NUR 3306 Final Study Guide A GUARANTEE
The nursing instructor is explaining SBAR documentation to students before taking them into the
clinical area. The instructor explains that SBAR charting is based on?
A. The client's background
B. Information that the nurse obtains from the family
C. Complete and accurate assessment findings
D. Data in old medical records -(ANSWER) C
What does the nurse know about normal blood pressure?
A. Stays level throughout the day
B. Follows a diurnal rhythm
C. Rises with the early morning fall of blood glucose
D. Follows the same cycle as the sun -(ANSWER) B
A nursing instructor is discussing the purposes of health assessment. What is one purpose of
health assessment?
A. To establish rapport with the client and family.
B. To gather information for specialists to whom the client might be referred.
C. To establish a database against which subsequent assessments can be measured.
D. To quantify the degree of pain a client may be experiencing. -(ANSWER) C
A nurse, who suffers from a respiratory infection is preparing to perform a shift assessment on a
client when she feels the urge to cough. What is the nurse's best action?
A. Perform hand hygiene before coughing into hands
B. Cover the mouth and nose with her hands while coughing
Cough into the air away from the client toward the hallway
D. Cough into the inner aspect of the elbow -(ANSWER) D
As part of the general survey, the nurse should shake hands with the client when first meeting
him or her as long as doing so in culturally appropriate. Why is this action so important?
A. The handshake portrays caring
B. The handshake shows how professional the nurse is
C. The handshake allows the nurse to get physically close to the client in a nonthreatening way
D. The handshake allows the nurse to assess how nervous the client is -(ANSWER) A
To make a legal entry into the medical record, the nurse must document what?
A. Laboratory tests ordered
B. Attending physician
C. Time of the assessment
D. Nature of the assessment
Response Feedback:
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,The nurse must record normal assessment data, abnormal assessment data, and the time of the
assessment. The nurse does not have to document laboratory tests ordered, the attending
physician, or the nature of the assessment. -(ANSWER) C
While assessing a new client, the nurse asks about a family history of genetic illnesses The client
states that her mother has diabetes. For which of the following is the patient at increased risk?
A. Diabetes
B. Hypertension
C. Cancer
D. Seizures -(ANSWER) A
Nursing students are learning about different methods of charting in clinical. What method is the
model for improving communication between and among clinicians?
A. SBAR
B. CBE
C. SOAP
D. PIE -(ANSWER) A
How does the nurse use critical thinking when accurately assessing vital signs?
A. Evaluating assessment techniques
B. Developing nursing diagnoses
C. Monitoring evaluations
D. Planning assessment techniques -(ANSWER) B
HIPAA gives clients greater control over their medical records. What else does HIPAA provide?
A. Copying of medical records
B. Education of lay people about medical records
C. Client recourse if privacy protections are violated
D. Legal use of medical records
Response Feedback:
HIPAA provides for client education on privacy protection, client access to medical records,
client consent prior to disclosing information from the record, and client recourse if privacy
protections are violated. HIPAA does not address copying of medical records, education of lay
people about medical records, or legal use of medical records. -(ANSWER) C
When caring for clients in any health care environment, what is the most important technique for
preventing infection?
A. Sterile technique
B. Standard precautions
C. Hand hygiene
D. Use of gloves -(ANSWER) C
Students are learning about the many uses of the medical record. One of these uses is to perform
an internal audit. What is the goal of an internal audit?
A. The evaluation of financial reimbursement
B. The evaluation of client nutrition
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, C. The evaluation of care for continual improvement
D. The evaluation of timely documentation of pain -(ANSWER) C
Upon entering an adult client's room to begin a shift assessment, the nurse should call the rapid
response team based on which assessment finding?
A. Systolic pressure 180 mm Hg
B. Apical pulse 70 beats/minute
C. Respirations 12 breaths/minute
D. Oxygen saturation 95% on room air -(ANSWER) A
The nursing instructor is teaching about health assessment and explains to students how to assess
the roles and relationships of the client. The students knows that this type of information is
assessed in what type of assessment?
A. Comprehensive
B. Functional
C. Head to toe
D. Body systems -(ANSWER) B
The nursing instructor is discussing the different types of pain with the nursing class. What type
of pain would the instructor explain originates from a specific site, yet the client feels the pain at
another site?
A. Chronic pain
B. Cutaneous pain
C. Referred pain
D. Somatic pain
Response Feedback:
Referred pain originates from a specific site, but the person experiencing it feels the pain at
another site along the innervating spinal nerve. Chronic pain is pain referred to as persistent.
Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues and is felt at its
origination. Somatic painoriginates from skin, muscles, bones, and joints and is felt at its
origination. -(ANSWER) C
When using Gordon's framework for a functional health assessment, the nurse asks a client,
"Have you made any changes in your environment because of vision, hearing, or memory
decrease?" What functional health pattern is the nurse assessing?
A. Vision
B. Hearing
C. Coping
D. Cognition -(ANSWER) D
Response Feedback:
A question to include in review of cognition and perception is whether the client has made any
environmental changes because of vision, hearing, or memory decrease. The options of vision or
hearing individually would not be complete as a response. The option of coping is not addressed
in the question posed by the nurse.
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The nursing instructor is explaining SBAR documentation to students before taking them into the
clinical area. The instructor explains that SBAR charting is based on?
A. The client's background
B. Information that the nurse obtains from the family
C. Complete and accurate assessment findings
D. Data in old medical records -(ANSWER) C
What does the nurse know about normal blood pressure?
A. Stays level throughout the day
B. Follows a diurnal rhythm
C. Rises with the early morning fall of blood glucose
D. Follows the same cycle as the sun -(ANSWER) B
A nursing instructor is discussing the purposes of health assessment. What is one purpose of
health assessment?
A. To establish rapport with the client and family.
B. To gather information for specialists to whom the client might be referred.
C. To establish a database against which subsequent assessments can be measured.
D. To quantify the degree of pain a client may be experiencing. -(ANSWER) C
A nurse, who suffers from a respiratory infection is preparing to perform a shift assessment on a
client when she feels the urge to cough. What is the nurse's best action?
A. Perform hand hygiene before coughing into hands
B. Cover the mouth and nose with her hands while coughing
Cough into the air away from the client toward the hallway
D. Cough into the inner aspect of the elbow -(ANSWER) D
As part of the general survey, the nurse should shake hands with the client when first meeting
him or her as long as doing so in culturally appropriate. Why is this action so important?
A. The handshake portrays caring
B. The handshake shows how professional the nurse is
C. The handshake allows the nurse to get physically close to the client in a nonthreatening way
D. The handshake allows the nurse to assess how nervous the client is -(ANSWER) A
To make a legal entry into the medical record, the nurse must document what?
A. Laboratory tests ordered
B. Attending physician
C. Time of the assessment
D. Nature of the assessment
Response Feedback:
Page | 1
,The nurse must record normal assessment data, abnormal assessment data, and the time of the
assessment. The nurse does not have to document laboratory tests ordered, the attending
physician, or the nature of the assessment. -(ANSWER) C
While assessing a new client, the nurse asks about a family history of genetic illnesses The client
states that her mother has diabetes. For which of the following is the patient at increased risk?
A. Diabetes
B. Hypertension
C. Cancer
D. Seizures -(ANSWER) A
Nursing students are learning about different methods of charting in clinical. What method is the
model for improving communication between and among clinicians?
A. SBAR
B. CBE
C. SOAP
D. PIE -(ANSWER) A
How does the nurse use critical thinking when accurately assessing vital signs?
A. Evaluating assessment techniques
B. Developing nursing diagnoses
C. Monitoring evaluations
D. Planning assessment techniques -(ANSWER) B
HIPAA gives clients greater control over their medical records. What else does HIPAA provide?
A. Copying of medical records
B. Education of lay people about medical records
C. Client recourse if privacy protections are violated
D. Legal use of medical records
Response Feedback:
HIPAA provides for client education on privacy protection, client access to medical records,
client consent prior to disclosing information from the record, and client recourse if privacy
protections are violated. HIPAA does not address copying of medical records, education of lay
people about medical records, or legal use of medical records. -(ANSWER) C
When caring for clients in any health care environment, what is the most important technique for
preventing infection?
A. Sterile technique
B. Standard precautions
C. Hand hygiene
D. Use of gloves -(ANSWER) C
Students are learning about the many uses of the medical record. One of these uses is to perform
an internal audit. What is the goal of an internal audit?
A. The evaluation of financial reimbursement
B. The evaluation of client nutrition
Page | 2
, C. The evaluation of care for continual improvement
D. The evaluation of timely documentation of pain -(ANSWER) C
Upon entering an adult client's room to begin a shift assessment, the nurse should call the rapid
response team based on which assessment finding?
A. Systolic pressure 180 mm Hg
B. Apical pulse 70 beats/minute
C. Respirations 12 breaths/minute
D. Oxygen saturation 95% on room air -(ANSWER) A
The nursing instructor is teaching about health assessment and explains to students how to assess
the roles and relationships of the client. The students knows that this type of information is
assessed in what type of assessment?
A. Comprehensive
B. Functional
C. Head to toe
D. Body systems -(ANSWER) B
The nursing instructor is discussing the different types of pain with the nursing class. What type
of pain would the instructor explain originates from a specific site, yet the client feels the pain at
another site?
A. Chronic pain
B. Cutaneous pain
C. Referred pain
D. Somatic pain
Response Feedback:
Referred pain originates from a specific site, but the person experiencing it feels the pain at
another site along the innervating spinal nerve. Chronic pain is pain referred to as persistent.
Cutaneous pain derives from the dermis, epidermis, and subcutaneous tissues and is felt at its
origination. Somatic painoriginates from skin, muscles, bones, and joints and is felt at its
origination. -(ANSWER) C
When using Gordon's framework for a functional health assessment, the nurse asks a client,
"Have you made any changes in your environment because of vision, hearing, or memory
decrease?" What functional health pattern is the nurse assessing?
A. Vision
B. Hearing
C. Coping
D. Cognition -(ANSWER) D
Response Feedback:
A question to include in review of cognition and perception is whether the client has made any
environmental changes because of vision, hearing, or memory decrease. The options of vision or
hearing individually would not be complete as a response. The option of coping is not addressed
in the question posed by the nurse.
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