WILSON: HEALTH ASSESSMENT FOR NURSING PRACTICE, 7TH EDITION TEST BANK Table of Contents Chapter 01: Introduction to Health Assessment ................................ ........................ 3 Chapter 02: Obtaining a Health History ................................ ................................ ... 10 Chapter 03: Techniques and Equipment for Physical Assessment ........................... 30 Chapter 04: General Inspection and Measurement of Vital Signs ............................ 46 Chapter 05: Cultural Assessment ................................ ................................ ............. 57 Chapter 06: Pain Assessment ................................ ................................ .................. 66 Chapter 07: Mental Health Assessment ................................ ................................ .. 76 Chapter 08: Nutritional Assessment ................................ ................................ ........ 87 Chapter 09: Skin, Hair, and Nails ................................ ................................ ............ 100 Chapter 10: Head, Eyes, Ears, Nose, and Throat ................................ .................... 117 Chapter 11: Lungs and Respiratory System ................................ ........................... 158 Chapter 12: Heart and Peripheral Vascular System ................................ ............... 176 Chapter 13: Abdomen and Gastrointestinal System ................................ .............. 195 Chapter 14: Musculoskeletal System ................................ ................................ ..... 217 Chapter 15: Neurologic System ................................ ................................ ............. 233 Chapter 16: Breasts and Axillae ................................ ................................ ............. 253 Chapter 17: Reproductive System and the Perineum ................................ ............ 266 Chapter 18: Developmental Assessment Throughout the Life Span ...................... 289 Chapter 19: Assessment of the Infant, Child, and Adolescent ............................... 299 Chapter 20: Assessment of the Pregnant Patient ................................ .................. 324 Chapter 21: Assessment of the Older Adult ................................ ........................... 340 Chapter 22: Conducting a Head -to-Toe Examination ................................ ............. 352 Chapter 23: Documenting the Comprehensive Health Assessment ....................... 356 Chapter 24: Adapting Health Assessment to the Hospitalized Patient ................... 360 Chapter 01: Introduction to Health Assessment Wilson: Health Assessment for Nursing Practice, 7th Edition MULTIPLE CHOICE 1. A Patient comes to the emergency department and tells the triage Nurse that he is “having a heart attack.” What is the Nurse ’s top priority at this time? a. Determine the Patient ’s personal Data and insurance coverage. b. Ask the Patient to take a seat in the waiting room until his name is called. c. Request that a Nurse collect Data for a comprehensive history. d. Ask a Nurse to start a focused Assessment of this Patient now. ANS: D The Nurse needs to begin an Assessment as soon as possible that is focused on this Patient ’s cardiovascular system. The type of Health Assessment performed by the Nurse is also driven by Patient need. Personal Data and insurance information will be obtained, but in this situation, these Data can wait until after the Patient is assessed. Based also on Maslow’s hierarchy of needs, physiologic needs take precedence. Rather than asking the Patient to wait, the Nurse needs to begin Data collection, such as vital signs, immediately to determine the Patient ’s Health status. Complications can be prevented if an immediate Assessment is made to analyze the Patient ’s symptoms. A comprehensive history is not indicated in this situation at this time. Some subjective Data will be collected, such as allergies and medical history related to cardiovascular disease. Eyes, ears, or a complete musculoskeletal or mental Health Assessment is not a priority at this time. DIF: Cognitive Level: Apply REF: Box 1-3 | p. 3 TOP: Nursing Process: Assessment MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Manageme nt of Care: Establishing Priorities 2. Which situation illustrates a screening Assessment ? a. A Patient visits an obstetric clinic for the first time and the Nurse conducts a detailed history and physical examination. b. A hospital sponsors a Health fair at a local mall and provides cholesterol and blood pressure checks to mall patrons. c. The Nurse in an urgent care center checks the vital signs of a Patient who is complaining of leg pain. d. A Patient newly diagnosed with diab etes mellitus comes to test his fasting blood glucose level. ANS: B A Health fair at a local mall that provides cholesterol and blood pressure checks is an example of a screening Assessment focused on disease detection. A detailed history and physical examination conducted during a first -time visit to an obstetric clinic is an example of a comprehensive Assessment . Assessing a Patient complaining of leg pain in the triage area of an urgent care center is an example of a problem -based/focused Assessment . A Patient ’s return appointment 1 month after today’s office visit to report fasting blood glucose levels is an exam ple of an episodic or follow -up Assessment . DIF: Cognitive Level: Understand REF: Box 1 -3 | p. 3 TOP: Nursing Process: Assessment MSC: NCLEX Patien t Needs: Health Promotion and Maintenance: Health Screening 3. For which person is a screening Assessment indicated? a. The person who had abdominal surgery yesterday b. The person who is unaware of his high serum glucose levels c. The person who is being admitted to a long -term care facility d. The person who is beginning rehabilitation after a knee replacement ANS: B A screening Assessment is performed for the purpose of disease detection. In this case this person may have diabetes mellitus. A shift Assessment is most appropriate for the person who is recovering in the hospital from surgery. A comprehensive Assess ment is performed during admission to a facility to obtain a detailed history and complete physical examination. An episodic or follow -up Assessment is performed after knee replacement to evaluate the outcome of the procedure.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller lauraskyperfect. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $13.39. You're not tied to anything after your purchase.
