, Chapter 01: Introduction to Health Assessment
gh gh gh gh gh
MULTIPLE CHOICE gh
1. A patient comes to the emergency department and tells the triage nurse
gh gh gh gh gh gh gh gh gh gh gh
that he is “having a heart attack.” What is the nurse’s top priority at this time?
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
a. Determine the patient’s personal data and gh gh gh gh gh
insurance coverage. gh gh
b. Ask the patient to take a seat in the gh gh gh gh gh gh gh gh
waiting room until his name is called. gh gh gh gh gh gh gh
c. Request that a nurse collect data for a gh gh gh gh gh gh gh
comprehensive history. gh gh
d. Ask a nurse to start a focused gh gh gh gh gh gh
assessment of this patient now. gh gh gh gh gh
ANS: D gh
The nurse needs to begin an assessment as soon as possible that is focused
gh gh gh gh gh gh gh gh gh gh gh gh gh
on this patient’s cardiovascular system. The type of health assessment performed
gh gh gh gh gh gh gh gh gh gh gh
by the nurse is also driven by patient need. Personal data and insurance
gh gh gh gh gh gh gh gh gh gh gh gh gh
information will be obtained, but in this situation, these data can wait until after
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
the patient is assessed. Based also on Maslow’s hierarchy of needs, physiologic
gh gh gh gh gh gh gh gh gh gh gh gh
needs take precedence. Rather than asking the patient to wait, the nurse needs to
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
begin data collection, such as vital signs, immediately to determine the patient’s
gh gh gh gh gh gh gh gh gh gh gh gh
health status. Complications can be prevented if an immediate assessment is made
gh gh gh gh gh gh gh gh gh gh gh gh
to analyze the patient’s symptoms. A comprehensive history is not indicated in this
gh gh gh gh gh gh gh gh gh gh gh gh gh
situation at this time. Some subjective data will be collected, such as allergies and
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
medical history related to cardiovascular disease. Eyes, ears, or a complete
gh gh gh gh gh gh gh gh gh gh gh
musculoskeletal or mental health assessment is not a priority at this time.
gh gh gh gh gh gh gh gh gh gh gh gh
DIF: Cognitive Level: Apply REF: Box 1-3 | gh gh gh gh
p. 3 TOP: Nursing Process: Assessment
gh gh gh gh gh gh
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of
gh gh gh gh gh gh gh gh gh gh
Care: Establishing Priorities
gh gh gh
2. Which situation illustrates a screening assessment?
gh gh gh gh gh
a. A patient visits an obstetric clinic for gh gh gh gh gh gh
the first time and the nurse conducts a gh gh gh gh gh gh gh gh
detailed history and physical gh gh gh gh
examination. gh
b. A hospital sponsors a health fair at a gh gh gh gh gh gh gh
local mall and provides cholesterol and gh gh gh gh gh gh
blood pressure checks to mall patrons. gh gh gh gh gh gh
c. The nurse in an urgent care center gh gh gh gh gh gh
checks the vital signs of a patient who gh gh gh gh gh gh gh gh
is complaining of leg pain. gh gh gh gh gh
This gh study g h source g h was gh downloaded g h by g h 100000838401522 gh from g h CourseHero.com gh on gh 03-03-2022 g h 08:46:13 g h GMT g h -06:00
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,https://www.coursehero.com/file/34584368/chapter-1pdf/
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d. A patient newly diagnosed with diabetes
gh gh gh gh gh
mellitus comes to test his fasting blood
gh gh gh gh gh gh gh
glucose level.
gh gh
ANS: B gh
A health fair at a local mall that provides cholesterol and blood pressure checks is
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
an example of a screening assessment focused on disease detection. A detailed
gh gh gh gh gh gh gh gh gh gh gh gh
history and physical examination conducted during a first-time visit to an obstetric
gh gh gh gh gh gh gh gh gh gh gh gh
clinic is an example of a comprehensive assessment. Assessing a patient
gh gh gh gh gh gh gh gh gh gh gh
complaining of leg pain in the triage area of an urgent care center is an example
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
of a problem-based/focused assessment. A patient’s return appointment 1 month
gh gh gh gh gh gh gh gh gh gh
after today’s office visit to report fasting blood glucose levels is an example of an
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
episodic or follow-up assessment.
gh gh gh gh
DIF: Cognitive Level: Understand REF: Box 1-3 | gh gh gh gh
p. 3 TOP: Nursing Process: Assessment
gh gh gh gh gh gh
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Screening
gh gh gh gh gh gh gh gh gh
3. For which person is a screening assessment indicated?
gh gh gh gh gh gh gh
a. The person who had abdominal surgery gh gh gh gh gh
yesterday gh
b. The person who is unaware of his high
gh gh gh gh gh gh gh
serum glucose levels
gh gh gh
c. The person who is being admitted
gh gh gh gh gh
to a long-term care facility
gh gh gh gh gh
d. The person who is beginning
gh gh gh gh
rehabilitation after a knee replacement
gh gh gh gh gh
ANS: B gh
A screening assessment is performed for the purpose of disease detection. In this
gh gh gh gh gh gh gh gh gh gh gh gh
case this person may have diabetes mellitus. A shift assessment is most appropriate
gh gh gh gh gh gh gh gh gh gh gh gh gh
for the person who is recovering in the hospital from surgery. A comprehensive
gh gh gh gh gh gh gh gh gh gh gh gh gh
assessment is performed during admission to a facility to obtain a detailed history
gh gh gh gh gh gh gh gh gh gh gh gh gh
and complete physical examination. An episodic or follow-up assessment is
gh gh gh gh gh gh gh gh gh gh
performed after knee replacement to evaluate the outcome of the procedure.
gh gh gh gh gh gh gh gh gh gh gh
DIF: Cognitive Level: Understand REF: Box 1-3 | gh gh gh gh
p. 3 TOP: Nursing Process: Assessment
gh gh gh gh gh gh
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of
gh gh gh gh gh gh gh gh gh gh
Care: Establishing Priorities
gh gh gh
4. For which person is a shift assessment indicated?
gh gh gh gh gh gh gh
a. The person who had abdominal surgery gh gh gh gh gh
yesterday gh
b. The person who is unaware of his high
gh gh gh gh gh gh gh
serum glucose levels
gh gh gh
c. The person who is being admitted
gh gh gh gh gh
to a long-term care facility
gh gh gh gh gh
d. The person who is beginning
gh gh gh gh
rehabilitation after a knee replacement
gh gh gh gh gh
ANS: A gh
A shift assessment is most appropriate for the person who is recovering in the
gh gh gh gh gh gh gh gh gh gh gh gh gh
hospital from surgery. A screening assessment is performed for the purpose of
gh gh gh gh gh gh gh gh gh gh gh gh
disease detection, in this case diabetes mellitus. A comprehensive assessment is
gh gh gh gh gh gh gh gh gh gh gh
performed during admission to a
gh gh gh gh gh
This gh study g h source g h was gh downloaded g h by g h 100000838401522 gh from g h CourseHero.com gh on gh 03-03-2022 g h 08:46:13 g h GMT g h -06:00
Downloaded by: cmedrano14 |
gh gh gh gh gh
MULTIPLE CHOICE gh
1. A patient comes to the emergency department and tells the triage nurse
gh gh gh gh gh gh gh gh gh gh gh
that he is “having a heart attack.” What is the nurse’s top priority at this time?
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
a. Determine the patient’s personal data and gh gh gh gh gh
insurance coverage. gh gh
b. Ask the patient to take a seat in the gh gh gh gh gh gh gh gh
waiting room until his name is called. gh gh gh gh gh gh gh
c. Request that a nurse collect data for a gh gh gh gh gh gh gh
comprehensive history. gh gh
d. Ask a nurse to start a focused gh gh gh gh gh gh
assessment of this patient now. gh gh gh gh gh
ANS: D gh
The nurse needs to begin an assessment as soon as possible that is focused
gh gh gh gh gh gh gh gh gh gh gh gh gh
on this patient’s cardiovascular system. The type of health assessment performed
gh gh gh gh gh gh gh gh gh gh gh
by the nurse is also driven by patient need. Personal data and insurance
gh gh gh gh gh gh gh gh gh gh gh gh gh
information will be obtained, but in this situation, these data can wait until after
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
the patient is assessed. Based also on Maslow’s hierarchy of needs, physiologic
gh gh gh gh gh gh gh gh gh gh gh gh
needs take precedence. Rather than asking the patient to wait, the nurse needs to
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
begin data collection, such as vital signs, immediately to determine the patient’s
gh gh gh gh gh gh gh gh gh gh gh gh
health status. Complications can be prevented if an immediate assessment is made
gh gh gh gh gh gh gh gh gh gh gh gh
to analyze the patient’s symptoms. A comprehensive history is not indicated in this
gh gh gh gh gh gh gh gh gh gh gh gh gh
situation at this time. Some subjective data will be collected, such as allergies and
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
medical history related to cardiovascular disease. Eyes, ears, or a complete
gh gh gh gh gh gh gh gh gh gh gh
musculoskeletal or mental health assessment is not a priority at this time.
gh gh gh gh gh gh gh gh gh gh gh gh
DIF: Cognitive Level: Apply REF: Box 1-3 | gh gh gh gh
p. 3 TOP: Nursing Process: Assessment
gh gh gh gh gh gh
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of
gh gh gh gh gh gh gh gh gh gh
Care: Establishing Priorities
gh gh gh
2. Which situation illustrates a screening assessment?
gh gh gh gh gh
a. A patient visits an obstetric clinic for gh gh gh gh gh gh
the first time and the nurse conducts a gh gh gh gh gh gh gh gh
detailed history and physical gh gh gh gh
examination. gh
b. A hospital sponsors a health fair at a gh gh gh gh gh gh gh
local mall and provides cholesterol and gh gh gh gh gh gh
blood pressure checks to mall patrons. gh gh gh gh gh gh
c. The nurse in an urgent care center gh gh gh gh gh gh
checks the vital signs of a patient who gh gh gh gh gh gh gh gh
is complaining of leg pain. gh gh gh gh gh
This gh study g h source g h was gh downloaded g h by g h 100000838401522 gh from g h CourseHero.com gh on gh 03-03-2022 g h 08:46:13 g h GMT g h -06:00
Downloaded by: cmedrano14 |
,https://www.coursehero.com/file/34584368/chapter-1pdf/
Downloaded by: cmedrano14 |
, Stuvia.com - The Marketplace to Buy and Sell your Study
d. A patient newly diagnosed with diabetes
gh gh gh gh gh
mellitus comes to test his fasting blood
gh gh gh gh gh gh gh
glucose level.
gh gh
ANS: B gh
A health fair at a local mall that provides cholesterol and blood pressure checks is
gh gh gh gh gh gh gh gh gh gh gh gh gh gh
an example of a screening assessment focused on disease detection. A detailed
gh gh gh gh gh gh gh gh gh gh gh gh
history and physical examination conducted during a first-time visit to an obstetric
gh gh gh gh gh gh gh gh gh gh gh gh
clinic is an example of a comprehensive assessment. Assessing a patient
gh gh gh gh gh gh gh gh gh gh gh
complaining of leg pain in the triage area of an urgent care center is an example
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
of a problem-based/focused assessment. A patient’s return appointment 1 month
gh gh gh gh gh gh gh gh gh gh
after today’s office visit to report fasting blood glucose levels is an example of an
gh gh gh gh gh gh gh gh gh gh gh gh gh gh gh
episodic or follow-up assessment.
gh gh gh gh
DIF: Cognitive Level: Understand REF: Box 1-3 | gh gh gh gh
p. 3 TOP: Nursing Process: Assessment
gh gh gh gh gh gh
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Screening
gh gh gh gh gh gh gh gh gh
3. For which person is a screening assessment indicated?
gh gh gh gh gh gh gh
a. The person who had abdominal surgery gh gh gh gh gh
yesterday gh
b. The person who is unaware of his high
gh gh gh gh gh gh gh
serum glucose levels
gh gh gh
c. The person who is being admitted
gh gh gh gh gh
to a long-term care facility
gh gh gh gh gh
d. The person who is beginning
gh gh gh gh
rehabilitation after a knee replacement
gh gh gh gh gh
ANS: B gh
A screening assessment is performed for the purpose of disease detection. In this
gh gh gh gh gh gh gh gh gh gh gh gh
case this person may have diabetes mellitus. A shift assessment is most appropriate
gh gh gh gh gh gh gh gh gh gh gh gh gh
for the person who is recovering in the hospital from surgery. A comprehensive
gh gh gh gh gh gh gh gh gh gh gh gh gh
assessment is performed during admission to a facility to obtain a detailed history
gh gh gh gh gh gh gh gh gh gh gh gh gh
and complete physical examination. An episodic or follow-up assessment is
gh gh gh gh gh gh gh gh gh gh
performed after knee replacement to evaluate the outcome of the procedure.
gh gh gh gh gh gh gh gh gh gh gh
DIF: Cognitive Level: Understand REF: Box 1-3 | gh gh gh gh
p. 3 TOP: Nursing Process: Assessment
gh gh gh gh gh gh
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of
gh gh gh gh gh gh gh gh gh gh
Care: Establishing Priorities
gh gh gh
4. For which person is a shift assessment indicated?
gh gh gh gh gh gh gh
a. The person who had abdominal surgery gh gh gh gh gh
yesterday gh
b. The person who is unaware of his high
gh gh gh gh gh gh gh
serum glucose levels
gh gh gh
c. The person who is being admitted
gh gh gh gh gh
to a long-term care facility
gh gh gh gh gh
d. The person who is beginning
gh gh gh gh
rehabilitation after a knee replacement
gh gh gh gh gh
ANS: A gh
A shift assessment is most appropriate for the person who is recovering in the
gh gh gh gh gh gh gh gh gh gh gh gh gh
hospital from surgery. A screening assessment is performed for the purpose of
gh gh gh gh gh gh gh gh gh gh gh gh
disease detection, in this case diabetes mellitus. A comprehensive assessment is
gh gh gh gh gh gh gh gh gh gh gh
performed during admission to a
gh gh gh gh gh
This gh study g h source g h was gh downloaded g h by g h 100000838401522 gh from g h CourseHero.com gh on gh 03-03-2022 g h 08:46:13 g h GMT g h -06:00
Downloaded by: cmedrano14 |
