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Essential Health Assessment 2nd Edition Thompson Test Bank A+

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Essential Health Assessment 2nd Edition Thompson Test Bank A+,,

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  • October 3, 2024
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  • 2024/2025
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Essential Health Assessment 2nd Edition Thompson

Test Bank A+
Chapter 1: Understanding Health Assessment

Question 1 Type: MCSA

The nurse is obtaining a health history from a client who reports that he is healthy and has no

health concerns. As part of the health history, the nurse documents that the client reported that he

has high blood pressure and suffers from a leg ulcer that remains unhealed after 6 months. Which

of the following statements would be the best choice for the nurse to use at this point in the

interview?



1. I feel that you may be in denial about your health status.



2. Tell me about your definition of being healthy.



3. Do you understand what hypertension is?



4. Is there anything else you are not telling me?



Correct Answer: 2



Rationale 1: More information would be needed before the nurse could attribute the clients

viewpoint as denial or lack of knowledge.


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Rationale 2: A client will have his or her own definition of health, illness, and wellness. The

individuals concept of health and wellness is influenced by many factors, including age, gender,

race, family, culture, religion, socioeconomic conditions, environment, previous experiences, and

self-expectations.



Rationale 3: The clients history of hypertension is a valid area requiring further investigation but

the nurse must first ascertain the clients definition of healthy.



Rationale 4: There is not enough information to determine the clients withholding of information

to the nurse.



Global Rationale: A client will have his or her own definition of health, illness, and wellness.

The individuals concept of health and wellness is influenced by many factors, including age,

gender, race, family, culture, religion, socioeconomic conditions, environment, previous

experiences, and self-expectations. More information would be needed before the nurse could

attribute the clients viewpoint as denial or lack of knowledge. The clients history of hypertension

is a valid area requiring further investigation but the nurse must first ascertain the clients

definition of healthy. There is also not enough information to determine the clients withholding

of information to the nurse.



Cognitive Level: Analyzing




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Client Need: Health Promotion and Maintenance



Client Need Sub:



Nursing/Integrated Concepts: Nursing Process: Assessment



Learning Outcome: 1.4: Identify the factors to consider in health assessment



Question 2 Type: MCSA

The nurse is documenting in the clients medical record and wishes to use SOAP charting. The

nurse includes which of the following under the assessment category?



1. The clients blood pressure was 177/93.



2. The recent loss of employment and insurance have prevented the client from being able

to afford prescription medications.



3. The client reports having lost her job and insurance 3 months ago.



4. Referrals have been made to social services to determine financial assistance programs

available.



Correct Answer: 2



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Rationale 1: This is the O component, objective data.



Rationale 2: The A component of the SOAP note refers to conclusions drawn from the subjective

and objective data obtained.



Rationale 3: This is subjective data.



Rationale 4: This is the P component, plan.



Global Rationale: The A component of the SOAP note refers to conclusions drawn from the

subjective and objective data obtained. The clients recent loss of employment and the potential

that this was a contributing factor in the inability to afford medications is an example of a

conclusion. The clients reported blood pressure would be an example of objective data.

Objective data is information that can be measured by the examiner. Blood pressure is not an

example of subjective information nor is it a conclusion. The clients reported loss of employment

and insurance is an example of subjective data. The statement does not include conclusions as to

the results of these events. Making referrals to social services is an example of an intervention. It

is not a conclusion.



Cognitive Level: Applying



Client Need: Health Promotion and Maintenance



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