NURSING 2362 Module 2 Exam with complete solution and Rationale
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NURSING 2362 Module 2 Exam with complete solution and Rationale/ NURSING 2362 Module 2 Exam with complete solution and Rationale/ NURSING 2362 Module 2 Exam with complete solution and Rationale/ NURSING 2362 Module 2 Exam with complete solution and Rationale
nursing 2362 module 2 exam with complete solution and rationale
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NURSING 2362 Module 2 Exam
Questions
1.ID: 8482581693A nurse performing a physical assessment of a client gathers
both subjective and objective data. Which finding would the nurse document as
subjective data?
A The client appears anxious.
B Blood pressure is 170/80 mm Hg.
C The client states that he has a rash. Correct
D The client has diminished reflexes in the legs.
Rationale: The purpose of a physical assessment is to collect both subjective and
objective data. Subjective data, collected during the health history, consist of
information that the client gives about himself or herself. Objective data are
obtained through physical examination and vital signs measurements, what the nurse
observes, and laboratory study and diagnostic test results.
Test-Taking Strategy: Eliminate the options that are comparable or alike and include
data that the nurse would obtain during the physical examination. Review: the
difference between subjective and objective data .
Reference: Jarvis, C. (2008). Physical examination and health assessment (5th ed.,
pp. 2, 55). St. Louis: Saunders.
Cognitive Ability: Applying
Client Needs: Health Promotion and Maintenance
Integrated Process: Communication and Documentation
Content Area: Health Assessment/Physical Exam
Priority Concepts: Clinical Judgment, Evidence
HESI Concepts: Clinical Decision-Making/Clinical Judgment, Evidence-Based
Practice/Evidence Awarded 1.0 points out of 1.0 possible points.
2.ID: 8482581647A nurse is reviewing the findings of a physical examination that
have been documented in a client's record. Which piece of information does the
nurse recognize as objective data?
A The client is allergic to strawberries.
B The last menstrual period was 30 days ago.
C The client takes acetaminophen (Tylenol) for headaches.
D A 1 × 2-inch scar is present on the lower right portion of the abdomen. Correct
Rationale: Subjective data, collected during the health history, consist of
information that the client gives about himself or herself. Objective data are
obtained through physical examination and vital signs measurements, what the nurse
observes, and laboratory study and diagnostic test results. Allergies, the date of the
client’s last menstrual period, and the reported use of medication for headaches are
all subjective data.
, Test-Taking Strategy: Eliminate the options that are comparable or alike and include
data that the nurse would obtain from the client during the health history.
Review: the difference between subjective and objective data .
Reference: Jarvis, C. (2008). Physical examination and health assessment (5th ed.,
pp. 2, 55). St. Louis: Saunders.
Cognitive Ability: Understanding
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process/Assessment
Content Area: Health Assessment/Physical Exam
Priority Concepts: Clinical Judgment, Evidence
HESI Concepts: Clinical Decision-Making/Clinical Judgment, Evidence-Based
Practice/Evidence Awarded 1.0 points out of 1.0 possible points.
3.ID: 8482580699A nurse is making an initial home visit to a client with chronic
obstructive pulmonary disease who was recently discharged from the hospital.
Which type of database does the nurse use to obtain information from the client?
A Episodic
B Follow-up
C Emergency
D Complete Correct
Rationale: A complete database includes a complete health history and a full
physical examination. It describes the client’s current and past state of health and
forms a baseline against which all future changes can be measured. The complete
database is collected in a primary care setting such as a pediatric or family
practice clinic, an independent or group private practice, a college health service,
a women’s healthcare agency, a visiting nurse agency, or a community health
agency. An episodic database is compiled for a limited or short-term problem and
is focused mainly on one problem or one body system. A follow-up database is
used to evaluate an identified problem at regular and appropriate intervals. An
emergency database involves the rapid collection of the data that are often
compiled as lifesaving measures are being performed.
Test-Taking Strategy: Noting the words “initial home visit” in the question will
direct you to the correct option. Review: the different types of databases .
Reference: Jarvis, C. (2008). Physical examination and health assessment (5th
ed., p.8). St. Louis: Saunders.
Cognitive Ability: Applying
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process/Assessment
Content Area: Health Assessment/Physical Exam
Priority Concepts: Evidence, Technology and Informatics
HESI Concepts: Evidence-Based Practice/Evidence, Informatics/Technology
Awarded 1.0 points out of 1.0 possible points.
4.ID: 8482580671A nurse is examining a 25-year-old client who was seen in the
clinic 2 weeks ago for symptoms of a cold and is now complaining of chest
congestion and cough. The nurse should proceed with the examination by
collecting which?
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A Data related to follow-up care
B A complete (total health) database
C Data related to the respiratory system Correct
D Data related to the treatment for the cold
Rationale: An episodic database is compiled for a limited or short-term problem and
is focused mainly on one problem or body system. The history and
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examination will be focused primarily on the respiratory system in this client. A
complete database includes a complete health history and a full physical
examination. It describes the client’s current and past state of health and forms a
baseline against which all future changes can be measured. A follow-up database
is used to evaluate an identified problem at regular and appropriate intervals. Test-
Taking Strategy: Focusing on the data in the question and noting the words “now
complaining of chest congestion and cough” will direct you to the correct option.
Review: the different types of databases .
Reference: Jarvis, C. (2008). Physical examination and health assessment (5th
ed., p. 8). St. Louis: Saunders.
Cognitive Ability: Applying
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process/Assessment
Content Area: Health Assessment/Physical Exam
Priority Concepts: Evidence, Gas Exchange
HESI Concepts: Evidence-Based Practice/Evidence, Oxygenation/Gas Exchange
Awarded 1.0 points out of 1.0 possible points.
5.ID: 8482580661A client is brought to the emergency department after a motor
vehicle accident. The client is alert and cooperative but has sustained multiple
fractures of the legs. How should the nurse proceed with data collection?
A Collect health history information first, then perform the physical examination
B Ask health history questions while performing the examination and initiating
emergency measures Correct
C Collect all information requested on the history form, including social support,
strengths, and coping patterns
D Perform emergency measures and not ask any health history questions until the
client's fractures have been treated in the operating room
Rationale: If the client is alert and cooperative and if the situation is not
lifethreatening, the nurse should attempt to obtain as much subjective and
objective data as possible while caring for the client. Collecting health history
information and then performing the physical examination does not address the
priority, which is treating the client. Collecting all data requested on the history
does not specifically address the client’s immediate problems. Performing
emergency measures and not asking any health history questions does not address
data collection before treatment.
Test-Taking Strategy: Focus on the data in the question and note the words “alert
and cooperative.” Noting that the client has not sustained life-threatening injuries
will direct you to the correct option. Review: the different types of databases .
Reference: Jarvis, C. (2008). Physical examination and health assessment (5th
ed., p. 8). St. Louis: Saunders.
Cognitive Ability: Applying
Client Needs: Health Promotion and Maintenance
Integrated Process: Nursing Process/Assessment
Content Area: Health Assessment/Physical Exam
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