Test Bank for Health Assessment for
b b b b b
Nursing Practice 7th Edition by Wilson
b b b b b b
Chapter 1 - 24
b b b b
,Chapter 01: Introduction to Health Assessment b b b b b
MULTIPLE CHOICE b
1. Apatient comesto the emergencydepartment and tells the triage nurse that heis
b b b b b b b b b b b b b b
“havinga heart attack.” What isthe nurse’stop priorityat this time?
b b b b b b b b b b b b b
a. Determine the patient’s personal data and b b b b b
insurance coverage. b b
b. Ask the patient to take a seat in the waiting
b b b b b b b b b
room until his name is called.
b b b b b b
c. Request that a nurse collect data for a b b b b b b b
comprehensive history.
b b
d. Ask a nurse to start a focused assessmentof
b b b b b b b b
thispatient now.
b b b
ANSWER: D b
The nurse needs to begin an assessment as soon as possible that is focused on this patient’s
b b b b b b b b b b b b b b b b
cardiovascular system. The type of health assessment performed by the nurse is also drivenby
b b b b b b b b b b b b b b b
patient need. Personal data and insurance information will be obtained, but in this situation,
b b b b b b b b b b b b b b
these data can wait until after the patient is assessed. Based also on Maslow’s hierarchy of
b b b b b b b b b b b b b b b b
needs, physiologic needs take precedence. Rather than asking the patient to wait, the nurse
b b b b b b b b b b b b b b
needs to begin data collection, such as vital signs, immediately to determinethe patient’s health
b b b b b b b b b b b b b b b
status. Complications can be prevented if an immediate assessment is made to analyze the
b b b b b b b b b b b b b b
patient’s symptoms. A comprehensive history is not indicated in this situation at this time.
b b b b b b b b b b b b b b
Some subjective data will be collected, such as allergies and medical history related to
b b b b b b b b b b b b b b
cardiovascular disease. Eyes, ears, or a complete musculoskeletal or mental health assessment
b b b b b b b b b b b b
is not a priorityat this time.
b b b b b b b
DIF: Cognitive Level: Apply
bb b REF: Box 1-3 | p. 3 b b b b b b b
TOP: Nursing Process: Assessment
b b b b
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:Establishing
b b b b b b b b b b b b
Priorities
b
2. Which situation illustratesa screening assessment?
b b b b b
a. A patient visits an obstetric clinic for the first b b b b b b b b
time and the nurse conducts a detailedhistory b b b b b b b b
and physical examination. b b b
b. A hospital sponsorsa health fair at a local b b b b b b b b
mall and provides cholesterol and blood b b b b b b
pressure checks to mall patrons. b b b b b
c. The nurse in an urgent care center checks b b b b b b b
the vital signs of a patient who is b b b b b b b b
complainingof legpain. b b b b
, d. A patient newly diagnosed with diabetes
b b b b b
mellitus comes to test his fasting blood
b b b b b b b
glucose level.
b b
ANSWER: B b
A health fair at a local mall that provides cholesterol and blood pressure checks is an example of
b b b b b b b b b b b b b b b b b
a screening assessment focused on disease detection. A detailed history and physical
b b b b b b b b b b b b
examination conducted during a first-time visit to an obstetric clinic is an exampleof a
b b b b b b b b b b b b b b b
comprehensive assessment. Assessing a patient complaining of leg pain in the triage area of an
b b b b b b b b b b b b b b b
urgent care center is an example of a problem-based/focused assessment. A patient’s return
b b b b b b b b b b b b b
appointment 1 month after today’s office visit to report fasting blood glucose levels is an
b b b b b b b b b b b b b b b
example of an episodic or follow-up assessment.
b b b b b b b
DIF: Cognitive Level: Understand
bb b REF: Box 1-3 | p. 3 b b b b b b b
TOP: Nursing Process: Assessment
b b b b
MSC: NCLEXPatient Needs: HealthPromotion and Maintenance: Health Screening
b b b b b b b b b
3. For whichpersonis a screeningassessment indicated?
b b b b b b b
a. The person who had abdominal surgery b b b b b
yesterday b
b. The person who is unaware of hishigh
b b b b b b b
serum glucose levels
b b b
c. The person who is being admitted to a
b b b b b b b
long-termcare facility
b b b
d. The person who is beginning rehabilitation
b b b b b
after a knee replacement
b b b b
ANSWER: B b
A screening assessment is performed for the purpose of disease detection. In this case this
b b b b b b b b b b b b b b
person may have diabetes mellitus. A shift assessment is most appropriate for the person who
b b b b b b b b b b b b b b b
is recovering in the hospital from surgery. A comprehensive assessment is performedduring
b b b b b b b b b b b b b
admission to a facility to obtain a detailed history and complete physical examination. An
b b b b b b b b b b b b b b
episodic or follow-up assessment is performed after knee replacement toevaluate the
b b b b b b b b b b b b
outcome of the procedure.
b b b b
DIF: Cognitive Level: Understand
bb b REF: Box 1-3 | p. 3 b b b b b b b
TOP: Nursing Process: Assessment
b b b b
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:Establishing
b b b b b b b b b b b b
Priorities
b
4. For whichperson isa shift assessment indicated?
b b b b b b b
a. The person who had abdominal surgery b b b b b
yesterday b
b. The person who is unaware of hishigh b b b b b b b
serum glucose levels b b b
c. The person who isbeing admitted to a b b b b b b b
long-termcare facility b b
d. The person who isbeginning rehabilitation b b b b b
after a knee replacement b b b b
ANSWER: A b
A shift assessment is most appropriate for the person who is recovering in the hospital from
b b b b b b b b b b b b b b b
surgery. A screening assessment is performed for the purpose of disease detection, in this case
b b b b b b b b b b b b b b b
diabetes mellitus. A comprehensive assessment isperformed duringadmission to a
b b b b b b b b b b b
, facility to obtain a detailed history and complete physical examination. An episodic or
b b b b b b b b b b b b
follow-up assessment isperformed after knee replacement to evaluate the outcome of the
b b b b b b b b b b b b b
procedure.
b
DIF: Cognitive Level: Understand
bb b REF: Box 1-3 | p. 4 b b b b b b b
TOP: Nursing Process: Assessment
b b b b
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:Establishing
b b b b b b b b b b b b
Priorities
b
5. For which personis a comprehensive assessment indicated?
b b b b b b b
a. The person who had abdominal surgery b b b b b
yesterday b
b. The person who is unaware of hishigh b b b b b b b
serum glucose levels b b b
c. The person who is being admitted to a b b b b b b b
long-termcare facility b b b
d. The person who is beginning rehabilitation b b b b b
after a knee replacement b b b b
ANSWER: C b
Acomprehensive assessment isperformed duringadmission to a facilityto obtain a
b b b b b b b b b b b b
detailed history and complete physical examination. A shift assessment is most appropriatefor
b b b b b b b b b b b b
the person who is recovering in the hospital from surgery. A screening assessment is
b b b b b b b b b b b b b b
performed for the purpose of disease detection, in this case diabetes mellitus. An episodic or
b b b b b b b b b b b b b b b
follow-up assessment is performed after knee replacement to evaluate the outcome of the
b b b b b b b b b b b b b
procedure.
b
DIF: Cognitive Level: Understand
bb b REF: Box 1-3 | p. 3 b b b b b b b
TOP: Nursing Process: Assessment
b b b b
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:Establishing
b b b b b b b b b b b b
Priorities
b
6. For whichperson is anepisodic or follow-up assessment indicated?
b b b b b b b b b
a. The person who had abdominal surgery b b b b b
yesterday b
b. The person who isunaware of his high b b b b b b b
serum glucose levels b b b
c. The person who isbeingadmitted to a b b b b b b b
long-termcare facility b b
d. The person who is beginning rehabilitation b b b b b
after a knee replacement b b b b
ANSWER: D b
An episodic or follow-up assessment is performed after the knee replacement to evaluate the
b b b b b b b b b b b b b
outcome of the procedure. A shift assessment is most appropriate for the person who is
b b b b b b b b b b b b b b b
recovering in the hospital from surgery. A screening assessment is performed for the purpose
b b b b b b b b b b b b b b
of disease detection, inthiscase diabetes mellitus. A comprehensive assessment is performed
b b b b b b b b b b b b b
during admission to a facility to obtain a detailed history and complete physicalexamination.
b b b b b b b b b b b b b b
DIF: Cognitive Level: Understand
bb b b b REF: Box 1-3 | p. 3 b b b b b
TOP: Nursing Process: Assessment
b b b b
b b b b b
Nursing Practice 7th Edition by Wilson
b b b b b b
Chapter 1 - 24
b b b b
,Chapter 01: Introduction to Health Assessment b b b b b
MULTIPLE CHOICE b
1. Apatient comesto the emergencydepartment and tells the triage nurse that heis
b b b b b b b b b b b b b b
“havinga heart attack.” What isthe nurse’stop priorityat this time?
b b b b b b b b b b b b b
a. Determine the patient’s personal data and b b b b b
insurance coverage. b b
b. Ask the patient to take a seat in the waiting
b b b b b b b b b
room until his name is called.
b b b b b b
c. Request that a nurse collect data for a b b b b b b b
comprehensive history.
b b
d. Ask a nurse to start a focused assessmentof
b b b b b b b b
thispatient now.
b b b
ANSWER: D b
The nurse needs to begin an assessment as soon as possible that is focused on this patient’s
b b b b b b b b b b b b b b b b
cardiovascular system. The type of health assessment performed by the nurse is also drivenby
b b b b b b b b b b b b b b b
patient need. Personal data and insurance information will be obtained, but in this situation,
b b b b b b b b b b b b b b
these data can wait until after the patient is assessed. Based also on Maslow’s hierarchy of
b b b b b b b b b b b b b b b b
needs, physiologic needs take precedence. Rather than asking the patient to wait, the nurse
b b b b b b b b b b b b b b
needs to begin data collection, such as vital signs, immediately to determinethe patient’s health
b b b b b b b b b b b b b b b
status. Complications can be prevented if an immediate assessment is made to analyze the
b b b b b b b b b b b b b b
patient’s symptoms. A comprehensive history is not indicated in this situation at this time.
b b b b b b b b b b b b b b
Some subjective data will be collected, such as allergies and medical history related to
b b b b b b b b b b b b b b
cardiovascular disease. Eyes, ears, or a complete musculoskeletal or mental health assessment
b b b b b b b b b b b b
is not a priorityat this time.
b b b b b b b
DIF: Cognitive Level: Apply
bb b REF: Box 1-3 | p. 3 b b b b b b b
TOP: Nursing Process: Assessment
b b b b
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:Establishing
b b b b b b b b b b b b
Priorities
b
2. Which situation illustratesa screening assessment?
b b b b b
a. A patient visits an obstetric clinic for the first b b b b b b b b
time and the nurse conducts a detailedhistory b b b b b b b b
and physical examination. b b b
b. A hospital sponsorsa health fair at a local b b b b b b b b
mall and provides cholesterol and blood b b b b b b
pressure checks to mall patrons. b b b b b
c. The nurse in an urgent care center checks b b b b b b b
the vital signs of a patient who is b b b b b b b b
complainingof legpain. b b b b
, d. A patient newly diagnosed with diabetes
b b b b b
mellitus comes to test his fasting blood
b b b b b b b
glucose level.
b b
ANSWER: B b
A health fair at a local mall that provides cholesterol and blood pressure checks is an example of
b b b b b b b b b b b b b b b b b
a screening assessment focused on disease detection. A detailed history and physical
b b b b b b b b b b b b
examination conducted during a first-time visit to an obstetric clinic is an exampleof a
b b b b b b b b b b b b b b b
comprehensive assessment. Assessing a patient complaining of leg pain in the triage area of an
b b b b b b b b b b b b b b b
urgent care center is an example of a problem-based/focused assessment. A patient’s return
b b b b b b b b b b b b b
appointment 1 month after today’s office visit to report fasting blood glucose levels is an
b b b b b b b b b b b b b b b
example of an episodic or follow-up assessment.
b b b b b b b
DIF: Cognitive Level: Understand
bb b REF: Box 1-3 | p. 3 b b b b b b b
TOP: Nursing Process: Assessment
b b b b
MSC: NCLEXPatient Needs: HealthPromotion and Maintenance: Health Screening
b b b b b b b b b
3. For whichpersonis a screeningassessment indicated?
b b b b b b b
a. The person who had abdominal surgery b b b b b
yesterday b
b. The person who is unaware of hishigh
b b b b b b b
serum glucose levels
b b b
c. The person who is being admitted to a
b b b b b b b
long-termcare facility
b b b
d. The person who is beginning rehabilitation
b b b b b
after a knee replacement
b b b b
ANSWER: B b
A screening assessment is performed for the purpose of disease detection. In this case this
b b b b b b b b b b b b b b
person may have diabetes mellitus. A shift assessment is most appropriate for the person who
b b b b b b b b b b b b b b b
is recovering in the hospital from surgery. A comprehensive assessment is performedduring
b b b b b b b b b b b b b
admission to a facility to obtain a detailed history and complete physical examination. An
b b b b b b b b b b b b b b
episodic or follow-up assessment is performed after knee replacement toevaluate the
b b b b b b b b b b b b
outcome of the procedure.
b b b b
DIF: Cognitive Level: Understand
bb b REF: Box 1-3 | p. 3 b b b b b b b
TOP: Nursing Process: Assessment
b b b b
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:Establishing
b b b b b b b b b b b b
Priorities
b
4. For whichperson isa shift assessment indicated?
b b b b b b b
a. The person who had abdominal surgery b b b b b
yesterday b
b. The person who is unaware of hishigh b b b b b b b
serum glucose levels b b b
c. The person who isbeing admitted to a b b b b b b b
long-termcare facility b b
d. The person who isbeginning rehabilitation b b b b b
after a knee replacement b b b b
ANSWER: A b
A shift assessment is most appropriate for the person who is recovering in the hospital from
b b b b b b b b b b b b b b b
surgery. A screening assessment is performed for the purpose of disease detection, in this case
b b b b b b b b b b b b b b b
diabetes mellitus. A comprehensive assessment isperformed duringadmission to a
b b b b b b b b b b b
, facility to obtain a detailed history and complete physical examination. An episodic or
b b b b b b b b b b b b
follow-up assessment isperformed after knee replacement to evaluate the outcome of the
b b b b b b b b b b b b b
procedure.
b
DIF: Cognitive Level: Understand
bb b REF: Box 1-3 | p. 4 b b b b b b b
TOP: Nursing Process: Assessment
b b b b
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:Establishing
b b b b b b b b b b b b
Priorities
b
5. For which personis a comprehensive assessment indicated?
b b b b b b b
a. The person who had abdominal surgery b b b b b
yesterday b
b. The person who is unaware of hishigh b b b b b b b
serum glucose levels b b b
c. The person who is being admitted to a b b b b b b b
long-termcare facility b b b
d. The person who is beginning rehabilitation b b b b b
after a knee replacement b b b b
ANSWER: C b
Acomprehensive assessment isperformed duringadmission to a facilityto obtain a
b b b b b b b b b b b b
detailed history and complete physical examination. A shift assessment is most appropriatefor
b b b b b b b b b b b b
the person who is recovering in the hospital from surgery. A screening assessment is
b b b b b b b b b b b b b b
performed for the purpose of disease detection, in this case diabetes mellitus. An episodic or
b b b b b b b b b b b b b b b
follow-up assessment is performed after knee replacement to evaluate the outcome of the
b b b b b b b b b b b b b
procedure.
b
DIF: Cognitive Level: Understand
bb b REF: Box 1-3 | p. 3 b b b b b b b
TOP: Nursing Process: Assessment
b b b b
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:Establishing
b b b b b b b b b b b b
Priorities
b
6. For whichperson is anepisodic or follow-up assessment indicated?
b b b b b b b b b
a. The person who had abdominal surgery b b b b b
yesterday b
b. The person who isunaware of his high b b b b b b b
serum glucose levels b b b
c. The person who isbeingadmitted to a b b b b b b b
long-termcare facility b b
d. The person who is beginning rehabilitation b b b b b
after a knee replacement b b b b
ANSWER: D b
An episodic or follow-up assessment is performed after the knee replacement to evaluate the
b b b b b b b b b b b b b
outcome of the procedure. A shift assessment is most appropriate for the person who is
b b b b b b b b b b b b b b b
recovering in the hospital from surgery. A screening assessment is performed for the purpose
b b b b b b b b b b b b b b
of disease detection, inthiscase diabetes mellitus. A comprehensive assessment is performed
b b b b b b b b b b b b b
during admission to a facility to obtain a detailed history and complete physicalexamination.
b b b b b b b b b b b b b b
DIF: Cognitive Level: Understand
bb b b b REF: Box 1-3 | p. 3 b b b b b
TOP: Nursing Process: Assessment
b b b b
