ADPIE NCLEX EXAM QUESTIONS WITH
COMPLETE SOLUTIONS
The nurse is conducting an initial assessment of a 79 year old female
patient admitted to the hospital with a diagnosis of dehydration. The
nurse: (1) uses clinical reasoning to gather the appropriate patient data,
(2) first ask the patient about the most important details leading to her
diagnosis, (3) collects as much information as possible to understand
the patient's health problems, (4) collects the patient data in an
organized manner, (5) verifies that the data obtained is pertinent to the
patient care plan, and (6) records the data according to agency policy. -
CORRECT ANSWER✔✔-1. Purposeful - The nurse identified the purpose
of the nursing assessment (comprehensive) and gathers the appropriate
data.
2. Prioritized - The nurse gets the most important information first.
3 . Complete - The nurse gathers as much data as possible to
understand the patient health problem and develop a plan of care.
4. Systematic - The nurse gathers the information in an organized
manner.
5. Factual & Accurate - The nurse verifies that the information is
reliable.
6. Recorded in a standard manner - The nurse records the data
according to agency policy so that all caregivers can easily access what
is learned.
,The nurse practitioner is performing a short assessment of a newborn
who is displaying signs of jaundice. The nurse observes the infant's skin
color and orders a test for bilirubin levels to report to the primary care
provider. What type of assessment has this nurse performed?
a. comprehensive
b. initial
c. time-lapsed
d. quick priority - CORRECT ANSWER✔✔-d
The nurse is admitting a 35 year old pregnant women to the hospital for
treatment of preeclampsia. The patient asks the nurse: "Why are you
doing a history and physical exam when the doctor just did one?"
Which statement best explains the primary reasons a nursing
assessment is performed? select all that apply
a. "The nursing assessment will allow us to plan and deliver
individualized, holistic nursing care that draws on your strengths."
b. "It's hospital policy, I know it must be tiresome, but I will try to make
it quick."
c. "I'm a student nurse and need to develop the skill of assessing your
health status and need for nursing care."
d. "We want to make sure your responses to the medical exam are
consistent and that all you data is accurate."
, e. "We need to check your health status to see what kind of nursing
care you may need."
f. "We need to see of you require a referral to a physician or other
health professio - CORRECT ANSWER✔✔-aef
When you receive the shift report, you learn that you patient has no
special skin care needs. You are surprised during the bath to observe
reddened areas over bony prominences. What action is appropriate?
a. correct the initial assessment form
b. redo the initial assessment and document current findings
c. conduct and document an emergency assessment
d. perform and document a focused assessment of skin integrity -
CORRECT ANSWER✔✔-d
A student nurse attempts to perform a nursing history for the first time.
The student nurse asks the instructor how anyone ever lens all the
questions a nurse must ask to get a good baseline of data. What would
be the instructors best reply?
a. "There's a lot to learn at first, but once it becomes part of you, you
just keep asking the same questions over and over in each situation
until you can do it in your sleep"
b. "You can make the basic questions part of you and then learn to
modify them for each unique situation, asking yourself how much you
need to know to plan good care."
COMPLETE SOLUTIONS
The nurse is conducting an initial assessment of a 79 year old female
patient admitted to the hospital with a diagnosis of dehydration. The
nurse: (1) uses clinical reasoning to gather the appropriate patient data,
(2) first ask the patient about the most important details leading to her
diagnosis, (3) collects as much information as possible to understand
the patient's health problems, (4) collects the patient data in an
organized manner, (5) verifies that the data obtained is pertinent to the
patient care plan, and (6) records the data according to agency policy. -
CORRECT ANSWER✔✔-1. Purposeful - The nurse identified the purpose
of the nursing assessment (comprehensive) and gathers the appropriate
data.
2. Prioritized - The nurse gets the most important information first.
3 . Complete - The nurse gathers as much data as possible to
understand the patient health problem and develop a plan of care.
4. Systematic - The nurse gathers the information in an organized
manner.
5. Factual & Accurate - The nurse verifies that the information is
reliable.
6. Recorded in a standard manner - The nurse records the data
according to agency policy so that all caregivers can easily access what
is learned.
,The nurse practitioner is performing a short assessment of a newborn
who is displaying signs of jaundice. The nurse observes the infant's skin
color and orders a test for bilirubin levels to report to the primary care
provider. What type of assessment has this nurse performed?
a. comprehensive
b. initial
c. time-lapsed
d. quick priority - CORRECT ANSWER✔✔-d
The nurse is admitting a 35 year old pregnant women to the hospital for
treatment of preeclampsia. The patient asks the nurse: "Why are you
doing a history and physical exam when the doctor just did one?"
Which statement best explains the primary reasons a nursing
assessment is performed? select all that apply
a. "The nursing assessment will allow us to plan and deliver
individualized, holistic nursing care that draws on your strengths."
b. "It's hospital policy, I know it must be tiresome, but I will try to make
it quick."
c. "I'm a student nurse and need to develop the skill of assessing your
health status and need for nursing care."
d. "We want to make sure your responses to the medical exam are
consistent and that all you data is accurate."
, e. "We need to check your health status to see what kind of nursing
care you may need."
f. "We need to see of you require a referral to a physician or other
health professio - CORRECT ANSWER✔✔-aef
When you receive the shift report, you learn that you patient has no
special skin care needs. You are surprised during the bath to observe
reddened areas over bony prominences. What action is appropriate?
a. correct the initial assessment form
b. redo the initial assessment and document current findings
c. conduct and document an emergency assessment
d. perform and document a focused assessment of skin integrity -
CORRECT ANSWER✔✔-d
A student nurse attempts to perform a nursing history for the first time.
The student nurse asks the instructor how anyone ever lens all the
questions a nurse must ask to get a good baseline of data. What would
be the instructors best reply?
a. "There's a lot to learn at first, but once it becomes part of you, you
just keep asking the same questions over and over in each situation
until you can do it in your sleep"
b. "You can make the basic questions part of you and then learn to
modify them for each unique situation, asking yourself how much you
need to know to plan good care."
