il il il
CHAPTER 1FoundationsforClinicalProficiency
MULTIPLE CHOICE
NL NL
1. Aftercompletinganinitial assessmentofa patient,the nursehaschartedthat his respirations are NL NL N
L NL NL NL NL
eupneic and his pulse is 58 beats per minute. These types of data would be:
NL NL NL NL NL NL NL NL NL NL NL NL NL NL NL
a Objective.
.
b Reflective.
.
c Subjective.
.
d Introspective.
.
ANS:A N
L
Objective data are what the health professional observes by inspecting, percussing, palpating, and
N
L N
L NL N
L N
L N
L N
L N
L N
L N
L NL N
L
auscultatingduring the physical examination. Subjective data is what the person says about him or
NL L
N N
L N
L N
L N
L N
L N
L N
L N
L N
L N
L N
L N
L
herselfduringhistorytaking. The termsreflective and introspective arenot used to describedata.
NL NL NL NL NL NL NL NL NL NL NL NL NL NL NL
DIF:Cognitive Level: Understanding(Comprehension) REF: p. 2
NL NL NL NL NL NL
MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare
N
L N
L N
L NL N
L NL N
L NL N
L N
L
2. Apatienttellsthenursethatheisverynervous,isnauseated,and feelshot.Thesetypesof data
N
L N
L N
L N
L N
L N
L N
L N
L il N
L N
L N
L NL
would be:
NL NL
a Objective.
.
b Reflective.
.
c Subjective.
.
d Introspective.
.
ANS:C N
L
Subjective data are what the person says about him or herself during history taking. Objective
NL NL NL NL NL NL NL NL NL NL NL NL NL NL
dataarewhatthehealthprofessionalobservesbyinspecting,percussing,palpating, and
N
L N
L N
L N
L L
N N
L N
L N
L N
L N
L NL
, il il il il il il il il
il il il
auscultatingduringthephysicalexamination.Theterms reflectiveandintrospective arenotused N
L N
L N
L N
L NL N
L N
L NL N
L N
L
todescribedata.
N
L N
L
DIF:Cognitive Level: Understanding(Comprehension) REF: p. 2
NL NL NL NL NL NL
MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare
N
L N
L N
L NL N
L NL N
L NL N
L N
L
3. Thepatientsrecord,laboratorystudies,objectivedata,andsubjectivedatacombineto
N
L N
L N
L N
L N
L N
L N
L N
L N
L N
L
form the:
NL NL
a Database. N
L
.
b Admittingdata.
.
c Financialstatement. N
L
.
d Dischargesummary. N
L
.
ANS:A N
L
Togetherwiththepatientsrecordandlaboratorystudies,theobjectiveandsubjectivedataform the data
N
L N
L N
L N
L N
L N
L N
L N
L N
L N
L NL NL
base. The other items are not part of the patients record, laboratory studies, or data.
NL NL NL NL NL NL NL NL NL NL NL NL NL NL NL
DIF:Cognitive Level:Remembering(Knowledge)REF: p. 2
N
L N L NL N
L NL NL
MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare
N
L N
L N
L NL N
L NL N
L NL N
L N
L
4. Whenlisteningtoapatientsbreathsounds,thenurseisunsureofasoundthatisheard. The
N
L N
L N
L N
L N
L N
L N
L N
L N
L N
L N
L N
L N
L N
L N
L N
L NL
nurses next action should be to:
NL NL NL NL NL NL
a Immediatelynotifythe patientsphysician. N
L NL N
L
.
b Documentthesoundexactlyasitwasheard. N
L N
L L
N N
L N
L N
L
.
c Validatethedata byaskinga coworkertolistentothe breath sounds. N
L NL N
L NL N
L N
L N
L N
L NL NL
.
d Assessagainin20minutestonotewhetherthesoundisstillpresent. N
L N
L N
L N
L N
L N
L N
L N
L N
L N
L N
L
.
ANS:C N
L
When unsure of a sound heard while listening to a patients breath sounds, the nurse validates the datato
NL NL NL NL NL NL NL NL NL NL NL NL NL NL NL NL NL N
L
ensure accuracy. Ifthe nursehaslessexperienceinanarea,thenheorsheasks anexpert to listen.
N
L NL NL NL NL NL NL N
L N
L N
L NL N
L NL NL NL N
L NL N
L N L NL
DIF:CognitiveLevel:Analyzing(Analysis)REF:p.2
N
L N
L N
L N
L N
L N
L
, MSC:ClientNeeds:SafeandEffectiveCareEnvironment:ManagementofCare
N
L N
L N
L NL N
L NL N
L NL N
L N
L