PHYSICALEXAMINATIONANDHEALTHASSESSMENT9TH
EDITION(JARVIS,2024)TESTBANK,ALLCHAPTERS1-32,
COMPLETENEWESTVERSION2024UPDATEQUESTIONSAND
ANSWERS ASCORERSSTUVIA
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SAMPLEQUESTIONS:
Thenurseisreviewingdatacollectedafteranassessment.Ofthedatalistedbelow,whichwouldbeconsidered
relatedcuesthatwouldbeclusteredtogetherduringdataanalysis?Selectallthatapply.
a.
Inspiratorywheezesnotedinleftlowerlobes
b.
Hypoactivebowelsounds
c.
Nonproductivecough
d.
Edema,+2,notedonlefthand
e.
Patientreportsdyspneauponexertion
f.
Rateofrespirations16breathsperminute ACEF
A42-year-oldpatientofAsiandescentisbeingseenattheclinicforaninitialexamination.Thenurseknowsthat
includingculturalinformationinhishealthassessmentisimportantto:
a.
Identifythecauseofhisillness.
b.
Makeaccuratediseasediagnoses.
c.
Provideculturalhealthrightsfortheindividual.
d.
Provideculturallysensitiveandappropriatecare. D
Anewlyadmittedpatientisinacutepain,hasnotbeensleepingwelllately,andishavingdifficultybreathing.
Howshouldthenurseprioritizetheseproblems? ASCORERSSTUVIA
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a.
Breathing,pain,andsleep
b.
Breathing,sleep,andpain
c.
Sleep,breathing,andpain
d.
Sleep,pain,andbreathing A
Apatientisattheclinictohaveherbloodpressurechecked.Shehasbeencomingtotheclinicweeklysinceshe
changedmedications2monthsago.Thenurseshould:
a.
Collectafollow-updatabaseandthencheckherbloodpressure.
b.
Askhertoreadherhealthrecordandindicateanychangessinceherlastvisit.
c.
Checkonlyherbloodpressurebecausehercompletehealthhistorywasdocumented2monthsago.
d.
Obtainacompletehealthhistorybeforecheckingherbloodpressurebecausemuchofherhistoryinformation
mayhavechanged. A
Apatientisbroughtbyambulancetotheemergencydepartmentwithmultipletraumasreceivedinan
automobileaccident.Heisalertandcooperative,buthisinjuriesarequitesevere.Howwouldthenurseproceed
withdatacollection?
a.
Collecthistoryinformationfirst,thenperformthephysicalexaminationandinstitutelife-savingmeasures.
b.
Simultaneouslyaskhistoryquestionswhileperformingtheexaminationandinitiatinglife-savingmeasures.
c.
Collectallinformationonthehistoryform,includingsocialsupportpatterns,strengths,andcopingpatterns.
d.
Performlife-savingmeasuresanddelayaskinganyhistoryquestionsuntilthepatientistransferredtothe ASCORERSSTUVIA
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intensivecareunit. B
Apatienttellsthenursethatheisverynervous,isnauseated,andfeelshot.Thesetypesofdatawouldbe:
a.
Objective.
b.
Reflective.
c.
Subjective.
d.
Introspective.C
Avisitingnurseismakinganinitialhomevisitforapatientwhohasmanychronicmedicalproblems.Whichtype
ofdatabaseismostappropriatetocollectinthissetting?
a.
Afollow-updatabasetoevaluatechangesatappropriateintervals
b.
Anepisodicdatabasebecauseofthecontinuing,complexmedicalproblemsofthispatient
c.
Acompletehealthdatabasebecauseofthenursesprimaryresponsibilityformonitoringthepatientshealth
d.
Anemergencydatabasebecauseoftheneedtocollectinformationandmakeaccuratediagnosesrapidly
C
a.
Apatientnewlydiagnosedwithtype2diabetesmellitusdoesnotknowhowtocheckhisownbloodglucose
levelswithaglucometer.
b.
Ateenagerwhowasstungbyabeeduringasoccermatchishavingtroublebreathing.
c.
Anolderadultwithaurinarytractinfectionisalsoshowingsignsofconfusionandagitation.
problem 1.a=First-levelpriorityproblem
2.b=Second-levelpriorityproblem ASCORERSSTUVIA
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3.c=Third-levelpriority
Aftercompletinganinitialassessmentofapatient,thenursehaschartedthathisrespirationsareeupneicandhis
pulseis58beatsperminute.Thesetypesofdatawouldbe:
a.
Objective.
b.
Reflective.
c.
Subjective.
d.
Introspective.A
BarrierstoincorporatingEBPinclude:
a.
Nurseslackofresearchskillsinevaluatingthequalityofresearchstudies.
b.
Lackofsignificantresearchstudies.
c.
Insufficientclinicalskillsofnurses.
d.
Inadequatephysicalassessmentskills.A
Duringastaffmeeting,nursesdiscusstheproblemswithaccessingresearchstudiestoincorporateevidence-
basedclinicaldecisionmakingintotheirpractice.Whichsuggestionbythenursemanagerwouldbesthelpthese
problems?
a.
Formacommitteetoconductresearchstudies.
b.
Postpublishedresearchstudiesontheunitsbulletinboards.
c. ASCORERSSTUVIA
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Encouragethenursestovisitthelibrarytoreviewstudies.
d.
Teachthenurseshowtoconductelectronicsearchesforresearchstudies. D
Expertnurseslearntoattendtoapatternofassessmentdataandactwithoutconsciouslylabelingit.These
responsesarereferredtoas:
a.
Intuition.
b.
Thenursingprocess.
c.
Clinicalknowledge.
d.
Diagnosticreasoning.A
Inthehealthpromotionmodel,thefocusofthehealthprofessionalincludes:
a.
Changingthepatientsperceptionsofdisease.
b.
Identifyingbiomedicalmodelinterventions.
c.
Identifyingnegativehealthactsoftheconsumer.
d.
Helpingtheconsumerchooseahealthierlifestyle. D
Thenursehasimplementedseveralplannedinterventionstoaddressthenursingdiagnosisofacutepain.Which
wouldbethenextappropriateaction?
a.
Establishpriorities.
b.
Identifyexpectedoutcomes. ASCORERSSTUVIA
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c.
Evaluatetheindividualscondition,andcompareactualoutcomeswithexpectedoutcomes.
d.
Interpretdata,andthenidentifyclustersofcuesandmakeinferences.C
Thenurseisconductingaclassfornewgraduatenurses.Duringtheteachingsession,thenurseshouldkeepin
mindthatnovicenurses,withoutabackgroundofskillsandexperiencefromwhichtodraw,aremorelikelyto
maketheirdecisionsusing:
a.
Intuition.
b.
Asetofrules.
c.
Articlesinjournals.
d.
Advicefromsupervisors. B
Thenurseisconductingaclassonprioritysettingforagroupofnewgraduatenurses.Whichisanexampleofa
first-levelpriorityproblem?
a.
Patientwithpostoperativepain
b.
Newlydiagnosedpatientwithdiabeteswhoneedsdiabeticteaching
c.
Individualwithasmalllacerationonthesoleofthefoot
d.
Individualwithshortnessofbreathandrespiratorydistress D
Thenurseisperformingaphysicalassessmentonanewlyadmittedpatient.Anexampleofobjectiveinformation
obtainedduringthephysicalassessmentincludesthe:
a.
Patientshistoryofallergies. ASCORERSSTUVIA
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b.
Patientsuseofmedicationsathome.
c.
Lastmenstrualperiod1monthago.
d.
25cmscarontherightlowerforearm.D
Thenurseisreviewinginformationaboutevidence-basedpractice(EBP).WhichstatementbestreflectsEBP?
a.
EBPreliesontraditionforsupportofbestpractices.
b.
EBPissimplytheuseofbestpracticetechniquesforthetreatmentofpatients.
c.
EBPemphasizestheuseofbestevidencewiththecliniciansexperience.
d.
ThepatientsownpreferencesarenotimportantwithEBP. C
Chapter01:Evidence-BasedAssessment
MULTIPLECHOICE
1.Aftercompletinganinitialassessmentofapatient,thenursehaschartedthathisrespirationsareeupneicand
hispulseis58beatsperminute.Thesetypesofdatawouldbe:
a.Objective.
b.Reflective.
c.Subjective.
d.Introspective.
ANS:A
Objectivedataarewhatthehealthprofessionalobservesbyinspecting,percussing,palpating,andauscultating
duringthephysicalexamination.Subjectivedataiswhatthepersonsaysabouthimorherselfduringhistory
taking.Thetermsreflectiveandintrospectivearenotusedtodescribedata.
DIF:CognitiveLevel:Understanding(Comprehension) ASCORERSSTUVIA
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MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare
2.Apatienttellsthenursethatheisverynervous,isnausea.CteOdM,andfeelshot.Thesetypesofdatawouldbe:
a.Objective.
b.Reflective.
c.Subjective.
d.Introspective.
ANS:C
Subjectivedataarewhatthepersonsaysabouthimorherselfduringhistorytaking.Objectivedataarewhatthe
healthprofessionalobservesbyinspecting,percussing,palpating,andauscultatingduringthephysical
examination.Thetermsreflectiveandintrospectivearenotusedtodescribedata.
DIF:CognitiveLevel:Understanding(Comprehension)
MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare
3.Thepatientsrecord,laboratorystudies,objectivedata,andsubjectivedatacombinetoformthe:
a.Database.
b.Admittingdata. ASCORERSSTUVIA
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c.Financialstatement.
d.Dischargesummary.
ANS:A
Togetherwiththepatientsrecordandlaboratorystudies,theobjectiveandsubjectivedataformthedatabase.
Theotheritemsarenotpartofthepatientsrecord,laboratorystudies,ordata.
DIF:CognitiveLevel:Remembering(Knowledge)
MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare
4.Whenlisteningtoapatientsbreathsounds,thenurseisunsureofasoundthatisheard.Thenursesnext
actionshouldbeto:
a.Immediatelynotifythepatientsphysician.
b.Documentthesoundexactlyasitwasheard.
c.Validatethedatabyaskingacoworkertolistentothebreathsounds.
d.Assessagainin20minutestonotewhetherthesoundisstillpresent.
ANS:C
Whenunsureofasoundheardwhilelisteningtoapatientsbreathsounds,thenursevalidatesthedatatoensure
accuracy.Ifthenursehaslessexperienceinanarea,thenheorsheasksanexperttolisten.
DIF:CognitiveLevel:Analyzing(Analysis)
MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare
5.Thenurseisconductingaclassfornewgraduatenurses.Duringtheteachingsession,thenurseshouldkeep
inmindthatnovicenurses,withoutabackgroundofskillsandexperiencefromwhichtodraw,aremorelikely
tomaketheirdecisionsusing:
a.Intuition.
b.Asetofrules.
c.Articlesinjournals.
d.Advicefromsupervisors.
ANS:B
Novicenursesoperatefromasetofdefined,structuredrules.Theexpertpractitionerusesintuitivelinks.
DIF:CognitiveLevel:Understanding(Comprehension)
