1. A client comes to the health care provider's office for a visit. The client has been seen in this office for the past
five years and arrives today complaining of a fever and sore throat. Which type of assessment would the nurse
most likely perform?: focused assessment
2. Nurses provide both direct and indirect care. What is an example of indirect care?: Participating in a client care
conference
3. A nurse is completing an assessment that will involve gathering subjective and objective data. Which of the
following assessment techniques will best allow the nurse to collect objective data?: Inspection
4. When doing an overall assessment of a patient, the nurse is able to utilize findings and do what?: Identify in
what areas the patient needs the most care
5. The preceptor of the student nurse is explaining the assessment that is considered the most organized for
gathering comprehensive physical data. What assessment is the preceptor talking about?: head to toe
6. A nurse provides care for a client with impaired respiratory function. The nurse frequently assesses the
client's skin color and the temperature of the extremities. What is the purpose of this ongoing or partial
assessment?: De- termine any changes from the baseline data
7. Mrs. Williams is an 89-year-old independent woman who lives alone and has severe arthritis in her hands. Over
the last few months the arthritis has gotten worse and she is concerned because she can no longer clean her
apartment. What question by the nurse would gain the most usable information to assist with this concern?: "Do
you have family who visit you regularly?"
8. A group of nurses are reviewing information about the potential oppor- tunities for nurses who have
advanced assessment skills. When discussing phenomena that have contributed to these increased opportunities,
what should the nurses identify?: Expansion of health care networks
9. A nurse will complete an initial comprehensive assessment of a 60-year-old client who is new to the clinic.
,What goal should the nurse identify for this type of assessment?: Establish a baseline for the comparison of future
health changes.
10. The nurse is reviewing a client's health history and the results of the most recent physical examination.
Which of the following data would the nurse identify as being subjective? Select all that apply.: 1. "I feel so tired
sometimes."
2. Client complains of a headache
3. "My father died of a heart attack."
11. subjective data: things a person tells you about that you cannot observe through your senses; symptoms
12. objective data: information that is seen, heard, felt, or smelled by an observer; signs
13. When discussing the nursing process with a group of students, which of the following statements best
describes it?: It is ongoing and continuous.
14. A nurse provides care for a client with an elevated temperature. The client is given the prescribed medication
and the nurse checks the client's temperature at repeated intervals. What step of the nursing process is the nurse
using to determine if the client has achieved the outcome criteria of the treatment?: - Evaluation
15. A nurse recognizes that a thorough and accurate assessment of a client is important to prevent what error
from occurring when utilizing the nursing process?: Making incorrect nursing judgments or diagnoses
16. The nurse discusses ear plugs for a patient with low tone deafness when working in a noisy environment.
The nurse is utilizing: tertiary prevention
17. A nurse is distracted during her assessment of a client and does not take as thorough or as accurate notes as
usual. Her supervisor, who is familiar with the client, reads the patient's chart and questions the nurse. The
supervisor should point out to the nurse that which of the following errors is most likely to occur due to the nurse's
lapse?: Making incorrect nursing judgments or diagnoses
,18. A client who is new to the facility has a recent history of chronic pain that is attributed to fibromyalgia. The
nurse has reviewed the available health records and suspects that pain management will be a major focus of
nursing care. How can the nurse best validate this assumption?: Ask the client about the most recent experiences of
pain.
19. The nurse is exhibiting critical thinking in which client care situation?: Per- forming a focused assessemt on a
client who is complaining of shortness of breath.
20. This type of assessment includes a health history and physical assess- ment.: Comprehensive
21. A student nurse is learning to document an initial assessment. What would the instructor tell the student that
accurate documentation of this specific assessment best provides?: A baseline for comparison with future findings
22. After receiving morning report the nurse prepares to assess a client who was admitted the day before.
Which type of assessment will the nurse com- plete at this time?: Ongoing
23. When performing the steps of the assessment phase of the nursing process, which of the following would
the nurse do first?: Collect subjective data
24. A home health nurse is visiting a patient who recently was hospitalized for repair of a fractured hip. The
patient tells the nurse, "I have had a lot of pain in my abdomen." What type of assessment would the nurse
conduct?: focused
25. A community health nurse is assessing an older adult client in the client's home. When the nurse is gathering
subjective data, which of the following would the nurse identify?: The client's feelings of happiness
26. What are nurses able to detect through the health assessment?: Areas in need of health adjustments
27. The result of a nursing assessment is the: formulation of nursing diagnoses.
28. A nurse is conducting a health assessment. How will the information collected from the patient be
used?: as a basis for the nursing process
, 29. The nurse at a busy primary care clinic is analyzing the data obtained from the following clients. For which
clients would the nurse most likely expect to facilitate a referral?: A 50-year-old client newly diagnosed with
diabetes
30. When assisting a patient with health promotion, what must the nurse also nurture?: A healthy environment
31. How does a nurse best facilitate the nursing health assessment?: Asking the appropriate questions
32. Why is it important for a new nurse, working on a step-down unit, to know the standards of care for the
facility in which the nurse is working?: Standards of care often set the time frame for assessing the clients on the unit
33. A nurse is gathering data from a client during a health assessment. Which assessment finding should the
nurse document as objective data?: The client's range of motion in her right arm
34. A nurse recommends that a client come back once every 3 months in the coming year to have his cholesterol
checked, to make sure he is maintaining a healthy level. Which type of assessment is the nurse proposing?:
Ongoing or partial
35. The nurse has completed the comprehensive health assessment of a client who has been admitted for the
treatment of community-acquired pneumonia. Following the completion of this assessment, the nurse periodically
performs a partial assessment primarily for which reason?: Reassess previously detected problems
36. A client comes to the health care provider's office for a visit. The client has been seen in this office on
occasion for the past 5 years and arrives today complaining of a fever and sore throat. Which type of assessment
would the nurse most likely perform?: Focused assessment
37. The RN is implementing which level of intervention when administering immunizations at a pediatric
clinic?: Primary
38. A patient is brought to the emergency department by ambulance after a motor vehicle accident. What
would be given the highest priority by the staff triaging the patient?: Airway
five years and arrives today complaining of a fever and sore throat. Which type of assessment would the nurse
most likely perform?: focused assessment
2. Nurses provide both direct and indirect care. What is an example of indirect care?: Participating in a client care
conference
3. A nurse is completing an assessment that will involve gathering subjective and objective data. Which of the
following assessment techniques will best allow the nurse to collect objective data?: Inspection
4. When doing an overall assessment of a patient, the nurse is able to utilize findings and do what?: Identify in
what areas the patient needs the most care
5. The preceptor of the student nurse is explaining the assessment that is considered the most organized for
gathering comprehensive physical data. What assessment is the preceptor talking about?: head to toe
6. A nurse provides care for a client with impaired respiratory function. The nurse frequently assesses the
client's skin color and the temperature of the extremities. What is the purpose of this ongoing or partial
assessment?: De- termine any changes from the baseline data
7. Mrs. Williams is an 89-year-old independent woman who lives alone and has severe arthritis in her hands. Over
the last few months the arthritis has gotten worse and she is concerned because she can no longer clean her
apartment. What question by the nurse would gain the most usable information to assist with this concern?: "Do
you have family who visit you regularly?"
8. A group of nurses are reviewing information about the potential oppor- tunities for nurses who have
advanced assessment skills. When discussing phenomena that have contributed to these increased opportunities,
what should the nurses identify?: Expansion of health care networks
9. A nurse will complete an initial comprehensive assessment of a 60-year-old client who is new to the clinic.
,What goal should the nurse identify for this type of assessment?: Establish a baseline for the comparison of future
health changes.
10. The nurse is reviewing a client's health history and the results of the most recent physical examination.
Which of the following data would the nurse identify as being subjective? Select all that apply.: 1. "I feel so tired
sometimes."
2. Client complains of a headache
3. "My father died of a heart attack."
11. subjective data: things a person tells you about that you cannot observe through your senses; symptoms
12. objective data: information that is seen, heard, felt, or smelled by an observer; signs
13. When discussing the nursing process with a group of students, which of the following statements best
describes it?: It is ongoing and continuous.
14. A nurse provides care for a client with an elevated temperature. The client is given the prescribed medication
and the nurse checks the client's temperature at repeated intervals. What step of the nursing process is the nurse
using to determine if the client has achieved the outcome criteria of the treatment?: - Evaluation
15. A nurse recognizes that a thorough and accurate assessment of a client is important to prevent what error
from occurring when utilizing the nursing process?: Making incorrect nursing judgments or diagnoses
16. The nurse discusses ear plugs for a patient with low tone deafness when working in a noisy environment.
The nurse is utilizing: tertiary prevention
17. A nurse is distracted during her assessment of a client and does not take as thorough or as accurate notes as
usual. Her supervisor, who is familiar with the client, reads the patient's chart and questions the nurse. The
supervisor should point out to the nurse that which of the following errors is most likely to occur due to the nurse's
lapse?: Making incorrect nursing judgments or diagnoses
,18. A client who is new to the facility has a recent history of chronic pain that is attributed to fibromyalgia. The
nurse has reviewed the available health records and suspects that pain management will be a major focus of
nursing care. How can the nurse best validate this assumption?: Ask the client about the most recent experiences of
pain.
19. The nurse is exhibiting critical thinking in which client care situation?: Per- forming a focused assessemt on a
client who is complaining of shortness of breath.
20. This type of assessment includes a health history and physical assess- ment.: Comprehensive
21. A student nurse is learning to document an initial assessment. What would the instructor tell the student that
accurate documentation of this specific assessment best provides?: A baseline for comparison with future findings
22. After receiving morning report the nurse prepares to assess a client who was admitted the day before.
Which type of assessment will the nurse com- plete at this time?: Ongoing
23. When performing the steps of the assessment phase of the nursing process, which of the following would
the nurse do first?: Collect subjective data
24. A home health nurse is visiting a patient who recently was hospitalized for repair of a fractured hip. The
patient tells the nurse, "I have had a lot of pain in my abdomen." What type of assessment would the nurse
conduct?: focused
25. A community health nurse is assessing an older adult client in the client's home. When the nurse is gathering
subjective data, which of the following would the nurse identify?: The client's feelings of happiness
26. What are nurses able to detect through the health assessment?: Areas in need of health adjustments
27. The result of a nursing assessment is the: formulation of nursing diagnoses.
28. A nurse is conducting a health assessment. How will the information collected from the patient be
used?: as a basis for the nursing process
, 29. The nurse at a busy primary care clinic is analyzing the data obtained from the following clients. For which
clients would the nurse most likely expect to facilitate a referral?: A 50-year-old client newly diagnosed with
diabetes
30. When assisting a patient with health promotion, what must the nurse also nurture?: A healthy environment
31. How does a nurse best facilitate the nursing health assessment?: Asking the appropriate questions
32. Why is it important for a new nurse, working on a step-down unit, to know the standards of care for the
facility in which the nurse is working?: Standards of care often set the time frame for assessing the clients on the unit
33. A nurse is gathering data from a client during a health assessment. Which assessment finding should the
nurse document as objective data?: The client's range of motion in her right arm
34. A nurse recommends that a client come back once every 3 months in the coming year to have his cholesterol
checked, to make sure he is maintaining a healthy level. Which type of assessment is the nurse proposing?:
Ongoing or partial
35. The nurse has completed the comprehensive health assessment of a client who has been admitted for the
treatment of community-acquired pneumonia. Following the completion of this assessment, the nurse periodically
performs a partial assessment primarily for which reason?: Reassess previously detected problems
36. A client comes to the health care provider's office for a visit. The client has been seen in this office on
occasion for the past 5 years and arrives today complaining of a fever and sore throat. Which type of assessment
would the nurse most likely perform?: Focused assessment
37. The RN is implementing which level of intervention when administering immunizations at a pediatric
clinic?: Primary
38. A patient is brought to the emergency department by ambulance after a motor vehicle accident. What
would be given the highest priority by the staff triaging the patient?: Airway
