Bates’ Guide To Physical Examination and History Taking 13th Edition Bickley Test Bank latest
updated
Bates’ Guide To Physical Examination and History Taking
1310. During a morning assessment, the nurse notices that an older patient is less attentive and is
unable to recall yesterdays events. Which test is appropriate for assessing the patients mental
status?
a Geriatric Depression Scale, short form
.
b Rapid Disability Rating Scale-2
.
c Mini-Cog
.
d Get Up and Go Test
.
ANS: C
For nurses in various settings, cognitive assessments provide continuing comparisons to the
individuals baseline to detect any acute changes in mental status. The Mini-Cog is a mental status
test that tests immediate and delayed recall and visuospatial abilities. The Geriatric Depression
Scale, short form, assesses for depression and changes in the level of depression, not mental status.
The Rapid Disability Rating Scale-2 measures what the person can actually do versus what he or she
could do, but not mental status. The Get Up and Go Test assesses functional mobility, not mental
status.
DIF: Cognitive Level: Applying (Application) REF: p.
837 MSC: Client Needs: Psychosocial Integrity
11. An older patient has been admitted to the intensive care unit (ICU) after falling at home. Within 8
hours, his condition has stabilized and he is transferred to a medical unit. The family is wondering
whether he will be able to go back home. Which assessment instrument is most appropriate for the
nurse to choose at this time?
a Lawton IADL instrument
.
b Hospital Admission Risk Profile (HARP)
.
, Bates’ Guide To Physical Examination and History Taking 13th
Edition Bickley Test Bank latest updated
c Mini-Cog
.
d NEECHAM Confusion Scale
.
ANS: B
Hospital-acquired functional decline may occur within 2 days of a hospital admission. The
HARP helps identify older adults who are at greatest risk of losing their ability to perform ADLs or
mobility at this critical time. The Lawton IADL measures instrumental activities of daily living, which
may be difficult to observe in the hospital setting. The Mini-Cog is an assessment of mental status.
The NEECHAM Confusion Scale is used to assess for delirium.
DIF: Cognitive Level: Applying (Application) REF: p.
835 MSC: Client Needs: Psychosocial Integrity
12. During a functional assessment of an older persons home environment, which statement or
question by the nurse is most appropriate regarding common environmental hazards?
a These low toilet seats are safe because they are nearer to the ground in case of
. falls.
b Do you have a relative or friend who can help to install grab bars in your
. shower?
c These small rugs are ideal for preventing you from slipping on the hard floor.
.
d It would be safer to keep the lighting low in this room to avoid glare in your
. eyes.
ANS: B
Environmental hazards within the home can be a potential constraint on the older persons day-today
functioning. Common environmental hazards, including inadequate lighting, loose throw rugs, curled
carpet edges, obstructed hallways, cords in walkways, lack of grab bars in tub and shower, and low
and loose toilet seats, are hazards that could lead to an increased risk of falls and fractures.
Environmental modifications can promote mobility and reduce the likelihood of the older adult
falling.
DIF: Cognitive Level: Analyzing (Analysis) REF: p. 840
MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control 13. When
beginning to assess a persons spirituality, which question by the nurse would be most appropriate?
, Bates’ Guide To Physical Examination and History Taking 13th
Edition Bickley Test Bank latest updated
a Do you believe in God?
.
b How does your spirituality relate to your health care decisions?
.
c What religious faith do you follow?
.
d Do you believe in the power of prayer?
.
ANS: B
Open-ended questions provide a foundation for future discussions. The other responses are easily
answered by one-word replies and are closed questions.
DIF: Cognitive Level: Analyzing (Analysis) REF: p. 842
MSC: Client Needs: Psychosocial Integrity
14. The nurse is preparing to assess an older adult and discovers that the older adult is in severe
pain. Which statement about pain and the older adult is true?
a Pain is inevitable with aging.
.
b Older adults with cognitive impairments feel less pain.
.
c Alleviating pain should be a priority over other aspects of the assessment.
.
d The assessment should take priority so that care decisions can be made.
.
ANS: C
If the older adult is experiencing pain or discomfort, then the depth of knowledge gathered through
the assessments will suffer. Alleviating pain should be a priority over other aspects of the
assessment. Remembering that older adults with cognitive impairment do not feel less pain is
paramount.
15. The nurse is assessing the abilities of an older adult. Which activities are considered IADLs?
Select all that apply.
, Bates’ Guide To Physical Examination and History Taking 13th
Edition Bickley Test Bank latest updated
a Feeding oneself
.
b Preparing a meal
.
c Balancing a checkbook
.
d Walking
.
e Toileting
.
f Grocery shopping
.
ANS: B, C, F
Typically, IADL tasks include shopping, meal preparation, housekeeping, laundry, managing finances,
taking medications, and using transportation. The other options listed are ADLs related to self-care.
th Edition Bickley Test Bank
CHAPTER 1 Foundations for Clinical Proficiency
MULTIPLE CHOICE
1. 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. These types of data would be:
a Objective.
.
b Reflective.
.
c Subjective.
.
updated
Bates’ Guide To Physical Examination and History Taking
1310. During a morning assessment, the nurse notices that an older patient is less attentive and is
unable to recall yesterdays events. Which test is appropriate for assessing the patients mental
status?
a Geriatric Depression Scale, short form
.
b Rapid Disability Rating Scale-2
.
c Mini-Cog
.
d Get Up and Go Test
.
ANS: C
For nurses in various settings, cognitive assessments provide continuing comparisons to the
individuals baseline to detect any acute changes in mental status. The Mini-Cog is a mental status
test that tests immediate and delayed recall and visuospatial abilities. The Geriatric Depression
Scale, short form, assesses for depression and changes in the level of depression, not mental status.
The Rapid Disability Rating Scale-2 measures what the person can actually do versus what he or she
could do, but not mental status. The Get Up and Go Test assesses functional mobility, not mental
status.
DIF: Cognitive Level: Applying (Application) REF: p.
837 MSC: Client Needs: Psychosocial Integrity
11. An older patient has been admitted to the intensive care unit (ICU) after falling at home. Within 8
hours, his condition has stabilized and he is transferred to a medical unit. The family is wondering
whether he will be able to go back home. Which assessment instrument is most appropriate for the
nurse to choose at this time?
a Lawton IADL instrument
.
b Hospital Admission Risk Profile (HARP)
.
, Bates’ Guide To Physical Examination and History Taking 13th
Edition Bickley Test Bank latest updated
c Mini-Cog
.
d NEECHAM Confusion Scale
.
ANS: B
Hospital-acquired functional decline may occur within 2 days of a hospital admission. The
HARP helps identify older adults who are at greatest risk of losing their ability to perform ADLs or
mobility at this critical time. The Lawton IADL measures instrumental activities of daily living, which
may be difficult to observe in the hospital setting. The Mini-Cog is an assessment of mental status.
The NEECHAM Confusion Scale is used to assess for delirium.
DIF: Cognitive Level: Applying (Application) REF: p.
835 MSC: Client Needs: Psychosocial Integrity
12. During a functional assessment of an older persons home environment, which statement or
question by the nurse is most appropriate regarding common environmental hazards?
a These low toilet seats are safe because they are nearer to the ground in case of
. falls.
b Do you have a relative or friend who can help to install grab bars in your
. shower?
c These small rugs are ideal for preventing you from slipping on the hard floor.
.
d It would be safer to keep the lighting low in this room to avoid glare in your
. eyes.
ANS: B
Environmental hazards within the home can be a potential constraint on the older persons day-today
functioning. Common environmental hazards, including inadequate lighting, loose throw rugs, curled
carpet edges, obstructed hallways, cords in walkways, lack of grab bars in tub and shower, and low
and loose toilet seats, are hazards that could lead to an increased risk of falls and fractures.
Environmental modifications can promote mobility and reduce the likelihood of the older adult
falling.
DIF: Cognitive Level: Analyzing (Analysis) REF: p. 840
MSC: Client Needs: Safe and Effective Care Environment: Safety and Infection Control 13. When
beginning to assess a persons spirituality, which question by the nurse would be most appropriate?
, Bates’ Guide To Physical Examination and History Taking 13th
Edition Bickley Test Bank latest updated
a Do you believe in God?
.
b How does your spirituality relate to your health care decisions?
.
c What religious faith do you follow?
.
d Do you believe in the power of prayer?
.
ANS: B
Open-ended questions provide a foundation for future discussions. The other responses are easily
answered by one-word replies and are closed questions.
DIF: Cognitive Level: Analyzing (Analysis) REF: p. 842
MSC: Client Needs: Psychosocial Integrity
14. The nurse is preparing to assess an older adult and discovers that the older adult is in severe
pain. Which statement about pain and the older adult is true?
a Pain is inevitable with aging.
.
b Older adults with cognitive impairments feel less pain.
.
c Alleviating pain should be a priority over other aspects of the assessment.
.
d The assessment should take priority so that care decisions can be made.
.
ANS: C
If the older adult is experiencing pain or discomfort, then the depth of knowledge gathered through
the assessments will suffer. Alleviating pain should be a priority over other aspects of the
assessment. Remembering that older adults with cognitive impairment do not feel less pain is
paramount.
15. The nurse is assessing the abilities of an older adult. Which activities are considered IADLs?
Select all that apply.
, Bates’ Guide To Physical Examination and History Taking 13th
Edition Bickley Test Bank latest updated
a Feeding oneself
.
b Preparing a meal
.
c Balancing a checkbook
.
d Walking
.
e Toileting
.
f Grocery shopping
.
ANS: B, C, F
Typically, IADL tasks include shopping, meal preparation, housekeeping, laundry, managing finances,
taking medications, and using transportation. The other options listed are ADLs related to self-care.
th Edition Bickley Test Bank
CHAPTER 1 Foundations for Clinical Proficiency
MULTIPLE CHOICE
1. 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. These types of data would be:
a Objective.
.
b Reflective.
.
c Subjective.
.
