Physical Examination: Best Practices
j j j
forHealthandWell-Being Assessment
j j j j j
2nd Edition by Kate Gawlik
j j j j j
ALL CHAPTERS 1-29 WITH RATIONALES| A+ GRADE
j j j j j j
Page 1 of 759
j j j
,Chapter 1. APPROACH TO EVIDENCE-BASED ASSESSMENT OF HEALTH AND WELL- BEING
j j j j j j j j j j
MULTIPLE CHOICE j
1. After completing an initial assessment of a patient, the nurse has charted that his respirations are
j j j j j j j j j j j j j j j
eupneic and his pulse is 58 beats per minute. These types of data would be:
j j j j j j j j j j j j j j j
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
ANS: A j
Objective data are what the health professional observes by inspecting, percussing, palpating, and
j j j j j j j j j j j j
auscultating during the physical examination. Subjective data is what the person says about him or herself
j j j j j j j j j j j j j j j j
during history taking. The terms reflective and introspective are not used to describe data.
j j j j j j j j j j j j j j
DIF: Cognitive Level: Understanding (Comprehension) REF: z. 2
j j j j j j j
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
j j j j j j j j j j
2. A patient tells the nurse that he is very nervous, is nauseated, and feels hot. These types of data would be:
j j j j j j j j j j j j j j j j j j j j
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
ANS: C j
Subjective data are what the person says about him or herself during history taking. Objective data are
j j j j j j j j j j j j j j j j
what the health professional observes by inspecting, percussing, palpating, and auscultating during the
j j j j j j j j j j j j j
physical examination. The terms reflective and introspective are not used to describe data.
j j j j j j j j j j j j j
DIF: Cognitive Level: Understanding (Comprehension) REF: z. 2
j j j j j j j
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
j j j j j j j j j j
Page 2 of 759j j j
,3. The patients record, laboratory studies, objective data, and subjective data combine to form the:
j j j j j j j j j j j j j
a. Data base. j
b. Admitting data. j
c. Financial statement. j
d. Discharge summary. j
ANS: A j
Together with the patients record and laboratory studies, the objective and subjective data form the data base.
j j j j j j j j j j j j j j j j
The other items are not part of the patients record, laboratory studies, or data.
j j j j j j j j j j j j j j
DIF: Cognitive Level: Remembering (Knowledge) REF: z. 2
j j j j j j j
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
j j j j j j j j j j
4. When listening to a patients breath sounds, the nurse is unsure of a sound that is heard. The nurses next
j j j j j j j j j j j j j j j j j j j
action should be to:
j j j j
a. Immediately notify the patients physician. j j j j
b. Document the sound exactly as it was heard. j j j j j j j
c. Validate the data by asking a coworker to listen to the breath sounds.
j j j j j j j j j j j j
d. Assess again in 20 minutes to note whether the sound is still present.
j j j j j j j j j j j j
ANS: C j
When unsure of a sound heard while listening to a patients breath sounds, the nurse validates the data to ensure
j j j j j j j j j j j j j j j j j j j
accuracy. If the nurse has less experience in an area, then he or she asks an expert to listen.
j j j j j j j j j j j j j j j j j j j
DIF: Cognitive Level: Analyzing (Analysis) REF: z. 2
j j j j j j j
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
j j j j j j j j j j
5. The nurse is conducting a class for new graduate nurses. During the teaching session, the nurse should keep
j j j j j j j j j j j j j j j j j
in mind that novice nurses, without a background of skills and experience from which to draw, are more
j j j j j j j j j j j j j j j j j j
likely to make their decisions using:
j j j j j j
a. Intuition.
b. A set of rules. j j j
Page 3 of 759j j j
, c. Articles in journals. j j
d. Advice from supervisors. j j
ANS: B j
Novice nurses operate from a set of defined, structured rules. The expert practitioner uses intuitive links. DIF:
j j j j j j j j j j j j j j j j
j Cognitive Level: Understanding (Comprehension) REF: z. 3 MSC: Client Needs: General
j j j j j j j j j j
6. Expert nurses learn to attend to a pattern of assessment data and act without consciously labeling it.
j j j j j j j j j j j j j j j j
These responses are referred to as:
j j j j j j
a. Intuition.
b. The nursing process. j j
c. Clinical knowledge. j
d. Diagnostic reasoning. j
ANS: A j
Intuition is characterized by pattern recognition expert nurses learn to attend to a pattern of assessment data
j j j j j j j j j j j j j j j j
and act without consciously labeling it. The other options are not correct.
j j j j j j j j j j j j
DIF: Cognitive Level: Understanding (Comprehension) REF: z. 4 MSC: Client Needs: General
j j j j j j j j j j j
7. The nurse is reviewing information about evidence-based practice (EBP). Which statement best reflects
j j j j j j j j j j j j
EBP?
j
a. EBP relies on tradition for support of best practices.
j j j j j j j j
b. EBP is simply the use of best practice techniques for the treatment of patients.
j j j j j j j j j j j j j
c. EBP emphasizes the use of best evidence with the clinicians experience.
j j j j j j j j j j
d. The patients own preferences are not important with EBP.
j j j j j j j j
j ANS: C j
EBP is a systematic approach to practice that emphasizes the use of best evidence in combination with the
j j j j j j j j j j j j j j j j j
clinicians experience, as well as patient preferences and values, when making decisions about care and treatment.
j j j j j j j j j j j j j j j j
EBP is more than simply using the best practice techniques to treat patients, and questioning tradition is important
j j j j j j j j j j j j j j j j j j
when no compelling and supportive research evidence exists.
j j j j j j j j
DIF: Cognitive Level: Applying (Application) REF: z. 5
j j j j j j j
Page 4 of 759 j j j