Test Bank for HealthAssessment in Nursing 7th Edition
xzxz xzxz xzxz xz x zx z x zx z x zx z x zx z
byJanetRWeberandJaneHKelley Fully Covered
xzz xzxz xzxz xz xz xz xzxz xzxz xzxz x zx z
Page 1 x zx z
, 1 A nurse on a postsurgical unit is admitting a client following the client's cholecystectomy
xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z
(gall bladder removal). What is the overallpurpose ofassessment forthis client?
xz xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz xz x zx z x zx z
A) Collecting accurate data xzxz xzxz
B) Assisting the primary care provider xzxz xzxz xxzz x zx z
C) Validatingpreviousdata xz xz
D) Making clinical judgments xzxz xzxz
2. Aclient has presented to the emergencydepartment (ED) withcomplaints ofabdominal
xzxz xzxz xzxz xzxz xzxz xzxz xz xzx z x zx z xxzz xzxz xz
pain. Which member of the care team would most likely be responsible for collecting the
xzxz xzxz xzxz xzxz xzxz xzxz xzx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z
subjective data on the client during the initial comprehensive assessment?
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z
A) Gastroenterologist
B) ED nurse xzxz
C) Admissionsclerk xz
D) Diagnostictechnician xz
3. The nurse has completed an initial assessment of a newly admitted client and is applying the
xzxz xzxz xzxz xzxz xzxz xzxz xzxz xz x zx z xzz xzxz x zx z x zx z xzxz x zx z
nursing process to plan the client's care. What principle should the nurse apply when using
xzxz xzxz xzxz xzxz xzxz xzxz x zxz xzx z x zx z x zx z x zx z x zx z x zx z xzxz x zx z
the nursing process?
xzxz xzxz xzxz
A) Each step is independent of the others. xzxz xzxz x zx z xzxz xzxz x zx z
B) It is ongoing and continuous. xzxz xzxz xzxz xzxz
C) It is used primarily in acute care settings. xzxz xzxz xzxz xzxz xzxz xzxz x zx z
D) It involves independent nursing actions. xzxz xzxz xzxz xzxz
4. The nurse who provides care at an ambulatory clinic is preparing to meet a client and
xzxz xzxz xzxz xzxz xzxz x zx z x zx z xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z
performa comprehensive healthassessment. Whichofthe following actions should the
xzxz xz xzxz xzxz xzz x zx z xzxz xz x zx z xzxz xzxz xzxz
nurse perform first?
xzxz xzxz xzxz
A) Review the client's medicalrecord. xzxz xzxz x zx z xz
B) Obtainbasic biographic data. xzxz xzxz xzxz
C) Consult clinicalresources explaining the client's diagnosis. xzxz xzz xzxz xzxz xzxz x zx z
D) Validate information withthe client. xzxz xzxz xz xzxz
5. Whichofthe following client situations would the nurse interpret asrequiring an
xz xz xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z xz xzxz
emergency assessment?
xzxz xzxz
A) Apediatric client withsevere sunburn xz xzxz xzxz xz xzxz
B) Aclient needing anemployment physical xzxz x zxz xzxz xzz x zx z
C) A client who overdosed on acetaminophen xzxz x zx z xzxz xzxz xzxz
D) Adistraught client who wants apregnancytest xzxz xzxz x zx z x zx z xzxz xzxz xz
Page 1 x zx z
,6. In response to a client's query, the nurse is explaining the differences between the
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z
physician's medical exam and the comprehensive health assessment performed by the
xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z
nurse. The nurse should describe the fact that the nursing assessment focuseson which
xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz x zx z xzxz xzxz
aspect of the client's situation?
xzxz xzxz xzxz xzxz xzxz
A) Current physiologicstatus xzxz xzxz
B) Effect ofhealth on functionalstatus xzxz xzz xzxz xzxz xxz
C) Past medical history xzxz xzxz
D) Motivationfor adherence to treatment xzxz xzxz xzxz xzxz
7. After teaching a group of students about the phases ofthe nursing process, the instructor
xzxz xzxz xzxz xzxz xzxz xzxz xzx z xzxz xzxz xz xzxz x zx z xzxz x zx z
determines that the teaching was successful when the students identify which phase as
xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z
being foundational to all other phases?
xzxz xzxz xzxz xzxz xzxz xzx z
A) Assessment
B) Planning
C) Implementation
D) Evaluation
8. The nurse hascompleted the comprehensive health assessment ofa client who hasbeen
xzxz xzxz xzxz xzxz xzxz x zx z xzxz xzxz xz xzxz x zx z x zx z xzxz
admitted for the treatment of community-acquired pneumonia. Following the
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z
completion of this assessment, the nurse periodically performs a partial assessment
xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z
primarily for which reason?
xzxz xzxz xzxz xzxz
A) Reassess previously detected problems xzxz xzxz x zx z
B) Provide information forthe client's record xzxz xzxz xz xzxz xzxz
C) Address areas previously omitted xzxz xzxz xzxz
D) Determinethe need forcrisis intervention xzxz xzxz x zx z xxzz x zx z
9. The nurse is working in an ambulatorycare clinic that is located in a busy, inner-city
xzxz xzxz xzxz xzxz xzxz xzxz xz xzxz xzxz x zx z xzx z xzxz xxzz x zxz x zx z
neighborhood. Which client would the nurse determine to be in most need of an
xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z
emergency assessment?
xzxz xzxz
A) A14-year-old girl who is crying because she thinks she is pregnant
xz xzxz xxzz x zx z xzxz x zx z xzxz xzxz xzxz x zx z xzxz
B) A45-year-old man with chest pain and diaphoresis for 1 hour
xzxz x zx z xzxz xzxz x zx z xzxz x zx z x zx z x zx z x zx z
C) A3-year-old child with fever, rash, and sore throat
xzxz xzxz xzxz xzxz x zx z x zx z xzx z xzxz
D) A20-year-old man with a 3-inch shallow laceration onhis leg
xzxz x zx z xzxz xzxz xzxz xzxz x zx z xzxz xzxz x zx z
Page 1 x zx z
, 10. A nurse has completed gathering some basic data about a client who has multiple health
xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zxz x zx z x zx z x zx z x zx z
problems that stem from heavy alcoholuse. The nurse has then reflected on her personal
xzxz xzxz xzxz xzxz xzxz xzxz xzx x zx z xzxz x zx z xzx z xzxz x zx z xzxz x zx z
feelings about the client and his circumstances. The nurse does this primarily to
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z
accomplish which of the following?
xzxz xzxz xzxz xzxz xzxz
A) Determine if pertinent datahas been omitted xzxz xzxz x zx z xzxz xzxz xzxz
B) Identifythe need for referral xzxz xzxz x zx z xzxz
C) Avoid biases and judgments xzxz xzxz x zx z
D) Construct a plan ofcare x zx z xzxz xzxz xzxz
11. The nurse is collecting data from a client who has recently been diagnosed with type 1
xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z
diabetes and who will begin an educational program. The nurse is collecting subjective
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z
and objective data. Whichofthe following would the nurse categorize as objective data?
xzxz xzxz xzxz xzxz xxzz xz xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz
A) Familyhistory xzxz
B) Occupation
C) Appearance
D) Historyof present health concern xz xzxz x zx z xzxz
12. An older adult client has been admitted to the hospital with failure to thrive resulting
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z xzxz x zx z x zx z x zx z x zx z
fromcomplications ofdiabetes. Whichofthe following would the nurse implement in
xzxz xz xzxz xz xzx z xzz xz x zx z xzxz xzxz x zx z x zx z x zx z
response to a collaborative problem?
xzxz xzxz xzxz xzxz xzxz
A) Encouragethe client to increase oralfluid intake. xzz xzxz xzxz x zx z xzxz xzxz x zx z
B) Provide the client witha bedtime protein snack. xzxz xzxz x zx z xz xzxz xzxz xzxz
C) Assist the client withpersonal hygiene. xzxz xzxz x zxz xz xzxz
D) Measure the client's blood glucose four times daily. xzxz xzxz xzxz xzxz xzx z xzxz xzxz
13. The nurse at a busy primary care clinic is analyzing the data obtained from the
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z
following clients. For which clients would the nurse most likelyexpect to facilitate a
xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz x zx z xzxz xzz x zx z xzxz xzxz
referral?
xzxz
A) An 80-year-old client who lives withher daughter
xzxz xzxz x zx z xzxz xzxz xzxz x zx z
B) A50-year-old client newlydiagnosed with diabetes
xzx xzxz x zx z xzxz x zx z xzxz
C) Anadult presenting for an influenza vaccination
xzx xzxz xzxz xzxz xzxz xzxz
D) Ateenager seeking informationabout contraception
xzxz xzxz x zx z xzxz x zx z
14. An instructor is reviewing the evolution of the nurse's role in health assessment. The
xzxz xzxz xzxz xzxz xzxz x zx z x zxz x zx z x zx z x zx z x zx z x zx z x zx z
instructor determines that the teaching was successfulwhen the students identifywhich of
xzxz xzxz xzxz xzxz xzxz xzx z xzxz xz xxzz x zx z x zx z xzxz x zx z
the following as the major method used by nurses early in the history of the profession?
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z
A) Naturalsenses xzx
B) Biomedicalknowledge xz
C) Simpletechnology xzz
D) Criticalpathways xz
Page 3 x z x z
.
xzxz xzxz xzxz xz x zx z x zx z x zx z x zx z
byJanetRWeberandJaneHKelley Fully Covered
xzz xzxz xzxz xz xz xz xzxz xzxz xzxz x zx z
Page 1 x zx z
, 1 A nurse on a postsurgical unit is admitting a client following the client's cholecystectomy
xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z
(gall bladder removal). What is the overallpurpose ofassessment forthis client?
xz xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz xz x zx z x zx z
A) Collecting accurate data xzxz xzxz
B) Assisting the primary care provider xzxz xzxz xxzz x zx z
C) Validatingpreviousdata xz xz
D) Making clinical judgments xzxz xzxz
2. Aclient has presented to the emergencydepartment (ED) withcomplaints ofabdominal
xzxz xzxz xzxz xzxz xzxz xzxz xz xzx z x zx z xxzz xzxz xz
pain. Which member of the care team would most likely be responsible for collecting the
xzxz xzxz xzxz xzxz xzxz xzxz xzx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z
subjective data on the client during the initial comprehensive assessment?
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z
A) Gastroenterologist
B) ED nurse xzxz
C) Admissionsclerk xz
D) Diagnostictechnician xz
3. The nurse has completed an initial assessment of a newly admitted client and is applying the
xzxz xzxz xzxz xzxz xzxz xzxz xzxz xz x zx z xzz xzxz x zx z x zx z xzxz x zx z
nursing process to plan the client's care. What principle should the nurse apply when using
xzxz xzxz xzxz xzxz xzxz xzxz x zxz xzx z x zx z x zx z x zx z x zx z x zx z xzxz x zx z
the nursing process?
xzxz xzxz xzxz
A) Each step is independent of the others. xzxz xzxz x zx z xzxz xzxz x zx z
B) It is ongoing and continuous. xzxz xzxz xzxz xzxz
C) It is used primarily in acute care settings. xzxz xzxz xzxz xzxz xzxz xzxz x zx z
D) It involves independent nursing actions. xzxz xzxz xzxz xzxz
4. The nurse who provides care at an ambulatory clinic is preparing to meet a client and
xzxz xzxz xzxz xzxz xzxz x zx z x zx z xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z
performa comprehensive healthassessment. Whichofthe following actions should the
xzxz xz xzxz xzxz xzz x zx z xzxz xz x zx z xzxz xzxz xzxz
nurse perform first?
xzxz xzxz xzxz
A) Review the client's medicalrecord. xzxz xzxz x zx z xz
B) Obtainbasic biographic data. xzxz xzxz xzxz
C) Consult clinicalresources explaining the client's diagnosis. xzxz xzz xzxz xzxz xzxz x zx z
D) Validate information withthe client. xzxz xzxz xz xzxz
5. Whichofthe following client situations would the nurse interpret asrequiring an
xz xz xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z xz xzxz
emergency assessment?
xzxz xzxz
A) Apediatric client withsevere sunburn xz xzxz xzxz xz xzxz
B) Aclient needing anemployment physical xzxz x zxz xzxz xzz x zx z
C) A client who overdosed on acetaminophen xzxz x zx z xzxz xzxz xzxz
D) Adistraught client who wants apregnancytest xzxz xzxz x zx z x zx z xzxz xzxz xz
Page 1 x zx z
,6. In response to a client's query, the nurse is explaining the differences between the
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z
physician's medical exam and the comprehensive health assessment performed by the
xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z
nurse. The nurse should describe the fact that the nursing assessment focuseson which
xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz x zx z xzxz xzxz
aspect of the client's situation?
xzxz xzxz xzxz xzxz xzxz
A) Current physiologicstatus xzxz xzxz
B) Effect ofhealth on functionalstatus xzxz xzz xzxz xzxz xxz
C) Past medical history xzxz xzxz
D) Motivationfor adherence to treatment xzxz xzxz xzxz xzxz
7. After teaching a group of students about the phases ofthe nursing process, the instructor
xzxz xzxz xzxz xzxz xzxz xzxz xzx z xzxz xzxz xz xzxz x zx z xzxz x zx z
determines that the teaching was successful when the students identify which phase as
xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z
being foundational to all other phases?
xzxz xzxz xzxz xzxz xzxz xzx z
A) Assessment
B) Planning
C) Implementation
D) Evaluation
8. The nurse hascompleted the comprehensive health assessment ofa client who hasbeen
xzxz xzxz xzxz xzxz xzxz x zx z xzxz xzxz xz xzxz x zx z x zx z xzxz
admitted for the treatment of community-acquired pneumonia. Following the
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z
completion of this assessment, the nurse periodically performs a partial assessment
xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z
primarily for which reason?
xzxz xzxz xzxz xzxz
A) Reassess previously detected problems xzxz xzxz x zx z
B) Provide information forthe client's record xzxz xzxz xz xzxz xzxz
C) Address areas previously omitted xzxz xzxz xzxz
D) Determinethe need forcrisis intervention xzxz xzxz x zx z xxzz x zx z
9. The nurse is working in an ambulatorycare clinic that is located in a busy, inner-city
xzxz xzxz xzxz xzxz xzxz xzxz xz xzxz xzxz x zx z xzx z xzxz xxzz x zxz x zx z
neighborhood. Which client would the nurse determine to be in most need of an
xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z
emergency assessment?
xzxz xzxz
A) A14-year-old girl who is crying because she thinks she is pregnant
xz xzxz xxzz x zx z xzxz x zx z xzxz xzxz xzxz x zx z xzxz
B) A45-year-old man with chest pain and diaphoresis for 1 hour
xzxz x zx z xzxz xzxz x zx z xzxz x zx z x zx z x zx z x zx z
C) A3-year-old child with fever, rash, and sore throat
xzxz xzxz xzxz xzxz x zx z x zx z xzx z xzxz
D) A20-year-old man with a 3-inch shallow laceration onhis leg
xzxz x zx z xzxz xzxz xzxz xzxz x zx z xzxz xzxz x zx z
Page 1 x zx z
, 10. A nurse has completed gathering some basic data about a client who has multiple health
xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zxz x zx z x zx z x zx z x zx z
problems that stem from heavy alcoholuse. The nurse has then reflected on her personal
xzxz xzxz xzxz xzxz xzxz xzxz xzx x zx z xzxz x zx z xzx z xzxz x zx z xzxz x zx z
feelings about the client and his circumstances. The nurse does this primarily to
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z
accomplish which of the following?
xzxz xzxz xzxz xzxz xzxz
A) Determine if pertinent datahas been omitted xzxz xzxz x zx z xzxz xzxz xzxz
B) Identifythe need for referral xzxz xzxz x zx z xzxz
C) Avoid biases and judgments xzxz xzxz x zx z
D) Construct a plan ofcare x zx z xzxz xzxz xzxz
11. The nurse is collecting data from a client who has recently been diagnosed with type 1
xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z
diabetes and who will begin an educational program. The nurse is collecting subjective
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z
and objective data. Whichofthe following would the nurse categorize as objective data?
xzxz xzxz xzxz xzxz xxzz xz xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz
A) Familyhistory xzxz
B) Occupation
C) Appearance
D) Historyof present health concern xz xzxz x zx z xzxz
12. An older adult client has been admitted to the hospital with failure to thrive resulting
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z xzxz x zx z x zx z x zx z x zx z
fromcomplications ofdiabetes. Whichofthe following would the nurse implement in
xzxz xz xzxz xz xzx z xzz xz x zx z xzxz xzxz x zx z x zx z x zx z
response to a collaborative problem?
xzxz xzxz xzxz xzxz xzxz
A) Encouragethe client to increase oralfluid intake. xzz xzxz xzxz x zx z xzxz xzxz x zx z
B) Provide the client witha bedtime protein snack. xzxz xzxz x zx z xz xzxz xzxz xzxz
C) Assist the client withpersonal hygiene. xzxz xzxz x zxz xz xzxz
D) Measure the client's blood glucose four times daily. xzxz xzxz xzxz xzxz xzx z xzxz xzxz
13. The nurse at a busy primary care clinic is analyzing the data obtained from the
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z
following clients. For which clients would the nurse most likelyexpect to facilitate a
xzxz xzxz xzxz xzxz xzxz xzxz xzxz xzxz x zx z xzxz xzz x zx z xzxz xzxz
referral?
xzxz
A) An 80-year-old client who lives withher daughter
xzxz xzxz x zx z xzxz xzxz xzxz x zx z
B) A50-year-old client newlydiagnosed with diabetes
xzx xzxz x zx z xzxz x zx z xzxz
C) Anadult presenting for an influenza vaccination
xzx xzxz xzxz xzxz xzxz xzxz
D) Ateenager seeking informationabout contraception
xzxz xzxz x zx z xzxz x zx z
14. An instructor is reviewing the evolution of the nurse's role in health assessment. The
xzxz xzxz xzxz xzxz xzxz x zx z x zxz x zx z x zx z x zx z x zx z x zx z x zx z
instructor determines that the teaching was successfulwhen the students identifywhich of
xzxz xzxz xzxz xzxz xzxz xzx z xzxz xz xxzz x zx z x zx z xzxz x zx z
the following as the major method used by nurses early in the history of the profession?
xzxz xzxz xzxz xzxz xzxz xzxz x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z x zx z
A) Naturalsenses xzx
B) Biomedicalknowledge xz
C) Simpletechnology xzz
D) Criticalpathways xz
Page 3 x z x z
.
