NURS 210 - Exam 1 QUESTIONS

30 to 50 mm Hg

A normal pulse pressure range for an adult client is typically

uses a flowchart format for easy documentation of objective data

An assessment form commonly used in long-term care facilities is the nursing minimum data set. One primary advantage to this type of assessment form is that it..

decreased body metabolism

An elderly client is seen but he nurse in the neighborhood clinic. The nurse observes that the client is dresses in several layers of clothing, although the temperature is warm outside. The nurse suspects that the clients cold intolerance is a result of...

identify risk factors to the client and his or her significant other

During a client interview, the nurse asks questions about the clients past health history. the primary purpose of asking about past health problems is to...

perception of pain

During an interview, the nurse collects both subjective and objective data from an adult client. subjective data would include the clients....

physiological status

The medical examination differs from a comprehensive nursing examination in that the medical examination focuses primarily on the client's..

continuous

although the assessment phase of the nursing process precedes the other phases, the assessment phase is...

blunt percussion

an adult client visits a clinic and tells the nurse that she suspects that she has urinary tract infection. to detect tenderness over the clients kidneys, the nurse should instruct the client that he or she will be performing

arrive as conclusions about the clients health

before beginning a comprehensive health assessment of an adult client, the nurse should explain to the client that the purpose of the assessment is to..

wash both hands with soap and water

before beginning a physical assessment of a client, the nurse should first

avoids excessive eye contact with the client

during a client interview, the nurse uses nonverbal expressions appropriately when the nurse...

1 1/2 inch diaphragm

during a comprehensive assessment of an adult client, the nurse can best hear high-pitched sounds by using a stethoscope with a ...

inspection

during a comprehensive assessment, the primary technique use by the nurse thought the examination is..

provide the client with information as questions arise

during the interview of an adult client, the nurse should

knowledge of his or her own thoughts on feelings about these issues

For a nurse to be therapeutic with clients when dealing with sensitive issues such as terminal illness or sexuality, the nurse should have

draw a line though the error, writing "error" and initialing

If the nurse make an error while documenting findings on a lens record, the nurse should

focused

In some health care settings, the institution uses an assessment form that assesses only one part of a client. These types of forms are termed..

vital signs

an example of an objective finding in an adult client is

"clients lung sounds were auscultated with a stethoscope and were clear on both sides"

the nurse has assessed the breath sounds of an adult client. The best way for the nurse to document these findings on a client is to write..

allow the client to ventilate his or her feelings

the nurse is beginning a health history interview with an adult client who expresses anger at the nurse. the best approach for dealing with an angry clients is for the nurse to..

comprehensive

when a client first entered the hospital for an elective surgical procedure, the nurse should perform an assessment termed...

validate all data before documentation of the data

The nurse is planning to assess a newly admitted adult client. While gathering data from the client, the nurse should

lacking adequate finances

The nurse is preparing to assess an adult client in the clinic. The nurse observes that the client is eating lightweight clothing that is worn and soiled, although the temperature is below freezing outside. The nurse anticipates that the client may be..

observe for equal bilateral chest expansion of 2.54 ro 5.08cm (1-2in)

The nurse is preparing to assess the respirations of an alert adult client. the nurse should...

prevents missed questions during data collection

The nurse is recording admission data for an adult client using a cued or checklist type of assessment form. This type of assessment form....

normal changes that occur with the aging process

While caring for an 80 year old client in his home, the nurse determines that the clients oral temperature is 35.8c (96.5f). the nurse determines that the client is most likely exhibiting..

focused or problem-oriented assessment

an assessment of a client who already has a complete record database in the system and returns to the health care agency with a specific health concern is referred to as an...

Hyperresonance

during a comprehensive assessment of the lungs of an adult client with a diagnosis of emphysema, the nurse anticipates that during percussion the client will exhibit

working

during an interview between a nurse and a client, the nurse and the client collaborate to identify problems and foals. this occurs during the phase of the interview termed..

rephrasing the clients statements

during an interview with an adult client for the first time, the nurse can clarify the clients statements by

using closed-ended questions

during an interview with an adult client, the nurse can keep the interview from going off course by...

deep palpation

during palpation of a clients organs, the nurse palpates the spleen by applying pressure between 2.5 and 5 cm. The nurse is performing

provides for easy and rapid documentation across clinical settings and populations

one advantage for an institution to use an integrated cued/checklist type of assessment data form is that it

requires a lot of time to complete

one disadvantage of the open-ended questions assessment form is that it....

rapid advances in biomedical knowledge and technology.

the depth and scope of nursing assessment has expanded significantly over the past several decades primarily because of...

indirect percussion

the most commonalty used method of percussion is

record the vital signs

the nurse assesses the clients vital signs as follows: respirations 20 breaths/minute, tympanic temperature 100.9F, pulse 88 beats/min, and blood pressure 104/64 mm Hg. The nurse should..

indicarte aceptase of the clients cultural differences

the nurse has interviewed a hispanic cliicm with limit4ed English skills for the first time. the nurse observes that the client is reluctant to reveal personal information and believes in hot-cold syndrome of disease causation. the nurse should...

expressing interest in a neutral manner

the nurse in planning to interview a client who is being treated for depression. when the nurse enters the examination room, the client is sitting on the bake with shoulders slumped. the nurse should plan to approach this client b..

vital signs

the nurse is assessing an elderly post surgical client in the home. To begin the physical examination, the nurse should first assess the client's..

"are you having pain from your surgery?"

the nurse is caring for a client who is having nothing by mouth (NPO) on the first postoperative day. The clients blood pressure was 120/80 mm Hg approximately 4 hours ago, but it is now 140/88 mm Hg. The nurse should ask the client which ion the following questions?

assess the clients hearing acuity

the nurse is interviewing a 78 year old client for the first time.the nurse should first..

use very basic lay terminology

the nurse is interviewing a client in the clinic for the first time. the client appears to have a very limited vocabulary. the nurse should plan to..

encourage the client to quit smoking

the nurse is interviewing a client in the clinic for the first time. when the cite tells the nurse that he smokes "about two packs of cigarettes a day", the nurse should

explain the role and nurse of the nurse

the nurse is operating to interview an adult client for the first time, the nurse observes that the client appears very anxious . the nurse should..

provide structure and set limits with the client

the nurse is planning to interview a client who has demonstrated manipulative behaviors during past clinic visits. During the interview process, the nurse should plan to...

record how the data were collected

the nurse is preparing to document assessment findings in a client's record. The nurse should..

avoid premature judgments about the client

the nurse is preparing to meet a client in the clinic for the first time. after reviewing the clients record the nurse should..

oral temperature of 37.7c (100F)

the nurse notes which of the following vital sign findings as an abnormal finding in an 88 year old client?

formulation of nursing diagnoses

the results of a nursing assessment is the

explain each procedure being performed and the reason for the procedure

to alleviate a clients anxiety during a comprehensive assessment, the nurse should

check for the presence of defining characteristics

to arrive at a nursing diagnosis or a collaborative problem, the nurse goes though the steps of analysis of data. after proposing possible nursing diagnosis, the nurse should next

review the clients health care record

to prepare for the assessment of a client visiting a neighborhood health care cline, the nurse should first...

blunt percussion

when the nurse places one hand flat on the body surface and uses the fist of the other hand to strike the back of the hand flat on the body surface, the nurse is using

shorter inspiratory phase

while assessing an older adult client's respirations, the nurse can anticipate that the respiratory pattern may exhibit a ....

dorsal surface of the hand

while examining a client the nurse plans to palpate temperate of the skin by using the

maintain eye contact while asking the questions from the from

while interviewing a client for the first time, the nurse is using a standardized nursing history form. the nurse should..

review the ChooseMyPlate information with the client

while interviewing an adult client about her nutrition habits, the nurses should

how do you manage your stress

while interviewing an adult client about the clients stress levels and coping responses, an appropriate question by the nurse is

bone

while percussing an adult client during a physical examination, the nurse can expect to hear flatness over the clients..

percusion

while performing a physical examination on an adult client, the nurse can detect the dentist of an underlying structure by using

use minimal position changes

while performing a physical examination on an older adult, the nurse should plan to

pain relief measurements

while recording the subjective data of an adult client who complains of pain un his lower back, the nurse should include the location of the pain and the....