a client's height during a general survey. Which of the following actions should the nurse take?
Ensure the client's feet are in contact with the wall or measuring pole.
A nurse is conducting a general survey on a client and notes a continuous twitching movement of a muscle in the client's left arm. Which of the following terms should the nurse use to describe this involuntary movement?
Fasciculation
When conducting a general survey of a client, the nurse should assess ________, ________, and ________.
Gait, Speech, and Level of Consciousness
A nurse is documenting a client's vital signs in the medical record following a general survey. Which of the following entries should the nurse place in the record?
Oxygen saturation 96% on oxygen 2 L/min via nasal cannula
A nurse is having difficulty obtaining a pulse oximetry reading from a client. The nurse should identify which of the following factors as possibly interfering with obtaining a pulse oximetry reading?
Recent scan with contrast dye
A nurse is caring for an adult client who is comatose. Which of the following routes should the nurse use to obtain the most accurate core body temperature of the client?
Rectal
A nurse is obtaining a client's pulse and notes a regular rhythm with a rate of 110/min. The nurse should identify this as which of the following unexpected findings?
Tachycardia
A nurse is assessing a client's respirations and notes they are shallow and at a rate of 24/min. The nurse should identify this as which of the following unexpected findings?
Tachypnea
While conducting a general survey on a client who is being admitted to a long-term care facility, a nurse is assessing the client's emotional state. Which of the following findings should the nurse record as an unexpected finding?
The client reports they feel sad and lonely most of the time.
A nurse assesses a client's respiratory rate and notes that it is below the expected reference range. The nurse should identify that which of the following findings can decrease a client's respiratory rate?
The client takes a narcotic pain medication for chronic pain.
A nurse is admitting a client who is 162.6 cm (64 in) tall and weighs 68.2 kg (150 lb). Using the BMI table shown below, what should the nurse record as the client's BMI? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)
The nurse should record the client's BMI as 25.
