lOMoARcPSD| 12286418
, lOMoARcPSD| 12286418
Chapter 1The Nurse Role In Health Assesment
s!
1. A nurse on a postsurgical unit is admitting a client following the client's cholecystecto
s! s! s! s! s! s! s! s! s! s! s! s! s!
my (gall bladder removal). What is the overall purpose of assessment for this client?
s! s! s! s! s! s! s! s! s! s! s! s! s!
A) Collecting accurate data s! s!
B) Assisting the primary care provider s! s! s! s!
C) Validating previous data s! s!
D) Making clinical judgments s! s!
2. A client has presented to the emergency department (ED) with complaints of abdominal
s! s! s! s! s! s! s! s! s! s! s! s! s!
pain. Which member of the care team would most likely be responsible for collecting th
s! s! s! s! s! s! s! s! s! s! s! s! s! s!
e subjective data on the client during the initial comprehensive assessment?
s! s! s! s! s! s! s! s! s! s!
A) Gastroenterologist
B) ED nurse s!
C) Admissions clerk s!
D) Diagnostic technician s!
3. The nurse has completed an initial assessment of a newly admitted client and is applying t
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
he nursing process to plan the client's care. What principle should the nurse apply when
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
using the nursing process? s! s! s!
A) Each step is independent of the others. s! s! s! s! s! s!
B) It is ongoing and continuous. s! s! s! s!
C) It is used primarily in acute care settings.
s! s! s! s! s! s! s!
D) It involves independent nursing actions.
s! s! s! s!
4. The nurse who provides care at an ambulatory clinic is preparing to meet a client and p
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
erform a comprehensive health assessment. Which of the following actions should the n
s! s! s! s! s! s! s! s! s! s! s! s!
urse perform first? s! s!
A) Review the client's medical record. s! s! s! s!
B) Obtain basic biographic data. s! s! s!
C) Consult clinical resources explaining the client's diagnosis. s! s! s! s! s! s!
D) Validate information with the client. s! s! s! s!
5. Which of the following client situations would the nurse interpret as requiring an
s! s! s! s! s! s! s! s! s! s! s! s! s!
emergency assessment? s!
A) A pediatric client with severe sunburn
s! s! s! s! s!
B) A client needing an employment physical
s! s! s! s! s!
C) A client who overdosed on acetaminophen
s! s! s! s! s!
D) A distraught client who wants a pregnancy test
s! s! s! s! s! s! s!
, lOMoARcPSD| 12286418
6. In response to a client's query, the nurse is explaining the differences between the phy
s! s! s! s! s! s! s! s! s! s! s! s! s! s!
sician's medical exam and the comprehensive health assessment performed by the nurs
s! s! s! s! s! s! s! s! s! s! s!
e. The nurse should describe the fact that the nursing assessment focuses on which aspe
s! s! s! s! s! s! s! s! s! s! s! s! s! s!
ct of the client's situation?
s! s! s! s!
A) Current physiologic status s! s!
B) Effect of health on functional status s! s! s! s! s!
C) Past medical history s! s!
D) Motivation for adherence to treatment s! s! s! s!
7. After teaching a group of students about the phases of the nursing process, the instructor
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
determines that the teaching was successful when the students identify which phase as b
s! s! s! s! s! s! s! s! s! s! s! s! s!
eing foundational to all other phases?
s! s! s! s! s!
A) Assessment
B) Planning
C) Implementation
D) Evaluation
8. The nurse has completed the comprehensive health assessment of a client who has been
s! s! s! s! s! s! s! s! s! s! s! s! s! s!
admitted for the treatment of community-
s! s! s! s! s!
acquired pneumonia. Following the completion of this assessment, the nurse periodical
s! s! s! s! s! s! s! s! s! s!
ly performs a partial assessment primarily for which reason?
s! s! s! s! s! s! s! s!
A) Reassess previously detected problems s! s! s!
B) Provide information for the client's record s! s! s! s! s!
C) Address areas previously omitted s! s! s!
D) Determine the need for crisis intervention s! s! s! s! s!
9. The nurse is working in an ambulatory care clinic that is located in a busy, inner-
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
city neighborhood. Which client would the nurse determine to be in most need of an
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
emergency assessment? s!
A) A 14-year-old girl who is crying because she thinks she is pregnant
s! s! s! s! s! s! s! s! s! s! s!
B) A 45-year-old man with chest pain and diaphoresis for 1 hour
s! s! s! s! s! s! s! s! s! s!
C) A 3-year-old child with fever, rash, and sore throat
s! s! s! s! s! s! s! s!
D) A 20-year-old man with a 3-inch shallow laceration on his leg
s! s! s! s! s! s! s! s! s! s!
, lOMoARcPSD| 12286418
10. A nurse has completed gathering some basic data about a client who has multiple health
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
problems that stem from heavy alcohol use. The nurse has then reflected on her personal f
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
eelings about the client and his circumstances. The nurse does this primarily to accompl
s! s! s! s! s! s! s! s! s! s! s! s! s!
ish which of the following?
s! s! s! s!
A) Determine if pertinent data has been omitted s! s! s! s! s! s!
B) Identify the need for referral s! s! s! s!
C) Avoid biases and judgments s! s! s!
D) Construct a plan of care s! s! s! s!
11. The nurse is collecting data from a client who has recently been diagnosed with type 1 d
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
iabetes and who will begin an educational program. The nurse is collecting subjective an
s! s! s! s! s! s! s! s! s! s! s! s! s!
d objective data. Which of the following would the nurse categorize as objective data?
s! s! s! s! s! s! s! s! s! s! s! s! s!
A) Family history s!
B) Occupation
C) Appearance
D) History of present health concern s! s! s! s!
12. An older adult client has been admitted to the hospital with failure to thrive resulting f
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
rom complications of diabetes. Which of the following would the nurse implement in r
s! s! s! s! s! s! s! s! s! s! s! s! s!
esponse to a collaborative problem?
s! s! s! s!
A) Encourage the client to increase oral fluid intake. s! s! s! s! s! s! s!
B) Provide the client with a bedtime protein snack. s! s! s! s! s! s! s!
C) Assist the client with personal hygiene. s! s! s! s! s!
D) Measure the client's blood glucose four times daily. s! s! s! s! s! s! s!
13. The nurse at a busy primary care clinic is analyzing the data obtained from the follo
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
wing clients. For which clients would the nurse most likely expect to facilitate a referr
s! s! s! s! s! s! s! s! s! s! s! s! s! s!
al?
A) An 80-year-old client who lives with her daughter
s! s! s! s! s! s! s!
B) A 50-year-old client newly diagnosed with diabetes
s! s! s! s! s! s!
C) An adult presenting for an influenza vaccination
s! s! s! s! s! s!
D) A teenager seeking information about contraception
s! s! s! s! s!
14. An instructor is reviewing the evolution of the nurse's role in health assessment. The in
s! s! s! s! s! s! s! s! s! s! s! s! s! s!
structor determines that the teaching was successful when the students identify which of
s! s! s! s! s! s! s! s! s! s! s! s! s!
the following as the major method used by nurses early in the history of the profession?
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
A) Natural senses s!
B) Biomedical knowledge s!
C) Simple technology s!
D) Critical pathways s!
, lOMoARcPSD| 12286418
Chapter 1The Nurse Role In Health Assesment
s!
1. A nurse on a postsurgical unit is admitting a client following the client's cholecystecto
s! s! s! s! s! s! s! s! s! s! s! s! s!
my (gall bladder removal). What is the overall purpose of assessment for this client?
s! s! s! s! s! s! s! s! s! s! s! s! s!
A) Collecting accurate data s! s!
B) Assisting the primary care provider s! s! s! s!
C) Validating previous data s! s!
D) Making clinical judgments s! s!
2. A client has presented to the emergency department (ED) with complaints of abdominal
s! s! s! s! s! s! s! s! s! s! s! s! s!
pain. Which member of the care team would most likely be responsible for collecting th
s! s! s! s! s! s! s! s! s! s! s! s! s! s!
e subjective data on the client during the initial comprehensive assessment?
s! s! s! s! s! s! s! s! s! s!
A) Gastroenterologist
B) ED nurse s!
C) Admissions clerk s!
D) Diagnostic technician s!
3. The nurse has completed an initial assessment of a newly admitted client and is applying t
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
he nursing process to plan the client's care. What principle should the nurse apply when
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
using the nursing process? s! s! s!
A) Each step is independent of the others. s! s! s! s! s! s!
B) It is ongoing and continuous. s! s! s! s!
C) It is used primarily in acute care settings.
s! s! s! s! s! s! s!
D) It involves independent nursing actions.
s! s! s! s!
4. The nurse who provides care at an ambulatory clinic is preparing to meet a client and p
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
erform a comprehensive health assessment. Which of the following actions should the n
s! s! s! s! s! s! s! s! s! s! s! s!
urse perform first? s! s!
A) Review the client's medical record. s! s! s! s!
B) Obtain basic biographic data. s! s! s!
C) Consult clinical resources explaining the client's diagnosis. s! s! s! s! s! s!
D) Validate information with the client. s! s! s! s!
5. Which of the following client situations would the nurse interpret as requiring an
s! s! s! s! s! s! s! s! s! s! s! s! s!
emergency assessment? s!
A) A pediatric client with severe sunburn
s! s! s! s! s!
B) A client needing an employment physical
s! s! s! s! s!
C) A client who overdosed on acetaminophen
s! s! s! s! s!
D) A distraught client who wants a pregnancy test
s! s! s! s! s! s! s!
, lOMoARcPSD| 12286418
6. In response to a client's query, the nurse is explaining the differences between the phy
s! s! s! s! s! s! s! s! s! s! s! s! s! s!
sician's medical exam and the comprehensive health assessment performed by the nurs
s! s! s! s! s! s! s! s! s! s! s!
e. The nurse should describe the fact that the nursing assessment focuses on which aspe
s! s! s! s! s! s! s! s! s! s! s! s! s! s!
ct of the client's situation?
s! s! s! s!
A) Current physiologic status s! s!
B) Effect of health on functional status s! s! s! s! s!
C) Past medical history s! s!
D) Motivation for adherence to treatment s! s! s! s!
7. After teaching a group of students about the phases of the nursing process, the instructor
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
determines that the teaching was successful when the students identify which phase as b
s! s! s! s! s! s! s! s! s! s! s! s! s!
eing foundational to all other phases?
s! s! s! s! s!
A) Assessment
B) Planning
C) Implementation
D) Evaluation
8. The nurse has completed the comprehensive health assessment of a client who has been
s! s! s! s! s! s! s! s! s! s! s! s! s! s!
admitted for the treatment of community-
s! s! s! s! s!
acquired pneumonia. Following the completion of this assessment, the nurse periodical
s! s! s! s! s! s! s! s! s! s!
ly performs a partial assessment primarily for which reason?
s! s! s! s! s! s! s! s!
A) Reassess previously detected problems s! s! s!
B) Provide information for the client's record s! s! s! s! s!
C) Address areas previously omitted s! s! s!
D) Determine the need for crisis intervention s! s! s! s! s!
9. The nurse is working in an ambulatory care clinic that is located in a busy, inner-
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
city neighborhood. Which client would the nurse determine to be in most need of an
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
emergency assessment? s!
A) A 14-year-old girl who is crying because she thinks she is pregnant
s! s! s! s! s! s! s! s! s! s! s!
B) A 45-year-old man with chest pain and diaphoresis for 1 hour
s! s! s! s! s! s! s! s! s! s!
C) A 3-year-old child with fever, rash, and sore throat
s! s! s! s! s! s! s! s!
D) A 20-year-old man with a 3-inch shallow laceration on his leg
s! s! s! s! s! s! s! s! s! s!
, lOMoARcPSD| 12286418
10. A nurse has completed gathering some basic data about a client who has multiple health
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
problems that stem from heavy alcohol use. The nurse has then reflected on her personal f
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
eelings about the client and his circumstances. The nurse does this primarily to accompl
s! s! s! s! s! s! s! s! s! s! s! s! s!
ish which of the following?
s! s! s! s!
A) Determine if pertinent data has been omitted s! s! s! s! s! s!
B) Identify the need for referral s! s! s! s!
C) Avoid biases and judgments s! s! s!
D) Construct a plan of care s! s! s! s!
11. The nurse is collecting data from a client who has recently been diagnosed with type 1 d
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
iabetes and who will begin an educational program. The nurse is collecting subjective an
s! s! s! s! s! s! s! s! s! s! s! s! s!
d objective data. Which of the following would the nurse categorize as objective data?
s! s! s! s! s! s! s! s! s! s! s! s! s!
A) Family history s!
B) Occupation
C) Appearance
D) History of present health concern s! s! s! s!
12. An older adult client has been admitted to the hospital with failure to thrive resulting f
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
rom complications of diabetes. Which of the following would the nurse implement in r
s! s! s! s! s! s! s! s! s! s! s! s! s!
esponse to a collaborative problem?
s! s! s! s!
A) Encourage the client to increase oral fluid intake. s! s! s! s! s! s! s!
B) Provide the client with a bedtime protein snack. s! s! s! s! s! s! s!
C) Assist the client with personal hygiene. s! s! s! s! s!
D) Measure the client's blood glucose four times daily. s! s! s! s! s! s! s!
13. The nurse at a busy primary care clinic is analyzing the data obtained from the follo
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
wing clients. For which clients would the nurse most likely expect to facilitate a referr
s! s! s! s! s! s! s! s! s! s! s! s! s! s!
al?
A) An 80-year-old client who lives with her daughter
s! s! s! s! s! s! s!
B) A 50-year-old client newly diagnosed with diabetes
s! s! s! s! s! s!
C) An adult presenting for an influenza vaccination
s! s! s! s! s! s!
D) A teenager seeking information about contraception
s! s! s! s! s!
14. An instructor is reviewing the evolution of the nurse's role in health assessment. The in
s! s! s! s! s! s! s! s! s! s! s! s! s! s!
structor determines that the teaching was successful when the students identify which of
s! s! s! s! s! s! s! s! s! s! s! s! s!
the following as the major method used by nurses early in the history of the profession?
s! s! s! s! s! s! s! s! s! s! s! s! s! s! s!
A) Natural senses s!
B) Biomedical knowledge s!
C) Simple technology s!
D) Critical pathways s!
