TEST BANK
All Chapters Included
, TABLE OF CONTENT
I. Foundations for Health Assessment
1. Importance of Health Assessment
2. Interviewing Patients to Obtain a Health History
3. Techniques and Equipment for Physical Assessment
4. General Inspection and Measurement of Vital Signs
5. Ethnic, Cultural, and Spiritual Considerations
6. Pain Assessment
7. Mental Health and Abusive Behavior Assessment
8. Nutritional Assessment
II. Health Assessment of the Adult
9. Skin, Hair, and Nails
10. Head, Eyes, Ears, Nose, and Throat
11. Lungs and Respiratory System
12. Heart and Peripheral Vascular System
13. Abdomen and Gastrointestinal System
14. Musculoskeletal System
15. Neurologic System
16. Breasts and Axillae
17. Reproductive System and the Perineum
III. Health Assessment Across the Life Span
18. Developmental Assessment Throughout the Life Span
19. Assessment of the Infant, Child, and Adolescent
20. Assessment of the Pregnant Patient
21. Assessment of the Older Adult
IV. Synthesis and Application of Health Assessment
22. Conducting a Head-to-Toe Examination
23. Documenting the Head-to-Toe Health Assessment
,24. Adapting Health Assessment to an Ill Patient
Chapter 1: Importance of Health Assessment
MULTIPLE CHOICE
1. A patient comes to the emergency department and tells the triage nurse that he is
“having a heart attack.” What is the nurse’s top priority at this time?
a. Determine the patient’s personal data and insurance coverage.
b. Ask the patient to take a seat in the waiting room until his name is called.
c. Request that a nurse collect data for a comprehensive history.
d. Ask a nurse to start a focused assessment of this patient now.
Answer: D
Feedback
A Personal data and insurance information will be obtained, but in this
situation, these data can wait until after the patient is assessed.
B Rather than asking the patient to wait, the nurse needs to begin data
collection, such as vital signs, immediately to determine the patient’s health
status.
C A comprehensive history is not indicated in this situation at this time. Some
subjective data will be collected, such as allergies and medical history
related to cardiovascular disease.
D The nurse needs to begin an assessment as soon as possible that is focused
on
this patient’s cardiovascular system. The type of health assessment
performed by the nurse is also driven by patient need.
DIF: Cognitive Level: Apply REF:
3 TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of
Care: Establishing Priorities
2. Which situation illustrates a screening assessment?
a. A patient visits an obstetric clinic for the first time and the nurse
conducts a detailed history and physical examination.
b. A hospital sponsors a health fair at a local mall and provides cholesterol and
blood pressure checks to mall patrons.
c. The nurse in an urgent care center checks the vital signs of a patient
, who is complaining of leg pain.
d. A patient newly diagnosed with diabetes mellitus comes to test his fasting
blood glucose level.
Answer: B
Feedback
A A detailed history and physical examination conducted during a first-time
visit to an obstetric clinic is an example of a comprehensive assessment.
B A health fair at a local mall that provides cholesterol and blood pressure
checks is an example of a screening assessment focused on disease
detection.
C Assessing a patient complaining of leg pain in the triage area of an urgent
care center is an example of a problem-based/focused assessment.
D A patient’s return appointment 1 month after today’s office visit to report
fasting blood glucose levels is an example of an episodic or follow-up
assessment.
DIF: Cognitive Level: Understand REF:
3 TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Screening
3. For which person is a screening assessment indicated?
a. The person who had abdominal surgery yesterday
b. The person who is unaware of his high serum glucose levels
c. The person who is being admitted to a long-term care facility
d. The person who is beginning rehabilitation after a knee replacement
Answer: B
Feedback
A A shift assessment is most appropriate for the person who is recovering in
the hospital from surgery.
B A screening assessment is performed for the purpose of disease detection. In
this case this person may have diabetes mellitus.
C A comprehensive assessment is performed during admission to a facility
to obtain a detailed history and complete physical examination.
D An episodic or follow-up assessment is performed after knee replacement to
evaluate the outcome of the procedure.
DIF: Cognitive Level: Understand REF:
3 TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of
Care: Establishing Priorities
4. For which person is a shift assessment indicated?
a. The person who had abdominal surgery yesterday
b. The person who is unaware of his high serum glucose levels.
c. The person who is being admitted to a long-term care facility.
All Chapters Included
, TABLE OF CONTENT
I. Foundations for Health Assessment
1. Importance of Health Assessment
2. Interviewing Patients to Obtain a Health History
3. Techniques and Equipment for Physical Assessment
4. General Inspection and Measurement of Vital Signs
5. Ethnic, Cultural, and Spiritual Considerations
6. Pain Assessment
7. Mental Health and Abusive Behavior Assessment
8. Nutritional Assessment
II. Health Assessment of the Adult
9. Skin, Hair, and Nails
10. Head, Eyes, Ears, Nose, and Throat
11. Lungs and Respiratory System
12. Heart and Peripheral Vascular System
13. Abdomen and Gastrointestinal System
14. Musculoskeletal System
15. Neurologic System
16. Breasts and Axillae
17. Reproductive System and the Perineum
III. Health Assessment Across the Life Span
18. Developmental Assessment Throughout the Life Span
19. Assessment of the Infant, Child, and Adolescent
20. Assessment of the Pregnant Patient
21. Assessment of the Older Adult
IV. Synthesis and Application of Health Assessment
22. Conducting a Head-to-Toe Examination
23. Documenting the Head-to-Toe Health Assessment
,24. Adapting Health Assessment to an Ill Patient
Chapter 1: Importance of Health Assessment
MULTIPLE CHOICE
1. A patient comes to the emergency department and tells the triage nurse that he is
“having a heart attack.” What is the nurse’s top priority at this time?
a. Determine the patient’s personal data and insurance coverage.
b. Ask the patient to take a seat in the waiting room until his name is called.
c. Request that a nurse collect data for a comprehensive history.
d. Ask a nurse to start a focused assessment of this patient now.
Answer: D
Feedback
A Personal data and insurance information will be obtained, but in this
situation, these data can wait until after the patient is assessed.
B Rather than asking the patient to wait, the nurse needs to begin data
collection, such as vital signs, immediately to determine the patient’s health
status.
C A comprehensive history is not indicated in this situation at this time. Some
subjective data will be collected, such as allergies and medical history
related to cardiovascular disease.
D The nurse needs to begin an assessment as soon as possible that is focused
on
this patient’s cardiovascular system. The type of health assessment
performed by the nurse is also driven by patient need.
DIF: Cognitive Level: Apply REF:
3 TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of
Care: Establishing Priorities
2. Which situation illustrates a screening assessment?
a. A patient visits an obstetric clinic for the first time and the nurse
conducts a detailed history and physical examination.
b. A hospital sponsors a health fair at a local mall and provides cholesterol and
blood pressure checks to mall patrons.
c. The nurse in an urgent care center checks the vital signs of a patient
, who is complaining of leg pain.
d. A patient newly diagnosed with diabetes mellitus comes to test his fasting
blood glucose level.
Answer: B
Feedback
A A detailed history and physical examination conducted during a first-time
visit to an obstetric clinic is an example of a comprehensive assessment.
B A health fair at a local mall that provides cholesterol and blood pressure
checks is an example of a screening assessment focused on disease
detection.
C Assessing a patient complaining of leg pain in the triage area of an urgent
care center is an example of a problem-based/focused assessment.
D A patient’s return appointment 1 month after today’s office visit to report
fasting blood glucose levels is an example of an episodic or follow-up
assessment.
DIF: Cognitive Level: Understand REF:
3 TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Screening
3. For which person is a screening assessment indicated?
a. The person who had abdominal surgery yesterday
b. The person who is unaware of his high serum glucose levels
c. The person who is being admitted to a long-term care facility
d. The person who is beginning rehabilitation after a knee replacement
Answer: B
Feedback
A A shift assessment is most appropriate for the person who is recovering in
the hospital from surgery.
B A screening assessment is performed for the purpose of disease detection. In
this case this person may have diabetes mellitus.
C A comprehensive assessment is performed during admission to a facility
to obtain a detailed history and complete physical examination.
D An episodic or follow-up assessment is performed after knee replacement to
evaluate the outcome of the procedure.
DIF: Cognitive Level: Understand REF:
3 TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of
Care: Establishing Priorities
4. For which person is a shift assessment indicated?
a. The person who had abdominal surgery yesterday
b. The person who is unaware of his high serum glucose levels.
c. The person who is being admitted to a long-term care facility.
