Evidence-Based Physical Examination Best Practices for Health & Well-Being Assessment 1st Edition By Kate Sustersic Gawlik, Bernadette Mazurek Melnyk, Alice M. Teall 9780826164537 -Test Bank

Evidence-Based Physical Examination Best Practices for
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Health & Well-Being Assessment 1st Edition Test Bank
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,Chapter 1. APPROACH TO EVIDENCE-BASED ASSESSMENT OF HEALTH AND WELL-
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BEING
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MULTIPLE CHOICE t


1. After completing an initial assessment of a patient, the nurse has charted that his respirations
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are eupneic and his pulse is 58 beats per minute. These types of data would be:
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a Objective.
.
b Reflective.
.
c Subjective.
.
d Introspective.
.

ANS: A t


Objective data are what the health professional observes by inspecting, percussing, palpating, and
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auscultating during the physical examination. Subjective data is what the person says about him or
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herself during history taking. The terms reflective and introspective are not used to describe data.
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DIF: Cognitive Level: Understanding (Comprehension) REF: z. 2
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MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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2. A patient tells the nurse that he is very nervous, is nauseated, and feels hot. These types of
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data would be:
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a Objective.
.
b Reflective.
.
c Subjective.
.
d Introspective.
.

ANS: C t


Subjective data are what the person says about him or herself during history taking. Objective
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,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 to
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describe data.
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DIF: Cognitive Level: Understanding (Comprehension) REF: z. 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 to form
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the:
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a Data base. t


.
b Admitting data. t


.
c Financial statement. t


.
d Discharge summary. t


.

ANS: A t


Together with the patients record and laboratory studies, the objective and subjective data form the
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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: z. 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. The
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nurses next action should be to:
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a Immediately notify the patients physician. t t t t


.
b Document the sound exactly as it was heard. t t t t t t t


.
c Validate the data by asking a coworker to listen to the breath sounds.
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d Assess again in 20 minutes to note whether the sound is still present.
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.

ANS: C t


When unsure of a sound heard while listening to a patients breath sounds, the nurse validates the data
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to ensure accuracy. If the nurse has less experience in an area, then he or she asks an expert to
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listen.
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, DIF: Cognitive Level: Analyzing (Analysis) REF: z. 2
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MSC: Client Needs: Safe and Effective Care Environment: Management of Care
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5. The nurse is conducting a class for new graduate nurses. During the teaching session, the
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nurse should keep in mind that novice nurses, without a background of skills and experience
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from which to draw, are more likely to make their decisions using:
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a Intuition.
.
b A set of rules. t t t


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c Articles in journals. t t


.
d Advice from supervisors. t t


.

ANS: B t


Novice nurses operate from a set of defined, structured rules. The expert practitioner uses intuitive
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links.
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DIF: Cognitive Level: Understanding (Comprehension) REF: z. 3
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MSC: Client Needs: General
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6. Expert nurses learn to attend to a pattern of assessment data and act without consciously
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labeling it. These responses are referred to as:
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a Intuition.
.
b The nursing process. t t


.
c Clinical knowledge. t


.
d Diagnostic reasoning. t


.

ANS: A t


Intuition is characterized by pattern recognitionexpert nurses learn to attend to a pattern of
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assessment data and act without consciously labeling it. The other options are not correct.
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DIF: Cognitive Level: Understanding (Comprehension) REF: z. 4
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MSC: Client Needs: General
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7. The nurse is reviewing information about evidence-based practice (EBP). Which statement
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best reflects EBP?
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