Test Bank for Health Assessment for Nursing Practice
Z Z Z Z Z Z Z
7th Edition by Wilson (NEWEST VERSION EXAM
Z Z Z Z Z Z Z
CHAPTERS 1-24.)
Z Z
, Chapter 01: Introduction to Health Assessment
Z Z Z Z Z
MULTIPLE CHOICE Z
1. A patient comes to the emergency department and tells the triage nurse that
Z Z Z Z Z Z Z Z Z Z Z Z
Zhe is “having a heart attack.” What is the nurse’s top priority at this time?
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
a. Determine the patient’s personal data and Z Z Z Z Z
insurance coverage. Z Z
b. Ask the patient to take a seat in the waiting
Z Z Z Z Z Z Z Z Z
room until his name is called.
Z Z Z Z Z Z
c. Request that a nurse collect data for a Z Z Z Z Z Z Z
comprehensive history.
Z Z
d. Ask a nurse to start a focused assessment
Z Z Z Z Z Z Z
of this patient now.
Z Z Z Z
ANS: D Z
The nurse needs to begin an assessment as soon as possible that is focused on this
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z
patient’s cardiovascular system. The type of health assessment performed by the nurse is
Z Z Z Z Z Z Z Z Z Z Z Z Z
also driven by patient need. Personal data and insurance information will be obtained, but
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
in this situation, these data can wait until after the patient is assessed. Based also on
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z
Maslow’s hierarchy of needs, physiologic needs take precedence. Rather than asking the
Z Z Z Z Z Z Z Z Z Z Z Z
patient to wait, the nurse needs to begin data collection, such as vital signs, immediately
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z
to determine the patient’s health status. Complications can be prevented if an immediate
Z Z Z Z Z Z Z Z Z Z Z Z Z
assessment is made to analyze the patient’s symptoms. A comprehensive history is not
Z Z Z Z Z Z Z Z Z Z Z Z Z
indicated in this situation at this time. Some subjective data will be collected, such as
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z
allergies and medical history related to cardiovascular disease. Eyes, ears, or a complete
Z Z Z Z Z Z Z Z Z Z Z Z Z
musculoskeletal or mental health assessment is not a priority at this time.
Z Z Z Z Z Z Z Z Z Z Z Z
DIF: Cognitive Level: Apply
Z REF: Box 1-3 | p. Z Z Z Z Z Z
3 TOP: Nursing Process: Assessment
Z Z Z Z Z
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:
Z Z Z Z Z Z Z Z Z Z Z
Establishing Priorities
Z Z
2. Which situation illustrates a screening assessment?
Z Z Z Z Z
a. A patient visits an obstetric clinic for the Z Z Z Z Z Z Z
first time and the nurse conducts a detailed Z Z Z Z Z Z Z Z
history and physical examination. Z Z Z Z
b. A hospital sponsors a health fair at a local Z Z Z Z Z Z Z Z
mall and provides cholesterol and blood Z Z Z Z Z
pressure checks to mall patrons. Z Z Z Z Z
c. The nurse in an urgent care center checks Z Z Z Z Z Z Z
the vital signs of a patient who is Z Z Z Z Z Z Z
complaining of leg pain. Z Z Z Z
This Zstudy Zsource Z was Zdownloaded Zby Z100000838401522 Zfrom ZCourseHero.com Zon Z03-03-2022 Z08:46:13 ZGMT Z-06:00
https://www.coursehero.com/file/34584368/chapter-1pdf/
Downloaded Zby: Zcmedrano14 Z|
Distribution Zof Zthis Zdocument Zis Zillegal
, Stuvia.com Z- ZThe ZMarketplace Zto ZBuy Zand ZSell Zyour ZStudy
ZMaterial
d. A Zpatient Znewly Zdiagnosed Zwith Zdiabetes
mellitus comes to test his fasting blood Z Z Z Z Z Z
glucose level.
Z Z
ANS: B Z
A health fair at a local mall that provides cholesterol and blood pressure checks is an
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z
example of a screening assessment focused on disease detection. A detailed history and
Z Z Z Z Z Z Z Z Z Z Z Z Z
physical examination conducted during a first-time visit to an obstetric clinic is an
Z Z Z Z Z Z Z Z Z Z Z Z Z
example of a comprehensive assessment. Assessing a patient complaining of leg pain in
Z Z Z Z Z Z Z Z Z Z Z Z Z
the triage area of an urgent care center is an example of a problem-based/focused
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
assessment. A patient’s return appointment 1 month after today’s office visit to report
Z Z Z Z Z Z Z Z Z Z Z Z Z
fasting blood glucose levels is an example of an episodic or follow-up assessment.
Z Z Z Z Z Z Z Z Z Z Z Z Z
DIF: Cognitive Level: Understand
Z REF: Box 1-3 | p. Z Z Z Z Z Z
3 TOP: Nursing Process: Assessment
Z Z Z Z Z
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Screening
Z Z Z Z Z Z Z Z Z
3. For which person is a screening assessment indicated?
Z Z Z Z Z Z Z
a. The person who had abdominal surgery Z Z Z Z Z
yesterday Z
b. The person who is unaware of his high Z Z Z Z Z Z Z
serum glucose levels Z Z Z
c. The person who is being admitted to Z Z Z Z Z Z
a long-term care facility Z Z Z Z
d. The person who is beginning rehabilitation Z Z Z Z Z
after a knee replacement Z Z Z Z
ANS: B Z
A screening assessment is performed for the purpose of disease detection. In this case this
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
person may have diabetes mellitus. A shift assessment is most appropriate for the person
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
who is recovering in the hospital from surgery. A comprehensive assessment is performed
Z Z Z Z Z Z Z Z Z Z Z Z Z
during admission to a facility to obtain a detailed history and complete physical
Z Z Z Z Z Z Z Z Z Z Z Z Z
examination. An episodic or follow-up assessment is performed after knee replacement to
Z Z Z Z Z Z Z Z Z Z Z Z
evaluate the outcome of the procedure.
Z Z Z Z Z Z
DIF: Cognitive Level: Understand
Z REF: Box 1-3 | p. Z Z Z Z Z Z
3 TOP: Nursing Process: Assessment
Z Z Z Z Z
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:
Z Z Z Z Z Z Z Z Z Z Z
Establishing Priorities
Z Z
4. For which person is a shift assessment indicated?
Z Z Z Z Z Z Z
a. The person who had abdominal surgery Z Z Z Z Z
yesterday Z
b. The person who is unaware of his high Z Z Z Z Z Z Z
serum glucose levels Z Z Z
c. The person who is being admitted to a Z Z Z Z Z Z Z
long-term care facility Z Z
d. The person who is beginning rehabilitation Z Z Z Z Z
after a knee replacement Z Z Z
ANS: A Z
A shift assessment is most appropriate for the person who is recovering in the hospital
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
from surgery. A screening assessment is performed for the purpose of disease detection,
Z Z Z Z Z Z Z Z Z Z Z Z Z
in this case diabetes mellitus. A comprehensive assessment is performed during
Z Z Z Z Z Z Z Z Z Z Z
admission to a
Z Z Z
This Zstudy Zsource Z was Zdownloaded Zby Z100000838401522 Zfrom ZCourseHero.com Zon Z03-03-2022 Z08:46:13 ZGMT Z-06:00
https://www.coursehero.com/file/34584368/chapter-1pdf/
Downloaded Zby: Zcmedrano14 Z|
Distribution Zof Zthis Zdocument Zis Zillegal
, Stuvia.com Z- ZThe ZMarketplace Zto ZBuy Zand ZSell Zyour ZStudy
facility to obtain a Material
detailed history and complete physical examination. An episodic or
Z Z Z
Z
Z Z Z Z Z Z Z Z Z
Zfollow-up assessment is performed after knee replacement to evaluate the outcome of
Z Z Z Z Z Z Z Z Z Z Z
Zthe procedure. Z
DIF: Cognitive Level: Understand
Z REF: Box 1-3 | p. Z Z Z Z Z Z
4 TOP: Nursing Process: Assessment
Z Z Z Z Z
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:
Z Z Z Z Z Z Z Z Z Z Z
Establishing Priorities
Z Z
5. For which person is a comprehensive assessment indicated?
Z Z Z Z Z Z Z
a. The person who had abdominal surgery Z Z Z Z Z
yesterday Z
b. The person who is unaware of his high Z Z Z Z Z Z Z
serum glucose levels Z Z Z
c. The person who is being admitted to Z Z Z Z Z Z
a long-term care facility Z Z Z Z
d. The person who is beginning rehabilitation Z Z Z Z Z
after a knee replacement Z Z Z Z
ANS: C Z
A comprehensive assessment is performed during admission to a facility to obtain a
Z Z Z Z Z Z Z Z Z Z Z Z
detailed history and complete physical examination. A shift assessment is most
Z Z Z Z Z Z Z Z Z Z
Zappropriate for the person who is recovering in the hospital from surgery. A screening
Z Z Z Z Z Z Z Z Z Z Z Z Z
Zassessment is performed for the purpose of disease detection, in this case diabetes
Z Z Z Z Z Z Z Z Z Z Z Z
Zmellitus. An episodic or follow-up assessment is performed after knee replacement to
Z Z Z Z Z Z Z Z Z Z Z
Zevaluate the outcome of the procedure.
Z Z Z Z Z
DIF: Cognitive Level: Understand
Z REF: Box 1-3 | p. Z Z Z Z Z Z
3 TOP: Nursing Process: Assessment
Z Z Z Z Z
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:
Z Z Z Z Z Z Z Z Z Z Z
Establishing Priorities
Z Z
6. For which person is an episodic or follow-up assessment indicated?
Z Z Z Z Z Z Z Z Z
a. The person who had abdominal surgery Z Z Z Z Z
yesterday Z
b. The person who is unaware of his high Z Z Z Z Z Z Z
serum glucose levels Z Z Z
c. The person who is being admitted to Z Z Z Z Z Z
a long-term care facility Z Z Z Z
d. The person who is beginning rehabilitation Z Z Z Z Z
after a knee replacement Z Z Z Z
ANS: D Z
An episodic or follow-up assessment is performed after the knee replacement to evaluate
Z Z Z Z Z Z Z Z Z Z Z Z
the outcome of the procedure. A shift assessment is most appropriate for the person who
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z
is recovering in the hospital from surgery. A screening assessment is performed for the
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
purpose of disease detection, in this case diabetes mellitus. A comprehensive assessment
Z Z Z Z Z Z Z Z Z Z Z Z
is performed during admission to a facility to obtain a detailed history and complete
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
physical examination.
Z Z
DIF: Cognitive Level: Understand
Z Z Z REF: Z Box 1-3 | p. Z Z Z
3 TOP: Nursing Process: Assessment
Z Z Z Z Z
This Zstudy Zsource Z was Zdownloaded Zby Z100000838401522 Zfrom ZCourseHero.com Zon Z03-03-2022 Z08:46:13 ZGMT Z-06:00
https://www.coursehero.com/file/34584368/chapter-1pdf/
Downloaded Zby: Zcmedrano14 Z|
Distribution Zof Zthis Zdocument Zis Zillegal
Z Z Z Z Z Z Z
7th Edition by Wilson (NEWEST VERSION EXAM
Z Z Z Z Z Z Z
CHAPTERS 1-24.)
Z Z
, Chapter 01: Introduction to Health Assessment
Z Z Z Z Z
MULTIPLE CHOICE Z
1. A patient comes to the emergency department and tells the triage nurse that
Z Z Z Z Z Z Z Z Z Z Z Z
Zhe is “having a heart attack.” What is the nurse’s top priority at this time?
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
a. Determine the patient’s personal data and Z Z Z Z Z
insurance coverage. Z Z
b. Ask the patient to take a seat in the waiting
Z Z Z Z Z Z Z Z Z
room until his name is called.
Z Z Z Z Z Z
c. Request that a nurse collect data for a Z Z Z Z Z Z Z
comprehensive history.
Z Z
d. Ask a nurse to start a focused assessment
Z Z Z Z Z Z Z
of this patient now.
Z Z Z Z
ANS: D Z
The nurse needs to begin an assessment as soon as possible that is focused on this
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z
patient’s cardiovascular system. The type of health assessment performed by the nurse is
Z Z Z Z Z Z Z Z Z Z Z Z Z
also driven by patient need. Personal data and insurance information will be obtained, but
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
in this situation, these data can wait until after the patient is assessed. Based also on
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z
Maslow’s hierarchy of needs, physiologic needs take precedence. Rather than asking the
Z Z Z Z Z Z Z Z Z Z Z Z
patient to wait, the nurse needs to begin data collection, such as vital signs, immediately
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z
to determine the patient’s health status. Complications can be prevented if an immediate
Z Z Z Z Z Z Z Z Z Z Z Z Z
assessment is made to analyze the patient’s symptoms. A comprehensive history is not
Z Z Z Z Z Z Z Z Z Z Z Z Z
indicated in this situation at this time. Some subjective data will be collected, such as
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z
allergies and medical history related to cardiovascular disease. Eyes, ears, or a complete
Z Z Z Z Z Z Z Z Z Z Z Z Z
musculoskeletal or mental health assessment is not a priority at this time.
Z Z Z Z Z Z Z Z Z Z Z Z
DIF: Cognitive Level: Apply
Z REF: Box 1-3 | p. Z Z Z Z Z Z
3 TOP: Nursing Process: Assessment
Z Z Z Z Z
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:
Z Z Z Z Z Z Z Z Z Z Z
Establishing Priorities
Z Z
2. Which situation illustrates a screening assessment?
Z Z Z Z Z
a. A patient visits an obstetric clinic for the Z Z Z Z Z Z Z
first time and the nurse conducts a detailed Z Z Z Z Z Z Z Z
history and physical examination. Z Z Z Z
b. A hospital sponsors a health fair at a local Z Z Z Z Z Z Z Z
mall and provides cholesterol and blood Z Z Z Z Z
pressure checks to mall patrons. Z Z Z Z Z
c. The nurse in an urgent care center checks Z Z Z Z Z Z Z
the vital signs of a patient who is Z Z Z Z Z Z Z
complaining of leg pain. Z Z Z Z
This Zstudy Zsource Z was Zdownloaded Zby Z100000838401522 Zfrom ZCourseHero.com Zon Z03-03-2022 Z08:46:13 ZGMT Z-06:00
https://www.coursehero.com/file/34584368/chapter-1pdf/
Downloaded Zby: Zcmedrano14 Z|
Distribution Zof Zthis Zdocument Zis Zillegal
, Stuvia.com Z- ZThe ZMarketplace Zto ZBuy Zand ZSell Zyour ZStudy
ZMaterial
d. A Zpatient Znewly Zdiagnosed Zwith Zdiabetes
mellitus comes to test his fasting blood Z Z Z Z Z Z
glucose level.
Z Z
ANS: B Z
A health fair at a local mall that provides cholesterol and blood pressure checks is an
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z
example of a screening assessment focused on disease detection. A detailed history and
Z Z Z Z Z Z Z Z Z Z Z Z Z
physical examination conducted during a first-time visit to an obstetric clinic is an
Z Z Z Z Z Z Z Z Z Z Z Z Z
example of a comprehensive assessment. Assessing a patient complaining of leg pain in
Z Z Z Z Z Z Z Z Z Z Z Z Z
the triage area of an urgent care center is an example of a problem-based/focused
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
assessment. A patient’s return appointment 1 month after today’s office visit to report
Z Z Z Z Z Z Z Z Z Z Z Z Z
fasting blood glucose levels is an example of an episodic or follow-up assessment.
Z Z Z Z Z Z Z Z Z Z Z Z Z
DIF: Cognitive Level: Understand
Z REF: Box 1-3 | p. Z Z Z Z Z Z
3 TOP: Nursing Process: Assessment
Z Z Z Z Z
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Screening
Z Z Z Z Z Z Z Z Z
3. For which person is a screening assessment indicated?
Z Z Z Z Z Z Z
a. The person who had abdominal surgery Z Z Z Z Z
yesterday Z
b. The person who is unaware of his high Z Z Z Z Z Z Z
serum glucose levels Z Z Z
c. The person who is being admitted to Z Z Z Z Z Z
a long-term care facility Z Z Z Z
d. The person who is beginning rehabilitation Z Z Z Z Z
after a knee replacement Z Z Z Z
ANS: B Z
A screening assessment is performed for the purpose of disease detection. In this case this
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
person may have diabetes mellitus. A shift assessment is most appropriate for the person
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
who is recovering in the hospital from surgery. A comprehensive assessment is performed
Z Z Z Z Z Z Z Z Z Z Z Z Z
during admission to a facility to obtain a detailed history and complete physical
Z Z Z Z Z Z Z Z Z Z Z Z Z
examination. An episodic or follow-up assessment is performed after knee replacement to
Z Z Z Z Z Z Z Z Z Z Z Z
evaluate the outcome of the procedure.
Z Z Z Z Z Z
DIF: Cognitive Level: Understand
Z REF: Box 1-3 | p. Z Z Z Z Z Z
3 TOP: Nursing Process: Assessment
Z Z Z Z Z
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:
Z Z Z Z Z Z Z Z Z Z Z
Establishing Priorities
Z Z
4. For which person is a shift assessment indicated?
Z Z Z Z Z Z Z
a. The person who had abdominal surgery Z Z Z Z Z
yesterday Z
b. The person who is unaware of his high Z Z Z Z Z Z Z
serum glucose levels Z Z Z
c. The person who is being admitted to a Z Z Z Z Z Z Z
long-term care facility Z Z
d. The person who is beginning rehabilitation Z Z Z Z Z
after a knee replacement Z Z Z
ANS: A Z
A shift assessment is most appropriate for the person who is recovering in the hospital
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
from surgery. A screening assessment is performed for the purpose of disease detection,
Z Z Z Z Z Z Z Z Z Z Z Z Z
in this case diabetes mellitus. A comprehensive assessment is performed during
Z Z Z Z Z Z Z Z Z Z Z
admission to a
Z Z Z
This Zstudy Zsource Z was Zdownloaded Zby Z100000838401522 Zfrom ZCourseHero.com Zon Z03-03-2022 Z08:46:13 ZGMT Z-06:00
https://www.coursehero.com/file/34584368/chapter-1pdf/
Downloaded Zby: Zcmedrano14 Z|
Distribution Zof Zthis Zdocument Zis Zillegal
, Stuvia.com Z- ZThe ZMarketplace Zto ZBuy Zand ZSell Zyour ZStudy
facility to obtain a Material
detailed history and complete physical examination. An episodic or
Z Z Z
Z
Z Z Z Z Z Z Z Z Z
Zfollow-up assessment is performed after knee replacement to evaluate the outcome of
Z Z Z Z Z Z Z Z Z Z Z
Zthe procedure. Z
DIF: Cognitive Level: Understand
Z REF: Box 1-3 | p. Z Z Z Z Z Z
4 TOP: Nursing Process: Assessment
Z Z Z Z Z
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:
Z Z Z Z Z Z Z Z Z Z Z
Establishing Priorities
Z Z
5. For which person is a comprehensive assessment indicated?
Z Z Z Z Z Z Z
a. The person who had abdominal surgery Z Z Z Z Z
yesterday Z
b. The person who is unaware of his high Z Z Z Z Z Z Z
serum glucose levels Z Z Z
c. The person who is being admitted to Z Z Z Z Z Z
a long-term care facility Z Z Z Z
d. The person who is beginning rehabilitation Z Z Z Z Z
after a knee replacement Z Z Z Z
ANS: C Z
A comprehensive assessment is performed during admission to a facility to obtain a
Z Z Z Z Z Z Z Z Z Z Z Z
detailed history and complete physical examination. A shift assessment is most
Z Z Z Z Z Z Z Z Z Z
Zappropriate for the person who is recovering in the hospital from surgery. A screening
Z Z Z Z Z Z Z Z Z Z Z Z Z
Zassessment is performed for the purpose of disease detection, in this case diabetes
Z Z Z Z Z Z Z Z Z Z Z Z
Zmellitus. An episodic or follow-up assessment is performed after knee replacement to
Z Z Z Z Z Z Z Z Z Z Z
Zevaluate the outcome of the procedure.
Z Z Z Z Z
DIF: Cognitive Level: Understand
Z REF: Box 1-3 | p. Z Z Z Z Z Z
3 TOP: Nursing Process: Assessment
Z Z Z Z Z
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:
Z Z Z Z Z Z Z Z Z Z Z
Establishing Priorities
Z Z
6. For which person is an episodic or follow-up assessment indicated?
Z Z Z Z Z Z Z Z Z
a. The person who had abdominal surgery Z Z Z Z Z
yesterday Z
b. The person who is unaware of his high Z Z Z Z Z Z Z
serum glucose levels Z Z Z
c. The person who is being admitted to Z Z Z Z Z Z
a long-term care facility Z Z Z Z
d. The person who is beginning rehabilitation Z Z Z Z Z
after a knee replacement Z Z Z Z
ANS: D Z
An episodic or follow-up assessment is performed after the knee replacement to evaluate
Z Z Z Z Z Z Z Z Z Z Z Z
the outcome of the procedure. A shift assessment is most appropriate for the person who
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z
is recovering in the hospital from surgery. A screening assessment is performed for the
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
purpose of disease detection, in this case diabetes mellitus. A comprehensive assessment
Z Z Z Z Z Z Z Z Z Z Z Z
is performed during admission to a facility to obtain a detailed history and complete
Z Z Z Z Z Z Z Z Z Z Z Z Z Z
physical examination.
Z Z
DIF: Cognitive Level: Understand
Z Z Z REF: Z Box 1-3 | p. Z Z Z
3 TOP: Nursing Process: Assessment
Z Z Z Z Z
This Zstudy Zsource Z was Zdownloaded Zby Z100000838401522 Zfrom ZCourseHero.com Zon Z03-03-2022 Z08:46:13 ZGMT Z-06:00
https://www.coursehero.com/file/34584368/chapter-1pdf/
Downloaded Zby: Zcmedrano14 Z|
Distribution Zof Zthis Zdocument Zis Zillegal
