11 11 11 11 11 1
Nursing Practice 7th Edition by Wils
1 11 11 11 11 1111
on.
100% Correct Answers Late
11 11 11
st Updated Examination Study
11 11 11 11
Guide 2023/2024 11
,Test11Bank11for11Health11Assessment11for11Nursing11Pra
ctice117th11Edition11by11Wilson.
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, .
Chapter1101:11Introduction11to11Health11Assessment
MULTIPLE11CHOICE
1. A11patient11comes11to11the11emergency11department11and11tells11the11triage1
1nurse11that11he11is11“having11a11heart11attack.”11What11is11the11nurse’s11top11priority
11at11this11time?
a. Determine11the11patient’s11personal11data1
1and11insurance11coverage.
b. Ask11the11patient11to11take11a11seat11in11t
he11waiting11room11until11his11name11is1
1called.
c. Request11that11a11nurse11collect11data11for
11a11comprehensive11history.
d. Ask11a11nurse11to11start11a11focused11ass
essment11of11this11patient11now.
ANS:11D
The11nurse11needs11to11begin11an11assessment11as11soon11as11possible11that11is11focused
11on11this11patient’s11cardiovascular11system.11The11type11of11health11assessment11perfor
med11by11the11nurse11is11also11driven11by11patient11need.11Personal11data11and11insuranc
e11information11will11be11obtained,11but11in11this11situation,11these11data11can11wait11unt
il11after11the11patient11is11assessed.11Based11also11on11Maslow’s11hierarchy11of11needs,1
1physiologic11needs11take11precedence.11Rather11than11asking11the11patient11to11wait,11th
e11nurse11needs11to11begin11data11collection,11such11as11vital11signs,11immediately11to11d
etermine11the11patient’s11health11status.11Complications11can11be11prevented11if11an11im
mediate11assessment11is11made11to11analyze11the11patient’s11symptoms.11A11comprehens
ive11history11is11not11indicated11in11this11situation11at11this11time.11Some11subjective11d
ata11will11be11collected,11such11as11allergies11and11medical11history11related11to11cardiov
ascular11disease.11Eyes,11ears,11or11a11complete11musculoskeletal11or11mental11health11as
sessment11is11not11a11priority11at11this11time.
DIF:1 1 Cognitive11Level:11Apply REF:1 1 Box111-
311|11p.11311TOP:11Nursing11Process:11Assessment
, Test Bank for Health Assessment for
11 11 11 11 11 1
Nursing Practice 7th Edition by Wils
1 11 11 11 11 1111
on.
100% Correct Answers Late 11 11 11
st Updated Examination Study
11 11 11 11
Guide 2023/2024 11
.
MSC:11NCLEX11Patient11Needs:11Safe11and11Effective11Care11Environment:11Management11of11C
are:11Establishing11Priorities
2. Which11situation11illustrates11a11screening11assessment?
a. A11patient11visits11an11obstetric11clinic11f
or11the11first11time11and11the11nurse11con
ducts11a11detailed11history11and11physical
11examination.
b. A11hospital11sponsors11a11health11fair11at1
1a11local11mall11and11provides11cholester
ol11and11blood11pressure11checks11to11ma
ll11patrons.
c. The11nurse11in11an11urgent11care11center11
checks11the11vital11signs11of11a11patient11
who11is11complaining11of11leg11pain.
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