Evidence-Based Physical Examination Best Practices for
Health & Well-BeingAssessment by Kate Gawlic
1st Edition
TEST BANK
,Chapter 1. APPROACH TO EVIDENCE-BASED ASSESSMENT OF HEALTH AND
WELL-BEING
Kate Gawlic: Evidence-Based Physical Examination Best Practices for Health & Well-
BeingAssessment 1st Edition
MULTIPLE CHOICE
1. After completing an initial assessment of a patient, the nurse has charted that his respirations
are eupneic and his pulse is 58 beats per minute. These types of data would be:
a Objective.
.
b Reflective.
.
c Subjective.
.
d Introspective.
.
ANS: A
Objective data are what the health professional observes by inspecting, percussing, palpating,
and auscultating during the physical examination. Subjective data is what the person says about
him or herself during history taking. The terms reflective and introspective are not used to
describe data.
DIF: Cognitive Level: Understanding (Comprehension) REF: z. 2
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
2. A patient tells the nurse that he is very nervous, is nauseated, and feels hot. These types of
data would be:
a Objective.
.
b Reflective.
.
c Subjective.
.
d Introspective.
.
ANS: C
Subjective data are what the person says about him or herself during history taking. Objective
,data are what the health professional observes by inspecting, percussing, palpating, and
auscultating during the physical examination. The terms reflective and introspective are not used
to describe data.
DIF: Cognitive Level: Understanding (Comprehension) REF: z. 2
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
3. The patients record, laboratory studies, objective data, and subjective data combine to form
the:
a Data base.
.
b Admitting data.
.
c Financial statement.
.
d Discharge summary.
.
ANS: A
Together with the patients record and laboratory studies, the objective and subjective data form
the data base. The other items are not part of the patients record, laboratory studies, or data.
DIF: Cognitive Level: Remembering (Knowledge) REF: z. 2
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
4. When listening to a patients breath sounds, the nurse is unsure of a sound that is heard. The
nurses next action should be to:
a Immediately notify the patients physician.
.
b Document the sound exactly as it was heard.
.
c Validate the data by asking a coworker to listen to the breath sounds.
.
d Assess again in 20 minutes to note whether the sound is still present.
.
ANS: C
When unsure of a sound heard while listening to a patients breath sounds, the nurse validates the
data to ensure accuracy. If the nurse has less experience in an area, then he or she asks an expert
to listen.
, DIF: lCognitive lLevel: lAnalyzing l(Analysis) lREF: lz. l2
MSC: lClient lNeeds: lSafe land lEffective lCare lEnvironment: lManagement lof lCare
5. The lnurse lis lconducting la lclass lfor lnew lgraduate lnurses. lDuring lthe lteaching lsession,
lthe lnurse lshould lkeep lin lmind lthat lnovice lnurses, lwithout la lbackground lof lskills land
lexperience lfrom lwhich lto ldraw, lare lmore llikely lto lmake ltheir ldecisions l using:
a Intuition.
.
b A lset lof lrules.
.
c Articles lin ljournals.
.
d Advice lfrom lsupervisors.
.
ANS: lB
Novice lnurses loperate lfrom la lset lof ldefined, lstructured lrules. lThe lexpert lpractitioner luses
lintuitive llinks.
DIF: lCognitive lLevel: lUnderstanding l(Comprehension) lREF: lz.
l3 lMSC: lClient lNeeds: lGeneral
6. Expert lnurses llearn lto lattend lto la lpattern lof lassessment ldata land lact lwithout
lconsciously llabeling lit. lThese lresponses lare lreferred lto las:
a Intuition.
.
b The lnursing lprocess.
.
c Clinical lknowledge.
.
d Diagnostic lreasoning.
.
ANS: lA
Intuition lis lcharacterized lby lpattern lrecognitionexpert lnurses llearn lto lattend lto la lpattern lof
lassessment ldata land lact lwithout lconsciously llabeling lit. lThe lother loptions lare lnot lcorrect.
DIF: lCognitive lLevel: lUnderstanding l(Comprehension) lREF: lz.
l4 lMSC: lClient lNeeds: lGeneral
7. The lnurse lis lreviewing linformation labout levidence-based lpractice l(EBP). lWhich
lstatement lbest lreflects lEBP?