EAQ chapter 1

The nurse is performing a screening examination for a patient using the Guide to Clinical Preventive Services. Which questions would the nurse include in the assessment? Select all that apply.

"Are you sexually active?" "Do you use alcohol or drugs?" "What is your height and weight?"

Which questions would the nurse ask during a follow-up database to determine compliance for the patient with new-onset type 1 diabetes mellitus? Select all that apply.

"Can you tell me what you eat on a normal day?" "How often do you perform blood glucose monitoring?" "How often do you perform blood glucose monitoring?"

Which question posed by the nurse is most appropriate to determine the next step in treatment for the patient who presents to the urgent care with a cough and is febrile?

"How long have you had the cough?"

While interviewing a patient in the clinic with arthritis, the nurse asks the patient questions from a follow-up database. Which question would the nurse ask during the assessment?

"Is the pain getting better or worse?"

Which statement made by the student nurse about the "evaluation" phase of the nursing process indicates effective learning?

"It is done to determine whether outcome goals have been met."

While assessing a Hispanic child, the nurse finds that the child's parents use herbal remedies, perform prayers, and consult the health care provider only when the child is ill. Which approach will the nurse take to provide culturally competent care?

Acknowledging the parents' practices

The nurse is caring for a patient who is hypertensive with acute abdominal pain and an increased heart rate and urinary frequency. The patient is anxious and hallucinating. Which of these conditions can be categorized as second-level priority problems? Select all that apply.

Acute pain Urinary frequency Change in mental status Abnormal electrolyte levels

In which case would a nurse establish a complete database of a patient? Select all that apply.

During an initial home visit In a primary health care setting In a community health care setting

The nurse caring for a patient with coronary artery disease finds the patient is nonresponsive and without a pulse. Which nursing intervention is best in this situation?

Beginning CPR with chest compression

Which is the foundation for evidence-based practice (EBP)?

Assessment

Which intervention would the nurse assign as the highest priority for a diabetic patient who presents to the emergency department with shortness of breath and decreased alertness?

Assist with breathing

A nursing student is completing an assessment on a patient with a diagnosis of human immunodeficiency virus (HIV) with a holistic approach in mind. Which action by the student indicates a need for further teachings?

Assuming the patient will not adhere to the treatment

Which factors encompass evidence-based practice? Select all that apply.

Clinical expertise Research findings Clinical knowledge Patient preferences

Which interventions will the nurse do to obtain objective data? Select all that apply.

Conduct a physical examination. Review the laboratory reports. Summon previous medical records.

During an assessment, the nurse reviews the clinical reports, health history, and conducts a physical examination. Which additional interventions would the nurse perform? Select all that apply.

Conduct a risk assessment. Conduct a functional assessment.

Which condition would the nurse categorize as a third-level priority problem?

Impaired physical activity

Which type of database would the nurse establish when caring for a patient with a skin infection and assessing the patient for fever and pain related specifically to the skin lesions?

Problem-centered

Which information is important for the nurse to know when providing care for people from diverse backgrounds?

Cultural competence

Which activity is the primary focus of the nursing process?

Diagnosing patient responses to actual or potential health problems

Upon reviewing a laboratory report, the nurse finds that the patient has hyperlipidemia and hypercholesterolemia. During which phase of the nursing process will the nurse use this data?

Diagnosis

Which database would the nurse establish for a patient who has accidentally consumed a pesticide?

Emergency

Which nursing action is the priority for a patient in the urgent care setting who reports having "crushing" chest pain?

Emergency assessment to initiate lifesaving measures

The nurse manager is explaining diagnostic reasoning in analyzing assessment data to a novice nurse before assessing a patient. Which are the components of this process? Select all that apply.

Evaluating each hypothesis Attending to initial available cues Formulating hypotheses based on data Gathering data to develop speculative hypotheses

The nurse is developing a holistic wellness program for a group of young adults at a college campus. Based on this model, which information would the nurse include when performing a focused assessment? Select all that apply.

Exercise Role in family Level of stress

Which database would the nurse complete for a patient who reports slight pain in the left ear for the past 2 days?

Focused

The nurse is caring for a patient who was in a car accident and has a knee ligament injury. The health care provider has prescribed a knee brace. After 2 weeks, the nurse assesses the patient and documents that the patient has a wider range of motion and less pain in the knee. Which type of database did the nurse establish in this situation?

Follow-up

A patient who complains of frequent urination and thirst is found to have lower limb edema and seborrheic dermatitis. Laboratory results include a fasting blood glucose level of 140 mg/dL. Which data obtained during the assessment are categorized as subjective data?

Frequent urination

Which assessment data would the nurse cluster together to determine the priority care for a patient with new-onset type 1 diabetes mellitus (DM)? Select all that apply.

Frequent urination No knowledge of type 1 DM Blood glucose level 425 mg/dL

While preparing a complete database for a 35-year-old female patient with diabetes, the nurse determines that the patient is following appropriate health-promotion techniques. Which findings support the nurse's conclusion? Select all that apply.

Has dental visits twice a year Walks 2 miles 3 times a week Uses sunscreen when going outside

During an assessment, the nurse evaluates the patient's perception of illness, activities of daily living, and health maintenance behaviors to establish a complete database. Which additional information would the nurse collect from the patient? Select all that apply.

Health goals Coping patterns Functional ability Partner intimacy

A nurse manager is presenting to management. Which information would the nurse manager include in a presentation about the importance of incorporating evidence-based practice (EBP) at the bedside?

Improved patient outcomes

Nursing care plans are written accurately and kept up-to-date. Which rationale supports the practice of writing accurate nursing care plans and keeping them up-to-date? Select all that apply.

Is useful for conducting research Assists with insurance reimbursement Helps evaluate the patient's response to treatment

Which emerging minorities would the nurse keep in mind when addressing health and wellness to a group at a local community center? Select all that apply.

Latinos Asian Americans African Americans

Upon entering a patient's room, the nurse notices the patient has a low oxygen saturation, and the patient reports a history of asthma and feeling short of breath within the past 5 minutes. Which finding would be documented under objective data?

Low oxygen saturation

Which condition would the nurse consider a third-level priority problem in a patient with a diagnosis of coronary artery disease who is hypertensive and who has chest pain, lower limb edema, and difficulty breathing?

Lower limb edema

A patient with bronchoconstriction and impaired skin integrity is found to have hypotension, tachypnea, decreased bowel movements, and reduced blood supply to the lower limbs. Which conditions are categorized as highest-level priority problems? Select all that apply.

Obstruction of the airway Change in vital signs Difficulty breathing Reduced circulation

Which function(s) do the nursing diagnoses in a plan of care serve? Select all that apply.

Organize the appropriate assessment data Serve as a focus for nursing documentation Provide a basis for developing a care plan

After performing an assessment on a patient, which information is documented under subjective data?

Pain level 8/10 in left hip

Which patient requires a database different from the one created by the nurse?

Patient C, patient C has undergone surgery and is experiencing a congested cough, so the nurse would establish a focused database, not a follow-up database, about the patient's respiratory problems.

Which type of database is suitable for a short-term problem?

Problem-centered

The nurse obtains the following data from a patient assessment: lung sounds are coarse throughout, regular heart rhythm, denies pain, ambulates with minimal assistance, and reports a productive cough. Which would the nurse document under objective data? Select all that apply.

Regular heart rhythm Lung sounds coarse throughout Ambulates with minimal assistance

Which are considered barriers to individual nurses performing research to improve nursing practice? Select all that apply.

Research skills Time to perform research Amount of available resources Confidence to implement changes

Which information would be most appropriate for the nurse to obtain when obtaining a complete database? Select all that apply.

Smokes 1 pack per day Current medication list Obtains screening tests

In which area of the medical record would the nurse document the patient's report of burning with urination?

Subjective data

Which pieces of data are considered subjective?

Symptoms reported by the patient

Which condition in a child necessitates the nurse establishing an emergency database for submission to the health care provider?

The child has consumed a disinfectant.

Which nurse is most likely to skip steps and arrive at a clinical judgment instantly during the nursing process?

The expert nurse

For which information would the nurse refer to the Guide to Clinical Preventive Servicesregularly? Select all that apply.

Up-to-date screening methods for disorders Description of various health counseling strategies Identification of the preventive measures for various disorders

Which describes the role of the novice nurse in respect to problem-solving?

Uses rules to guide performance

The nurse is preparing a care plan for a patient with a complex cardiovascular disorder. Which actions would the nurse consider to provide effective care for the patient? Select all that apply.

Work with the patient to facilitate outcome achievement. Discuss patient data with the interdisciplinary team members. Set small, achievable goals to be accomplished in a given time frame.