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Test Bank For Health Assessment for Nursing Practice 7th Edition By Susan Fickertt Wilson Jean Foret Giddens | 9780323661195 | Chapter 1- 24 | All Chapters with Answers and Rationals$17.99
Test Bank For Health Assessment for Nursing Practice 7th Edition By Susan Fickertt Wilson Jean Foret Giddens | 9780323661195 | Chapter 1- 24 | All Chapters with Answers and Rationals
Test Bank For Health Assessment for Nursing Practice 7th Edition By Susan Fickertt Wilson Jean Foret Giddens | 9780323661195 | Chapter 1- 24 | All Chapters with Answers and Rationals
Test Bank For Health Assessment for Nursing Practice 7th Edition By Susan Fickertt Wilson Jean Foret Giddens | 9780...
1. Apatientcomestotheemergencydepartment andtellsthetriagenursethatheis ―havingaheart n n n n
n attack.‖Whatisthenurse‘stoppriorityatthistime?
n n n n n n n
a. Determinethepatient‘spersonaldata andinsurancecoverage. n n
b. Askthepatienttotakeaseatinthewaitingroomuntilhis nameiscalled. n n n n
c. Requestthatanursecollectdataforacomprehensivehistory. n n
d. Askanursetostartafocusedassessment ofthis patientnow. n n n
ANS: D n
Thenurseneedsto begin anassessment assoon aspossiblethatisfocusedon thispatient‘s n n n n n n n n n
cardiovascularsystem.Thetypeofhealthassessmentperformedbythenurseisalsodrivenby
n n n
npatientneed.Personaldataand insuranceinformationwillbeobtained,butinthissituation,these data
n n n n n n n n
canwaituntil afterthepatientisassessed.Basedalsoon Maslow‘shierarchyofneeds,
n n n n n n n n n n n
physiologicneedstakeprecedence.Ratherthanaskingthepatienttowait,thenurseneedstobegin data
n n n n n n n n n n n n
collection,suchasvitalsigns,immediatelytodeterminethepatient‘s healthstatus.
n n n n n n n n
Complicationscanbepreventedifan immediate assessmentismadetoanalyzethepatient‘s n n n n n n n
symptoms.Acomprehensivehistoryisnotindicatedinthissituationatthistime.Somesubjective data
n n n n n n n n n n
willbecollected, suchas allergies andmedical historyrelated to cardiovasculardisease.
n n n n n n n n n
Eyes,ears,oracompletemusculoskeletalormentalhealthassessmentisnotapriorityatthistime.
n n n n n n n n n n
DIF:Cognitive Level: Apply REF: Box 1-3 n n n n
TOP:NursingProcess:Assessment
n n n
MSC:NCLEX Patient Needs:SafeandEffectiveCareEnvironment:ManagementofCare:Establishing n n n n n n n
Priorities
n
2. Whichsituationillustratesascreeningassessment? n
a. Apatientvisitsanobstetricclinicforthefirsttimeandthenurseconductsa n n
n detailedhistoryandphysicalexamination. n n
b. Ahospitalsponsorsahealthfairatalocalmallandprovidescholesterolandblood n n
n pressurecheckstomallpatrons. n
c. Thenurseinanurgentcarecenterchecksthevitalsignsofapatientwhois n n
n complainingoflegpain. n n
d. Apatientnewlydiagnosed withdiabetesmellituscomestotesthisfastingblood n n
n glucoselevel.
ANS: B n
Ahealthfair at alocalmall thatprovides cholesterolandbloodpressurechecksisanexampleofa
n n n n n n n n
screeningassessmentfocusedondiseasedetection.Adetailedhistoryandphysicalexamination
n n n n n n n
conductedduringafirst-timevisittoanobstetricclinicisanexampleofacomprehensive
n n n n n n n n n n n n
assessment.Assessingapatientcomplainingoflegpaininthetriageareaof an urgentcarecenter
n n n n n n n n n n n
isanexampleofaproblem-based/focusedassessment.Apatient‘sreturnappointment1month
n n n n n n n n
aftertoday‘s officevisittoreport fastingblood glucoselevels isan exampleofanepisodicor follow-
n n n n n n n n n n n
upassessment.
n
DIF:CognitiveLevel:Understand REF:Box1-3 n n
, TOP:NursingProcess:Assessment
MSC:NCLEXPatientNeeds:HealthPromotion and Maintenance:Health Screening n n n n n n
3. Forwhichpersonisascreeningassessmentindicated? n
a. Thepersonwhohadabdominalsurgeryyesterday n n
b. Thepersonwhoisunawareofhishighserumglucoselevels
n n n n
c. Thepersonwhoisbeingadmitted toalong-termcarefacility n n
d. Thepersonwhoisbeginningrehabilitation afterakneereplacement n n
ANS:B n
Ascreeningassessmentis performed forthepurpose ofdiseasedetection. In thiscasethisperson
n n n n n n n n
mayhavediabetesmellitus.Ashiftassessmentis mostappropriateforthepersonwhois recoveringin
n n n n n n n n n
thehospitalfromsurgery.Acomprehensiveassessmentisperformedduring admissiontoafacilityto
n n n n n n
obtainadetailedhistoryandcompletephysical examination.Anepisodic orfollow-
n n n n n n
up assessment isperformed afterkneereplacementtoevaluatetheoutcome of the procedure.
n n n
DIF:CognitiveLevel:Understand REF:Box1-3
n n
TOP:NursingProcess:Assessment
n n n
MSC:NCLEX Patient Needs:SafeandEffectiveCareEnvironment:ManagementofCare:Establishing n n n n n n n
Priorities
n
4. Forwhichpersonisashiftassessmentindicated? n n n n
a. Thepersonwhohadabdominalsurgeryyesterday n n
b. Thepersonwhoisunawareofhishighserumglucoselevels
n n n n
c. Thepersonwhoisbeingadmitted toalong-termcarefacility n n
d. Thepersonwhoisbeginningrehabilitation afterakneereplacement n n
ANS:A n
Ashiftassessmentismost appropriate fortheperson whoisrecoveringinthehospitalfrom
n n n n n n n n
surgery.Ascreeningassessmentisperformedforthepurposeofdiseasedetection,inthiscase
n n n
ndiabetesmellitus.Acomprehensiveassessmentisperformedduringadmissiontoafacilityto
n n n n n n
obtainadetailedhistoryandcompletephysicalexamination.Anepisodicorfollow-upassessment
n n n n n n n n n
isperformedafterkneereplacementtoevaluatetheoutcomeoftheprocedure.
n n n n n n
DIF:CognitiveLevel:Understand REF:Box1-3
n n
TOP:NursingProcess:Assessment
n n n
MSC:NCLEX Patient Needs:SafeandEffectiveCareEnvironment:ManagementofCare:Establishing n n n n n n n
Priorities
n
5. Forwhichpersonisacomprehensiveassessmentindicated?
a. Thepersonwhohadabdominalsurgeryyesterday n n
b. Thepersonwhoisunawareofhishighserumglucoselevels
n n n n
c. Thepersonwhoisbeingadmitted toalong-termcarefacility n n
d. Thepersonwhoisbeginningrehabilitation afterakneereplacement n n
ANS:C n
Acomprehensiveassessmentisperformedduringadmissiontoafacilitytoobtainadetailed n
nhistoryandcompletephysicalexamination.Ashift assessmentismost appropriatefortheperson
n n n n n n
whoisrecoveringinthehospitalfromsurgery.Ascreeningassessmentisperformedforthe
n n n n
npurposeofdiseasedetection,inthiscasediabetesmellitus.Anepisodicorfollow-upassessment
n n n n n n n
isperformedafterkneereplacementtoevaluatetheoutcomeoftheprocedure.
n n n n n n
, DIF:CognitiveLevel:Understand REF:Box1-3 n n
TOP:NursingProcess:Assessment
n n n
MSC:NCLEX Patient Needs:SafeandEffectiveCareEnvironment:ManagementofCare:Establishing n n n n n n n
Priorities
n
6. Forwhichperson is an episodicorfollow-upassessmentindicated? n n n
a. Thepersonwhohadabdominalsurgeryyesterday n n
b. Thepersonwhoisunawareofhishighserumglucoselevels n n n n
c. Thepersonwhoisbeingadmitted toalong-termcarefacility n n
d. Thepersonwhoisbeginningrehabilitation afterakneereplacement n n
ANS:D n
Anepisodicorfollow-up assessmentisperformed afterthekneereplacementtoevaluatethe
n n n n n n n n
outcomeofthe procedure. Ashiftassessmentismostappropriateforthepersonwhoisrecovering
n n n n n n n n
inthehospitalfromsurgery.Ascreeningassessmentisperformedforthepurposeofdisease
n n n n
detection,inthiscasediabetesmellitus.Acomprehensiveassessmentisperformedduring
n n n
admissiontoafacilitytoobtainadetailedhistoryand completephysicalexamination.
n n n n n
DIF:CognitiveLevel:Understand REF:Box1-3 n n
TOP:NursingProcess:Assessment
n n n
MSC:NCLEX Patient Needs:SafeandEffectiveCareEnvironment:ManagementofCare:Establishing n n n n n n n
Priorities
n
7. Whichisan exampleofdataanursecollects duringaphysicalexamination?
n n n
a. Thepatient‘slackofhairandshinyskinoverbothshins n n
b. Thepatient‘sstatedconcernaboutlackofmoneyforprescriptions n n n
c. Thepatient‘scomplaintsoftinglingsensationsinthefeet n
d. Thepatient‘smother‘sstatementsthatthepatient isverynervouslately n n n
ANS:A n
Thelackofhair and shinyskinoverboth shinsareobjectivedataorsignsthat arepartofthe physical
n n n n n n n n
examination.Apatient‘sconcernsaboutlackofmoneyaresubjectivedata and arepart ofthehealth
n n n n n n n n n
history. Apatient‘scomplaintsoftinglingsensationsinthefeet aresubjectivedata
n n n n n n n n n
andarepartofthehealthhistory.Apatient‘sfamilystatementsareconsideredsecondarydata,are
n n n n
subjectivedata,andarepartofthehealthhistory.
n n n
DIF:Cognitive Level: Apply REF: Box 1-3 n n n n
TOP:NursingProcess:Assessment
n n n
MSC:NCLEXPatientNeeds:PhysiologicalIntegrity:ReductionofRiskPotential:System Specific n n n n n n n n
Assessments
n
8. Thenursedocumentswhichinformationinthepatient‘shistory?
a. Thepatient‘sskinfeelswarmtothetouch. n
b. Thepatientisscratchinghisarm. n n
c. Thepatient‘stemperatureis100F. n n
d. Thepatientcomplainsofitching. n n n
ANS:D n
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