1. A nurse on a postsurgical unit is admitting a client following the client's
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cholecystectomy (gall bladder removal). What is the overall purpose of assessment for
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this client?
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A) Collecting accurate data f f
B) Assisting the primary care provider f f f f
C) Validating previous data f f
D) Making clinical judgments f f
2. A client has presented to the emergency department (ED) with complaints of abdominal
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pain. Which member of the care team would most likely be responsible for collecting the
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subjective data on the client during the initial comprehensive assessment?
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A) Gastroenterologist
B) ED nurse f
C) Admissions clerk f
D) Diagnostic technician f
3. The nurse has completed an initial assessment of a newly admitted client and is applying
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the nursing process to plan the client's care. What principle should the nurse apply when
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using the nursing process?
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A) Each step is independent of the others. f f f f f f
B) It is ongoing and continuous.
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C) It is used primarily in acute care settings.
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D) It involves independent nursing actions.
f f f f
4. The nurse who provides care at an ambulatory clinic is preparing to meet a client and
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perform a comprehensive health assessment. Which of the following actions should the
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nurse perform first?
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A) Review the client's medical record. f f f f
B) Obtain basic biographic data. f f f
C) Consult clinical resources explaining the client's diagnosis. f f f f f f
D) Validate information with the client. f f f f
5. Which of the following client situations would the nurse interpret as requiring an
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emergency assessment?
f f
A) A pediatric client with severe sunburn
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B) A client needing an employment physical
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C) A client who overdosed on acetaminophen
f f f f f
D) A distraught client who wants a pregnancy test
f f f f f f f
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6. In response to a client's query, the nurse is explaining the differences between the
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physician's medical exam and the comprehensive health assessment performed by the
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nurse. The nurse should describe the fact that the nursing assessment focuses on which
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aspect of the client's situation?
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A) Current physiologic status f f
B) Effect of health on functional status f f f f f
C) Past medical history f f
D) Motivation for adherence to treatment f f f f
7. After teaching a group of students about the phases of the nursing process, the instructor
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determines that the teaching was successful when the students identify which phase as
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being foundational to all other phases?
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A) Assessment
B) Planning
C) Implementation
D) Evaluation
8. The nurse has completed the comprehensive health assessment of a client who has been
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admitted for the treatment of community-acquired pneumonia. Following the
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completion of this assessment, the nurse periodically performs a partial assessment
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primarily for which reason?
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A) Reassess previously detected problems f f f
B) Provide information for the client's record f f f f f
C) Address areas previously omitted f f f
D) Determine the need for crisis intervention f f f f f
9. The nurse is working in an ambulatory care clinic that is located in a busy, inner-city
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neighborhood. Which client would the nurse determine to be in most need of an
f f f f f f f f f f f f f f
emergency assessment?
f f
A) A 14-year-old girl who is crying because she thinks she is pregnant
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B) A 45-year-old man with chest pain and diaphoresis for 1 hour
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C) A 3-year-old child with fever, rash, and sore throat
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D) A 20-year-old man with a 3-inch shallow laceration on his leg
f f f f f f f f f f
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10. A nurse has completed gathering some basic data about a client who has multiple health
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problems that stem from heavy alcohol use. The nurse has then reflected on her personal
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feelings about the client and his circumstances. The nurse does this primarily to
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accomplish which of the following?
f f f f f
A) Determine if pertinent data has been omitted f f f f f f
B) Identify the need for referral f f f f
C) Avoid biases and judgments f f f
D) Construct a plan of care f f f f
11. The nurse is collecting data from a client who has recently been diagnosed with type 1
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diabetes and who will begin an educational program. The nurse is collecting subjective
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and objective data. Which of the following would the nurse categorize as objective data?
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A) Family history f
B) Occupation
C) Appearance
D) History of present health concern f f f f
12. An older adult client has been admitted to the hospital with failure to thrive resulting
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from complications of diabetes. Which of the following would the nurse implement in
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response to a collaborative problem?
f f f f f
A) Encourage the client to increase oral fluid intake. f f f f f f f
B) Provide the client with a bedtime protein snack. f f f f f f f
C) Assist the client with personal hygiene. f f f f f
D) Measure the client's blood glucose four times daily. f f f f f f f
13. The nurse at a busy primary care clinic is analyzing the data obtained from the
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following clients. For which clients would the nurse most likely expect to facilitate a
f f f f f f f f f f f f f f
referral?
f
A) An 80-year-old client who lives with her daughter
f f f f f f f
B) A 50-year-old client newly diagnosed with diabetes
f f f f f f
C) An adult presenting for an influenza vaccination
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D) A teenager seeking information about contraception
f f f f f
14. An instructor is reviewing the evolution of the nurse's role in health assessment. The
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instructor determines that the teaching was successful when the students identify which
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of the following as the major method used by nurses early in the history of the
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profession?
f
A) Natural senses f
B) Biomedical knowledge f
C) Simple technology f
D) Critical pathways f
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