Bates’ Guide To Physical Examination and History Taking 13th
b b b b b b b b
Edition Bickley Test Bank b b b b
CHAPTER 1 Foundations for Clinical Proficiency b b b b
MULTIPLE CHOICE
b b
1. After completing an initial assessment of a patient, the nurse has charted that his respirationsare
b b b b b b b b b b b b b b b
eupneic and his pulse is 58 beats per minute. These types of data would be:
b b b b b b b b b b b b b b b
a Objective.
.
b Reflective.
.
c Subjective.
.
d Introspective.
.
ANS: A b
Objective data are what the health professional observes by inspecting, percussing, palpating, and
b b b b b b b b b b b b
auscultating during the physical examination. Subjective data is what the person says abouthim or
b b b b b b b b b b b b b b b
herself during history taking. The terms reflective and introspective are not used to describe data.
b b b b b b b b b b b b b b b
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 2
b b b b b b b
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
b b b b b b b b b b
2. A patient tells the nurse that he is very nervous, is nauseated, and feels hot. These types ofdata
b b b b b b b b b b b b b b b b b b
would be:
b b
a Objective.
.
b Reflective.
.
c Subjective.
.
d Introspective.
.
ANS: C b
Subjective data are what the person says about him or herself during history taking. Objectivedata
b b b b b b b b b b b b b b b
are what the health professional observes by inspecting, percussing, palpating, and
b b b b b b b b b b b
auscultating during the physical examination. The terms reflective and introspective are not used
b b b b b b b b b b b b
,to describe data.
b b
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 2
b b b b b b b
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
b b b b b b b b b b
3. The patients record, laboratory studies, objective data, and subjective data combine to formthe:
b b b b b b b b b b b b b
a Data base. b
.
b Admitting data. b
.
c Financial statement. b
.
d Discharge summary. b
.
ANS: A b
Together with the patients record and laboratory studies, the objective and subjective data form the
b b b b b b b b b b b b b b
data base. The other items are not part of the patients record, laboratory studies, or data.
b b b b b b b b b b b b b b b b
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 2
b b b b b b b
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
b b b b b b b b b b
4. When listening to a patients breath sounds, the nurse is unsure of a sound that is heard. The
b b b b b b b b b b b b b b b b b
nurses next action should be to:
b b b b b b
a Immediately notify the patients physician. b b b b
.
b Document the sound exactly as it was heard. b b b b b b b
.
c Validate the data by asking a coworker to listen to the breath sounds.
b b b b b b b b b b b b
.
d Assess again in 20 minutes to note whether the sound is still present.
b b b b b b b b b b b b
.
ANS: C b
When unsure of a sound heard while listening to a patients breath sounds, the nurse validates the data
b b b b b b b b b b b b b b b b b
to ensure accuracy. If the nurse has less experience in an area, then he or she asks an expert to
b b b b b b b b b b b b b b b b b b b b
listen.
b
DIF: Cognitive Level: Analyzing (Analysis) REF: p. 2
b b b b b b b
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
b b b b b b b b b b
,5. The nurse is conducting a class for new graduate nurses. During the teaching session, the
b b b b b b b b b b b b b b
nurse should keep in mind that novice nurses, without a background of skills and experience
b b b b b b b b b b b b b b b
from which to draw, are more likely to make their decisions using:
b b b b b b b b b b b b
a Intuition.
.
b A set of rules. b b b
.
c Articles in journals. b b
.
d Advice from supervisors. b b
.
ANS: B b
Novice nurses operate from a set of defined, structured rules. The expert practitioner uses
b b b b b b b b b b b b b
intuitive links.
b b
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 3
b b b b b b b
MSC: Client Needs: General
b b b b
6. Expert nurses learn to attend to a pattern of assessment data and act without consciously
b b b b b b b b b b b b b b
labeling it. These responses are referred to as:
b b b b b b b b
a Intuition.
.
b The nursing process. b b
.
c Clinical knowledge. b
.
d Diagnostic reasoning. b
.
ANS: A b
Intuition is characterized by pattern recognitionexpert nurses learn to attend to a pattern of
b b b b b b b b b b b b b
assessment data and act without consciously labeling it. The other options are not correct.
b b b b b b b b b b b b b b
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 4
b b b b b b b
MSC: Client Needs: General
b b b b
7. The nurse is reviewing information about evidence-based practice (EBP). Which statement
b b b b b b b b b b
best reflects EBP?
b b b
, a EBP relies on tradition for support of best practices.
b b b b b b b b
.
b EBP is simply the use of best practice techniques for the treatment of patients.
b b b b b b b b b b b b b
.
c EBP emphasizes the use of best evidence with the clinicians experience.
b b b b b b b b b b
.
d The patients own preferences are not important with EBP.
b b b b b b b b
.
ANS: C b
EBP is a systematic approach to practice that emphasizes the use of best evidence in combinationwith
b b b b b b b b b b b b b b b b
the clinicians experience, as well as patient preferences and values, when making decisions about
b b b b b b b b b b b b b b
care and treatment. EBP is more than simply using the best practice techniques to treat patients, and
b b b b b b b b b b b b b b b b b
questioning tradition is important when no compelling and supportive research evidence exists.
b b b b b b b b b b b b
DIF: Cognitive Level: Applying (Application) REF: p. 5
b b b b b b b
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
b b b b b b b b b b
8. The nurse is conducting a class on priority setting for a group of new graduate nurses. Whichis an
b b b b b b b b b b b b b b b b b b
example of a first-level priority problem?
b b b b b b
a Patient with postoperative pain b b b
.
b Newly diagnosed patient with diabetes who needs diabetic teaching
b b b b b b b b
.
c Individual with a small laceration on the sole of the foot b b b b b b b b b b
.
d Individual with shortness of breath and respiratory distress b b b b b b b
.
ANS: D b
First-level priority problems are those that are emergent, life threatening, and immediate (e.g.,
b b b b b b b b b b b b
establishing an airway, supporting breathing, maintaining circulation, monitoring abnormal vital
b b b b b b b b b b
signs) (see Table 1-1).
b b b b
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 4
b b b b b b b
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
b b b b b b b b b b
9. When considering priority setting of problems, the nurse keeps in mind that second-level
b b b b b b b b b b b b
priority problems include which of these aspects?
b b b b b b b
b b b b b b b b
Edition Bickley Test Bank b b b b
CHAPTER 1 Foundations for Clinical Proficiency b b b b
MULTIPLE CHOICE
b b
1. After completing an initial assessment of a patient, the nurse has charted that his respirationsare
b b b b b b b b b b b b b b b
eupneic and his pulse is 58 beats per minute. These types of data would be:
b b b b b b b b b b b b b b b
a Objective.
.
b Reflective.
.
c Subjective.
.
d Introspective.
.
ANS: A b
Objective data are what the health professional observes by inspecting, percussing, palpating, and
b b b b b b b b b b b b
auscultating during the physical examination. Subjective data is what the person says abouthim or
b b b b b b b b b b b b b b b
herself during history taking. The terms reflective and introspective are not used to describe data.
b b b b b b b b b b b b b b b
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 2
b b b b b b b
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
b b b b b b b b b b
2. A patient tells the nurse that he is very nervous, is nauseated, and feels hot. These types ofdata
b b b b b b b b b b b b b b b b b b
would be:
b b
a Objective.
.
b Reflective.
.
c Subjective.
.
d Introspective.
.
ANS: C b
Subjective data are what the person says about him or herself during history taking. Objectivedata
b b b b b b b b b b b b b b b
are what the health professional observes by inspecting, percussing, palpating, and
b b b b b b b b b b b
auscultating during the physical examination. The terms reflective and introspective are not used
b b b b b b b b b b b b
,to describe data.
b b
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 2
b b b b b b b
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
b b b b b b b b b b
3. The patients record, laboratory studies, objective data, and subjective data combine to formthe:
b b b b b b b b b b b b b
a Data base. b
.
b Admitting data. b
.
c Financial statement. b
.
d Discharge summary. b
.
ANS: A b
Together with the patients record and laboratory studies, the objective and subjective data form the
b b b b b b b b b b b b b b
data base. The other items are not part of the patients record, laboratory studies, or data.
b b b b b b b b b b b b b b b b
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 2
b b b b b b b
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
b b b b b b b b b b
4. When listening to a patients breath sounds, the nurse is unsure of a sound that is heard. The
b b b b b b b b b b b b b b b b b
nurses next action should be to:
b b b b b b
a Immediately notify the patients physician. b b b b
.
b Document the sound exactly as it was heard. b b b b b b b
.
c Validate the data by asking a coworker to listen to the breath sounds.
b b b b b b b b b b b b
.
d Assess again in 20 minutes to note whether the sound is still present.
b b b b b b b b b b b b
.
ANS: C b
When unsure of a sound heard while listening to a patients breath sounds, the nurse validates the data
b b b b b b b b b b b b b b b b b
to ensure accuracy. If the nurse has less experience in an area, then he or she asks an expert to
b b b b b b b b b b b b b b b b b b b b
listen.
b
DIF: Cognitive Level: Analyzing (Analysis) REF: p. 2
b b b b b b b
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
b b b b b b b b b b
,5. The nurse is conducting a class for new graduate nurses. During the teaching session, the
b b b b b b b b b b b b b b
nurse should keep in mind that novice nurses, without a background of skills and experience
b b b b b b b b b b b b b b b
from which to draw, are more likely to make their decisions using:
b b b b b b b b b b b b
a Intuition.
.
b A set of rules. b b b
.
c Articles in journals. b b
.
d Advice from supervisors. b b
.
ANS: B b
Novice nurses operate from a set of defined, structured rules. The expert practitioner uses
b b b b b b b b b b b b b
intuitive links.
b b
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 3
b b b b b b b
MSC: Client Needs: General
b b b b
6. Expert nurses learn to attend to a pattern of assessment data and act without consciously
b b b b b b b b b b b b b b
labeling it. These responses are referred to as:
b b b b b b b b
a Intuition.
.
b The nursing process. b b
.
c Clinical knowledge. b
.
d Diagnostic reasoning. b
.
ANS: A b
Intuition is characterized by pattern recognitionexpert nurses learn to attend to a pattern of
b b b b b b b b b b b b b
assessment data and act without consciously labeling it. The other options are not correct.
b b b b b b b b b b b b b b
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 4
b b b b b b b
MSC: Client Needs: General
b b b b
7. The nurse is reviewing information about evidence-based practice (EBP). Which statement
b b b b b b b b b b
best reflects EBP?
b b b
, a EBP relies on tradition for support of best practices.
b b b b b b b b
.
b EBP is simply the use of best practice techniques for the treatment of patients.
b b b b b b b b b b b b b
.
c EBP emphasizes the use of best evidence with the clinicians experience.
b b b b b b b b b b
.
d The patients own preferences are not important with EBP.
b b b b b b b b
.
ANS: C b
EBP is a systematic approach to practice that emphasizes the use of best evidence in combinationwith
b b b b b b b b b b b b b b b b
the clinicians experience, as well as patient preferences and values, when making decisions about
b b b b b b b b b b b b b b
care and treatment. EBP is more than simply using the best practice techniques to treat patients, and
b b b b b b b b b b b b b b b b b
questioning tradition is important when no compelling and supportive research evidence exists.
b b b b b b b b b b b b
DIF: Cognitive Level: Applying (Application) REF: p. 5
b b b b b b b
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
b b b b b b b b b b
8. The nurse is conducting a class on priority setting for a group of new graduate nurses. Whichis an
b b b b b b b b b b b b b b b b b b
example of a first-level priority problem?
b b b b b b
a Patient with postoperative pain b b b
.
b Newly diagnosed patient with diabetes who needs diabetic teaching
b b b b b b b b
.
c Individual with a small laceration on the sole of the foot b b b b b b b b b b
.
d Individual with shortness of breath and respiratory distress b b b b b b b
.
ANS: D b
First-level priority problems are those that are emergent, life threatening, and immediate (e.g.,
b b b b b b b b b b b b
establishing an airway, supporting breathing, maintaining circulation, monitoring abnormal vital
b b b b b b b b b b
signs) (see Table 1-1).
b b b b
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 4
b b b b b b b
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
b b b b b b b b b b
9. When considering priority setting of problems, the nurse keeps in mind that second-level
b b b b b b b b b b b b
priority problems include which of these aspects?
b b b b b b b
