Janet R. Weber; Jane H. Kelley
The nurse is performing a physical assessment on a newly admitted patient. Which is
an example of objective information obtained during the physical assessment?
a. 2 x 5 cm scar on the right lower forearm
b. Patient's history of allergies
c. Last menstrual period 1 month ago
d. Patient's use of medications at home - ANSWER: a. 2 x 5 cm scar on the right lower
forearm
A patient is brought by ambulance to the emergency department with multiple
injuries received in an automobile accident. He is alert and cooperative, but his
injuries are quite severe. How would the nurse proceed with data collected?
a. Perform lifesaving measures and delay asking any history questions until the
patient is transferred to the intensive care unit.
b. Simultaneously ask history questions while performing the examination and
initiating lifesaving measures.
c. Collect all information on the history form, including social support patterns,
strengths, and coping patterns
d. Collect history information first, then perform the physical examination and
institute lifesaving measures - ANSWER: b. Simultaneously ask history questions
while performing the examination and initiating lifesaving measures.
After completing an initial assessment of a patient, the nurse has charted that his
respirations are eupneic and his pulse is 58 beats per minute. What type of
assessment data is this?
a. Introspective
b. Reflective
c. Subjective
d. Objective - ANSWER: d. Objective
Which statement best desribes a proficient nurse?
a. Has little experience with a specified population and uses rules to guide
performance
b. Has an intuitive grasp of a clinical situation and quickly identifies the accurate
solution
, c. Sees actions in the context of daily plans for patients
d. Understands a patient situation as a whole rather than a list of tasks and
recognizes the long-term goals for the patient - ANSWER: d. Understands a patient
situation as a whole rather than a list of tasks and recognizes the long-term goals for
the patient
The nurse is conducting a class for new graduate nurses. While teaching the class,
what should the nurse keep in mind regarding what novice nurses, without a
background of skills and experience from which to draw upon, are more likely to
base their decisions on?
a. Intuition
b. A set of rules
c. Articles in journals
d. Advice from supervisors - ANSWER: b. A set of rules
What information obtained by the nurse regarding a patient's skin should the nurse
record in the patient's health history?
a. Patient denies any color change
b. Lesion is noted on the lateral aspect of the right arm
c. No lesions are obvious
d. Skin appears dry - ANSWER: a. Patient denies any color change
When the nurse is evaluating the reliability of a patient's responses, which of these
statements would be correct?
a. Patient has a history of drug abuse and therefore is not reliable
b. Patient provided consistent information and therefore is reliable
c. Patient would not answer questions concerning stress and therefore is not reliable
d. Patient smiled throughout interview and therefore is assumed reliable - ANSWER:
b. Patient provided consistent information and therefore is reliable
The nurse is preparing to do a functional assessment. Which statement best
describes the purpose of a functional assessment?
a. It determines how children are meeting developmental milestones
b. It helps determine how a person is managing day-to-day activities
c. The functional assessment assesses how the individual is coping with life at home
d. The functional assessment can identify any problems with memory the individual
may be experiencing - ANSWER: b. It helps determine how a person is managing day-
to-day activities
A patient is describing his symptoms to the nurse. Which of these statements
reflects a description of the setting of his symptoms?
a. "I think this pain is telling me that something bad is wrong with me."