Nursing Assessment Exam 1 (1-9) Questions with Correct Answers
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Advanced RN math ability
Institution
Advanced RN Math Ability
What are the 6 steps of the nursing process? if asking for 5 remove (outcome identification) - Answer-ADOPIE
Assessment
Diagnosis
Outcome Identification
Planning
Implementation
Evaluation
What are the types of Health Assessment? - Answer-1) Comprehensive assessment
2)Problem-based/Focuse...
Nursing Assessment Exam 1 (1-9)
Questions with Correct Answers
What are the 6 steps of the nursing process? if asking for 5 remove (outcome
identification) - Answer-ADOPIE
Assessment
Diagnosis
Outcome Identification
Planning
Implementation
Evaluation
What are the types of Health Assessment? - Answer-1) Comprehensive assessment
2)Problem-based/Focused assessment
3) Emergency assessment
What are the 3 primary components of Health Assessment? - Answer-History
(subjective data)
Physical examination (objective data)
Documentation of data
Why do we document all of our data? - Answer-Improves plan of care
It is a legal document of patient's health
Draws a baseline for future evaluations
It must be accurate, concise, and without bias
T/F If it is not documented you did not do it. - Answer-True
What is context of care? - Answer-it refers to circumstance or situation related to health
care delivery.
1) may be related to setting or environment
2) may be related to physical, psychological, or SES circumstances involving the pt.
What is a comprehensive assessment? - Answer-A detailed H&P exam performed at
the onset of care in a primary care setting or on admission to a hospital or long-term
facility.
What is a Problem-based/focused assessment? - Answer-the problem-based or
focused assessment involves a history and examination that are limited to a specific
problem or complaint. This type of assessment is most commonly used in a walk-in
clinic or emergency department, but it may also be applied in other outpatient setting.
What is emergency assessment? - Answer-life-threatening situation
,What is a screening assessment? - Answer-a short examination focused on disease
detection. usually conducted in health fairs.
What is Health promotion? - Answer-Behavior motivated by desire to increase well-
being and actualize health potential.
What is Health protection? - Answer-Behavior motivated by desire to avoid illness,
detect illnesses early, and maintain functioning when ill.
What are the 3 levels of health promotion? - Answer-Primary= preventing disease from
developing through promoting a healthy lifestyle.
Secondary= Screening efforts to promote early detection of disease.
Tertiary= minimizing disability from acute or cronic illness or injury and allowing for most
productive life within lilmitations.
What are examples for the 3 levels of health promotion? - Answer-Primary=
Immunizations
Secondary= Mammogram
Tertiary = The disease is already present: Hypertension management.
A mother of three is being seen for a screening assessment. While planning the initial
part of the visit with this patient, the nurse needs to ensure that:
a)The patient receives a refill for her thyroid medication.
b)The patient is instructed on preventive measures for hypertension.
C)Other family members are present during the interview.
D)Information about the patient's lifestyle habits is gathered. - Answer-Correct Answer:
D
Rationale: There are multiple types of health assessments. If a patient receives a refill,
this is an episodic or follow-up assessment. If a patient is instructed in preventive
measures, this is more along the lines of a comprehensive assessment. A screening
assessment would require the nurse to have data about lifestyle habits.
The medical-surgical nurse is reviewing the practice related to a patient who acquired
pneumonia while recovering from a hip replacement. The unit documents this event as
failure to rescue and would like the nurse to develop a personal professional action
plan. This plan will most likely include:
A)Reflection on action
B)Tertiary prevention of health care-associated infections
C)Reasoning patterns - Answer-Correct Answer: A
Rationale: Reflection on action represents the contribution of an experience to a nurse's
collective experiences. Reflection in action specifically relates to evaluating outcomes of
interventions. The nurse needs to look at his practice to identify whether something can
change.
, A nurse is assessing a female teenager. The nurse asks the young woman to bend over
and touch her toes. The nurse assesses the curvature of the spine as a means of
detecting scoliosis. Assessing the curvature of the spine is an example of:
A)Health education
B)Primary prevention
C)Secondary prevention
D)Tertiary prevention - Answer-Correct Answer: C
Rationale: Primary prevention is preventing the disease before it begins. Secondary
prevention means that the nurse is trying to detect disease as early as possible to
improve outcomes.
What are the two primary components of health assessment? - Answer-Health history
Physical examination
Is a health history subjective or objective data? - Answer-Subjective
Single-most important factor for successful interviewing is the ______ skill of the nurse.
- Answer-communication
What are some factors that affect a nurses therapeutic communication? - Answer-
Physical setting, nurse behaviors, type of questions asked, how questions are asked.
Behavior of pt. How the pt. feels during the interview, nature of information being
discussed or problem being confronted
Begin interviews with what type of questions? - Answer-open-ended. encourage a free-
flowing open response.
If want more precise data from your patients what type of question should you ask? -
Answer-Close-ended
What do directive questions do? - Answer-lead patient to focus on one set of thoughts.
Most often used in reviewing systems and evaluation functional status.
Use _____ to help concentrate on pt. responses and subtleties. - Answer-listening
_______ uses verbal and nonverbal phrases to encrourage patinets to continue to talk
further. - Answer-Facilitation
_____ is used to gather more information. - Answer-Clarification.
_______ is repeating what patient says ini different words to confirm interpretation. -
Answer-Restatement
_____ reflection is repeating what the patient said and encourages elaboration or more
information. - Answer-Reflection
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