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Edition by Janet R Weber and Jane H Kelley
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FullyCovered
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,1 A nurse on a postsurgical unit is admitting a client following the
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client's cholecystectomy (gall bladder removal). What is the overall purpose
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of assessment forthisclient?
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A) Collecting accurate data g g g g
B) Assisting the primary care provider gg g g gg g g
C) Validating previous gg
data Making
D) clinical judgments
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2. A client has presented to the emergency department (ED) with complaints
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of abdominal pain. Which member of the care team would most likely
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be responsible for collecting the subjective data on the client during
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the initial comprehensive assessment?
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A) Gastroenterologist
B) ED nurse
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C) Admissions clerk gg
D) Diagnostic technician gg
3. The nurse has completed an initial assessment of a newly admitted client and is
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applyingthe nursing process to plan the client's care. What principle
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should the nurse apply when using the nursing process?
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A) Each step is independent of the gg gg gg gg gg
others.
It isB)ongoing and continuous.
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C) It is used primarily in acute care settings.
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D) It involves independent nursing actions.
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4. The nurse who provides care at an ambulatory clinic is preparing to
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meet a client and perform a comprehensive health assessment. Which of
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the following actions should thenurse perform first?
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A) Review the client's medical record. gg gg gggg gg
B) Obtain basic biographic data. gg g g g g
C) Consult clinical resources explaining the client's diagnosis. g g gg gg gg gg g g
D) Validate information with the client. gg gg gg g g
5. Which of the following client situations would the nurse
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interpret as requiring anemergency assessment?
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A) A pediatric client with severe sunburn
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B) A client needing an employment gg g g gg gg
physical C) who overdosed on acetaminophen
A client
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D) A distraught client who wants a pregnancy test
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,6. In response to a client's query, the nurse
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differences between the physician's medical
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comprehensive health assessment performed
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nurse should describe the fact that the
g g g g g g g g g g g g g g g g nursing assessment focuses gg g g
on whichaspect of the client's situation?
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A) Current physiologic gg
ggstatus B) of health on functional status
Effect gg gg gg gg gggg gg
C) Past medical history g g g g
D) Motivation for adherence to treatment gg g g gg gg
7. After teaching a group of students about the phases of the nursing
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process, the instructordetermines that the teaching was successful
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when the students identify which phase as being foundational to all
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other phases?
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A) Assessment
B) Planning
C) Implementation
D) Evaluation
8. The nurse has completed the comprehensive health assessment of a client
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who has beenadmitted for the treatment of community-acquired
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pneumonia. Following the completion of this assessment, the nurse
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periodically performs a partial assessment primarily for which reason?
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A) Reassess previously detected problems gg gg gg
B) Provide information for the client's record gg g g gg gg g g
C) Address areas previously omitted gg g g gg
D) Determine the need for crisis intervention gg gg g g gg g g
9. The nurse is working in an ambulatory care clinic that is located
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in a busy, inner-cityneighborhood. Which client would the nurse
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determine to be in most need of an emergency assessment?
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A) A 14-year-old girl who is crying because she thinks she is
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pregnant
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A 45-year-old man with chest pain and diaphoresis for 1 hour
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C) A 3-year-old child with fever, rash, and sore throat
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D) A 20-year-old man with a 3-inch shallow laceration on his leg
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, 10. A nurse has completed gathering some basic data about a client who
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has multiple healthproblems that stem from heavy alcohol use. The
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nurse has then reflected on her personalfeelings about the client and
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his circumstances. The nurse does this primarily to accomplish which
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of the following?
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A) Determine if pertinent data has been omitted g g gg g g gg gg gg
B) Identify the need for gg gg g g
ggreferral C) biases and judgments
Avoid gg gg gg gg
D) Construct a plan of care g g g g gg gg
11. The nurse is collecting data from a client who has recently been
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diagnosed with type 1 diabetes and who will begin an educational
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program. The nurse is collecting subjective and objective data.
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Which of the following would the nurse categorize as objective data?
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A) Family history gg
B) Occupation
C) Appearance
D) History of present health concern gg gg g g gg
12. An older adult client has been admitted to the hospital with failure
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to thrive resulting from complications of diabetes. Which of the following
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would the nurse implement in response to a collaborative problem?
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A) Encourage the client to increase oral fluid intake. gg g g gg g g gg gg g g
B) Provide the client with a bedtime protein snack. gg g g g g gg gg g g gg
C) Assist the client with personal gg gg g g gg
hygiene.
gg D) the client's blood glucose four times daily.
Measure gg gg gg gg gg gg gg gg
13. The nurse at a busy primary care clinic is analyzing the data
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obtained from the following clients. For which clients would the
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nurse most likely expect to facilitate a referral?
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A) An 80-year-old client who lives with her
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daughter
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A 50-year-old client newly diagnosed with diabetes
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C) An adult presenting for an influenza vaccination
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D) A teenager seeking information about contraception
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14. An instructor is reviewing
g g g g g g g g the evolution of the nurse's role in health
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assessment. The instructor
g g gg g g gg determines that the teaching was successful g g g g g g g g g g
when the students identify
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method used by nurses
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A) Natural senses gg
B) Biomedical knowledge gg
C) Simple technology gg
D) Critical pathways gg
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