Nursing 110 - Exam 4 Questions and
Answers
Purposes of Assessment - Answer-Gather baseline data
Identify actual & potential problems
Establish base of the nursing process
Types of Assessment - Answer-Comprehensive
Ongoing partial
Focused
Emergency
Comprehensive Assessment - Answer-Includes a health history and physical exam. Usually conducted
when a patient first enters a health care setting, with information providing a baseline for comparing
later assessments.
ongoing partial assessment - Answer-Or follow up assessment, is one that is conducted at regular
intervals during care of the patient. This type of assessment concentrates on identified health problems
to monitor positive or negative changes and evaluate the effectiveness of interventions.
focused assessment - Answer-is conducted to assess a specific problem
,emergency assessment - Answer-rapid focused assessment conducted to determine potentially fatal
situations. Always assess ABCs first
Parts of Assessment/Preventative Health Assessment - Answer-Health History:
-Biographical data (face sheet)
-Reason for seeking health care
-Hx of present illness
-Past medical Hx
-Family Hx
-Lifestyle
Physical Exam
Risk for depression
Functional ability
Level of safety
Education and Counseling
Nursing Health Assessment - Answer-Differs from other types of health assessments because it is a
holistic collection of information about factors that affect or are affected by ones level of health. The
information from this assessment is used to formulate nursing diagnoses that require nursing care.
physical examination - Answer-Assess each body part and compare bilaterally. Must be systematic and
well organized. Use a head to toe approach.
Compare for symmetry. Provide for rest periods to prevent fatigue. Record findings on appropriate
form.
Assessment Techniques (IPPA) - Answer-Inspection
, Palpation
Percussion
Auscultation
Health History - Answer-a collection of subjective information that provides information about the
patient's health status. Nurses use therapeutic communication skills and interviewing techniques to
establish an effective nurse-patient relationship and to gather data to identify actual and potential
health problems as well as health-promotion activities and sources of strength.
Inspection - Answer-The use of vision, hearing, and smell
-use proper lighting
-position and expose body, one part at a time
-be systematic and thorough
-compare opposite sides
-assess for size, shape, color, & symmetry
Note normal findings and any deviations from normal
Palpation - Answer-Using the hands to touch and assess body parts
-Light = <1 cm
-Deep = >2 cm
Palpation of skin - Answer-Temperature
Turgor
Texture
Moisture
Vibrations
Answers
Purposes of Assessment - Answer-Gather baseline data
Identify actual & potential problems
Establish base of the nursing process
Types of Assessment - Answer-Comprehensive
Ongoing partial
Focused
Emergency
Comprehensive Assessment - Answer-Includes a health history and physical exam. Usually conducted
when a patient first enters a health care setting, with information providing a baseline for comparing
later assessments.
ongoing partial assessment - Answer-Or follow up assessment, is one that is conducted at regular
intervals during care of the patient. This type of assessment concentrates on identified health problems
to monitor positive or negative changes and evaluate the effectiveness of interventions.
focused assessment - Answer-is conducted to assess a specific problem
,emergency assessment - Answer-rapid focused assessment conducted to determine potentially fatal
situations. Always assess ABCs first
Parts of Assessment/Preventative Health Assessment - Answer-Health History:
-Biographical data (face sheet)
-Reason for seeking health care
-Hx of present illness
-Past medical Hx
-Family Hx
-Lifestyle
Physical Exam
Risk for depression
Functional ability
Level of safety
Education and Counseling
Nursing Health Assessment - Answer-Differs from other types of health assessments because it is a
holistic collection of information about factors that affect or are affected by ones level of health. The
information from this assessment is used to formulate nursing diagnoses that require nursing care.
physical examination - Answer-Assess each body part and compare bilaterally. Must be systematic and
well organized. Use a head to toe approach.
Compare for symmetry. Provide for rest periods to prevent fatigue. Record findings on appropriate
form.
Assessment Techniques (IPPA) - Answer-Inspection
, Palpation
Percussion
Auscultation
Health History - Answer-a collection of subjective information that provides information about the
patient's health status. Nurses use therapeutic communication skills and interviewing techniques to
establish an effective nurse-patient relationship and to gather data to identify actual and potential
health problems as well as health-promotion activities and sources of strength.
Inspection - Answer-The use of vision, hearing, and smell
-use proper lighting
-position and expose body, one part at a time
-be systematic and thorough
-compare opposite sides
-assess for size, shape, color, & symmetry
Note normal findings and any deviations from normal
Palpation - Answer-Using the hands to touch and assess body parts
-Light = <1 cm
-Deep = >2 cm
Palpation of skin - Answer-Temperature
Turgor
Texture
Moisture
Vibrations
