Questions and Answers 100% Pass
Physical Assessment - ✔✔systematic examination of the patient for objective data to
better define the patient's condition and to help the nurse in planning care, usually
performed in a head-to-toe format; a collection of objective data about changes in the
patient's body systems
focused assessment - ✔✔A type of physical assessment that is based on the chief
complaint and focuses on one body system or part.
emergency assessment - ✔✔rapid focused assessment conducted to determine
potentially fatal situations
subjective data - ✔✔what the person says about himself or herself during history taking
objective data - ✔✔information that is seen, heard, felt, or smelled by an observer; signs
What does COLDSPA mean? - ✔✔Character
Onset
Location
100% Pass Guarantee Sophia Bennett, All Rights Reserved © 2025 1
,Duration
Severity
Pattern
Associated factors
Used to ensure that you collect enough information regarding pain
Normal body temperature (oral) - ✔✔96 - 98 Deg F (35.8-37.3 C)
Temperature vs. Route - ✔✔Auxillary will result in the lowest temp (-1 degree)
Rectum will result in +1 F degree (should only be used if client can't cooperate, or
others are not available)
Tempanic will result in the highest temperature (+3 to +6)
lower for older adults
Normal pulse rate - ✔✔60-100 bpm
arteries of older pts may feel rigid, hard or bent
Normal respiration rate - ✔✔12-20 breaths per minute
older adult can range from 15-22 breaths/min
100% Pass Guarantee Sophia Bennett, All Rights Reserved © 2025 2
, normal oxygen saturation - ✔✔95-100%
normal blood pressure - ✔✔120/80 mmHg
no nicotine or caffeine 30 mins prior
client should empty bladder
older adults usually have high bp due rigid arteries
hypertension= over 140, under 90
othostatic hypotension= drop over more than 20 mmHg
Phases of the interview process - ✔✔pre-interaction phase- Review medical records
before meeting client
working phase- gathering subjective and objective data
closing phase- validates findings and sets goals
Phases of collecting objective data - ✔✔inspection- use of vision, smelling and learning
Palpitations- using fingers and hands to feel abnormalities
Percussion- the use of tapping to find superficial abnormalities
Auscultation- use of the stethoscope
Steps of the Nursing Process - ✔✔ADPIE
100% Pass Guarantee Sophia Bennett, All Rights Reserved © 2025 3