and history taking 13th edition By
Bickley
All Chapters Covered
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, Bates’GuideToPhysicalExaminationandHistoryTaking13th 87h 87h 87h h
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CHAPTER
1 Foundations for ClinicalProficienc 87h 87h 87h h
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y MULTIPLE CHOICE
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1. After completing an initial assessment ofa patient, the nurse has charted that his respirations
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a Objective.
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b Reflective.
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c Subjective.
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d Introspective.
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ANS: A 87h
Objective data are what the health professional observes by inspecting, percussing, palpating,
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hand auscultating during the physical examination. Subjective data is what the person says abo
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ut him or herself during history taking. The terms reflective and introspective are not used to d
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escribe data. 87h
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 2
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MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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2. Apatient tells the nurse that he is verynervous, is nauseated, and feels hot. These types of
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data would be: 87h 87h
a Objective.
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b Reflective.
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c Subjective.
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d Introspective.
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ANS: C 87h
Subjective data are what the person says about him or herself during history taking. Objecti
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ve data are what the health professional observes by inspecting, percussing, palpating, and
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auscultating during the physical examination. The terms reflective and introspective are not used 87h 87h 87h 87h 87h 87h 87h 87h 87h 87h 87h 87h
to describe data.
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DIF: Cognitive Level: Understanding (Comprehension) REF: p. 2
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MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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3. The patients record, laboratory studies, objective data, and subjective data combine t
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o form the: 8 7 h 87h
a Data base. 87h
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b Admitting data. 87h
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c Financial statement. 87h
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d Discharge summary. 87h
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ANS: A 87h
Together with the patients record and laboratory studies, the objective and subjective data form
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the data base. The other items are not part of the patients record, laboratory studies, or data.
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DIF: Cognitive Level: Remembering (Knowledge) REF: p. 2
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MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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4. When listening to a patients breath sounds, the nurse is unsure of a sound that is heard.
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8 The nurses next action should be to:
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a Immediately notify the patients physician. 87h 87h 87h 87h
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b Document the sound exactly as it was heard. 87h 87h 87h 87h 87h 87h 87h
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c Validate the data by asking a coworker to listen to the breath sounds. 87h 87h 87h 87h 87h 87h 87h 87h 87h 87h 87h 87h
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d Assess again in 20 minutes to note whether the sound is still present.
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ANS: C 87h
When unsure of a sound heard while listening to a patients breath sounds, the nurse validates
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the data to ensure accuracy. If the nurse has less experience in an area, then he or she ask
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s an expert to listen.
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DIF: Cognitive Level: Analyzing (Analysis) REF: p. 2
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