Unit 1 Ch. 1 PrepU questions
focused
A home health nurse is visiting a patient who recently was hospitalized for repair of a fractured hip. The patient tells the nurse, "I have had a lot of pain in my abdomen." What type of assessment would the nurse conduct?
significantly impaired hearing
The nurse has completed a health assessment on an older adult client being seen at a neighborhood clinic. What client-specific information should the nurse identify as being a priority?
Ongoing or partial
A nurse recommends that a client come back once every 3 months in the coming year to have his cholesterol checked, to make sure he is maintaining a healthy level. Which type of assessment is the nurse proposing?
Ongoing
After receiving morning report the nurse prepares to assess a client who was admitted the day before. Which type of assessment will the nurse complete at this time?
Participating in a client care conference
Nurses provide both direct and indirect care. What is an example of indirect care?
Appearance
The nurse is collecting data from a client. Which of the following best reflects objective data?
Measuring blood pressure, inquiring about a client's nutritional intake, assessing for depression, and asking the client how his condition affects family gatherings
Which of the following is the best example of holistic data collection by a nurse?
environmental
During a health assessment the nurse learns that a client lives in an urban area with a high crime rate. Which category of health is affecting this client?
Healthy People 2020
Staff are talking to the hospital educator and ask about "a government project that is meant to improve the health of people in the United States." The educator bases her response on the knowledge of
Primary
The RN is implementing which level of intervention when administering immunizations at a pediatric clinic?
A 50-year-old client newly diagnosed with diabetes
The nurse at a busy primary care clinic is analyzing the data obtained from the following clients. For which clients would the nurse most likely expect to facilitate a referral?
focused or problem-oriented assessment.
An assessment of a client who already has a complete recorded database in the system and returns to the health care agency with a specific health concern is referred to as a(n)
Focused assessment
A client comes to the health care provider's office for a visit. The client has been seen in this office on occasion for the past 5 years and arrives today complaining of a fever and sore throat. Which type of assessment would the nurse most likely perform?
Ask the client about the most recent experiences of pain.
A client who is new to the facility has a recent history of chronic pain that is attributed to fibromyalgia. The nurse has reviewed the available health records and suspects that pain management will be a major focus of nursing care. How can the nurse best validate this assumption?
Collect subjective data related to overall function
A nurse conducts an initial comprehensive assessment for a client admitted with a fever of unknown origin. Which area of assessment is primarily the nurse's responsibility?
Determine any changes from the baseline data
A nurse provides care for a client with impaired respiratory function. The nurse frequently assesses the client's skin color and the temperature of the extremities. What is the purpose of this ongoing or partial assessment?
Open the client's airway
An adult client is brought to the ED by ambulance and is anxious and very short of breath. While the nurse is completing the emergency assessment, the client stops breathing. What is the first action of the nurse?
Evaluation
Revising the plan as needed occurs in what part of the nursing process?
"I feel so tired sometimes." Client complains of a headache "My father died of a heart attack."
The nurse is reviewing a client's health history and the results of the most recent physical examination. Which of the following data would the nurse identify as being subjective? Select all that apply.
Head-to-toe
The preceptor of the student nurse is explaining the assessment that is considered the most organized for gathering comprehensive physical data. What assessment is the preceptor talking about?
Reassess previously detected problems
The nurse has completed the comprehensive health assessment of a client who has been admitted for the treatment of community-acquired pneumonia. Following the completion of this assessment, the nurse periodically performs a partial assessment primarily for which reason?
Appearance
The nurse is collecting data from a client who has recently been diagnosed with type 1 diabetes and who will begin an educational program. The nurse is collecting subjective and objective data. Which of the following would the nurse categorize as objective data?
Interpret the information about the client in context.
The nurse is performing a health assessment on a community-dwelling client who is recovering from hip replacement surgery. Which of the following actions should the nurse prioritize during assessment?
Collect subjective data
When performing the steps of the assessment phase of the nursing process, which of the following would the nurse do first?
Measuring the remaining tread on a car tire to determine whether it is time to replace it
Which of the following is the best example of assessment in everyday life?
"I'm going to assess the client now so that I can begin formulating the care plan."
A client is being admitted to the medical unit after being seen in the emergency department. Which statement by the nurse indicates an understanding of the importance of the appropriate timing of a health assessment?
Making incorrect nursing judgments or diagnoses
A nurse is distracted during her assessment of a client and does not take as thorough or as accurate notes as usual. Her supervisor, who is familiar with the client, reads the patient's chart and questions the nurse. The supervisor should point out to the nurse that which of the following errors is most likely to occur due to the nurse's lapse?
Evaluation
A nurse provides care for a client with an elevated temperature. The client is given the prescribed medication and the nurse checks the client's temperature at repeated intervals. What step of the nursing process is the nurse using to determine if the client has achieved the outcome criteria of the treatment?
Reassess previously detected problems
Following completion of the comprehensive health assessment, the nurse periodically performs a partial assessment primarily for which reason?
Nurses collaborate with clients to identify areas in which clients are willing to make changes
How does a nurse decide what health-promotion activities are necessary for a particular client?
