,Chapter 01: Evidence-Based Assessment
MULTIPLE CHOICE
1. Afterjcompletingjanjinitialjassessmentjofjajpatient,jthejnursejhasjchartedjthatjhisjrespirationsjarejeupneicjandjhisj p
ulsej isj 58j beatsj perj minute.j Thesej typesj ofj dataj wouldbe:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
ANS:j A
Objectivejdatajarejwhatjthejhealthjprofessionaljobservesjbyjinspecting,jpercussing,jpalpating,jandjauscultatingjduring
jthejphysicaljexamination.jSubjectivejdatajisjwhatjthejpersonjsaysjaboutjhimjorjherselfjduringjhistoryjtaking.j Thej ter
msj reflectivej andj introspectivej arej notj usedj toj describej data.
DIF:j Cognitivej Level:j Understandingj (Comprehension)
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
2. Ajpatientjtellsjthejnursejthatjhejisj veryjnervous,jisjnauseated,j andjfeelsj hot.jThesejtypesj ofj datajwouldjbe:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
ANS:j C
Subjectivejdatajarejwhatjthejpersonjsaysjaboutjhimjorjherselfjduringjhistoryjtaking.jObjectivejdatajarejwhatjthejhealt
hj professionalj observesj byj inspecting,j percussing,j palpating,j andj auscultatingj duringj thej physicaljexaminatio
n.j Thej termsj reflectivej andj introspectivej arej notj usedjtoj describej data.
DIF:j Cognitivej Level:j Understandingj (Comprehension)
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
3. Thej patientsj record,j laboratoryj studies,j objectivej data,j andjsubjectivej dataj combinej tojformjthe:
a. Datajbase.
b. Admittingj data.
,c. Financialj statement.
d. Dischargej summary.
ANS:j A
Togetherjwithjthejpatientsjrecordjandjlaboratoryjstudies,jthejobjectivejandjsubjectivejdatajformjthejdatajbase.jThej ot
herj itemsj arej notj partj ofj thej patientsj record,j laboratoryj studies,j orj data.
DIF:j Cognitivej Level:j Rememberingj (Knowledge)
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
4. Whenjlisteningjtojajpatientsjbreathjsounds,jthejnursejisjunsurejofjajsoundjthatjisjheard.jThejnursesjnextjactio
njshouldjbejto:
a. Immediatelyj notifyj thej patientsj physician.
b. Documentj thej soundjexactlyj asj itj wasjheard.
c. Validatejthejdataj byjaskingjajcoworkerjtojlistenjtojthejbreathjsounds.
d. Assessjagainjinj20jminutesjtojnotejwhetherjthejsoundjisjstilljpresent.
ANS:j C
Whenjunsurejofjajsoundjheardjwhilejlisteningjtojajpatientsjbreathjsounds,jthejnursejvalidatesjthejdatajtojensurejaccur
acy.j Ifj thej nursej hasj lessjexperiencej inj anj area,j thenj hej orj shej asksj anj expertj toj listen.
DIF:j Cognitivej Level:j Analyzingj (Analysis)
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
5. Thejnursejisjconductingj ajclassjforjnewj graduatejnurses.j Duringjthejteachingjsession,jthejnursejshouldj keepj inj mi
ndj thatj novicejnurses,j withoutj aj backgroundj ofjskillsj andjexperiencej fromjwhichj tojdraw,j arej morej likelyjtojmakejth
eirjdecisionsjusing:
a. Intuition.
b. Ajsetjofjrules.
c. Articlesj injjournals.
d. Advicej fromjsupervisors.
ANS:j B
Novicejnursesjoperatejfromjajsetjofjdefined,jstructuredjrules.jThejexpertjpractitionerjusesjintuitivejlinks.jDIF:jCo
gnitivej Level:j Understandingj(Comprehension)
, MSC:j Clientj Needs:j General
6. Expertjnursesjlearnjtojattendjtojajpatternjofjassessmentjdatajandjactjwithoutjconsciouslyjlabelingjit.jThesejresp
onsesjarejreferredjtojas:
a. Intuition.
b. Thej nursingj process.
c. Clinicalj knowledge.
d. Diagnosticj reasoning.
ANS:j A
Intuitionjisjcharacterizedjbyjpatternjrecognitionexpertjnursesjlearnjtojattendjtojajpatternjofjassessmentjdatajandjactj
withoutj consciouslyj labelingj it.j Thej otherj optionsj arej notjcorrect.
DIF:jCognitivejLevel:jUnderstandingj(Comprehension)j
MSC:jClientjNeeds:jGeneral
7. Thejnursejisjreviewingjinformationjaboutjevidence-
basedjpracticej(EBP).jWhichjstatementjbestjreflectsjEBP?
a. EBPjreliesj onj traditionj forj supportj ofj bestjpractices.
b. EBPjisjsimplyjthej usejofjbestj practicej techniquesj forjthej treatmentj ofjpatients.
c. EBPjemphasizesj thej usej ofjbestj evidencej withjthejcliniciansj experience.
d. ThejpatientsjownjpreferencesjarejnotjimportantjwithjEBP.
ANS:jC
EBPjisjajsystematicjapproachjtojpracticejthatjemphasizesjthejusejofjbestjevidencejinjcombinationjwithjthejclinici
ansjexperience,jasjwelljasjpatientjpreferencesjandjvalues,jwhenjmakingjdecisionsjaboutjcarejandjtreatment.jEBPj
isjmorejthanjsimplyjusingjthejbestjpracticejtechniquesjtojtreatjpatients,jandjquestioningjtraditionj isj importantj w
henj noj compellingj andj supportivej researchj evidencej exists.
DIF:j Cognitivej Level:j Applyingj (Application)
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
8. Thejnursejisjconductingjajclassjonjpriorityjsettingjforjajgroupjofjnewjgraduatejnurses.jWhichjisjanjexamplejofjajfi
rst-leveljpriorityjproblem?
a. Patientj withj postoperativej pain
b. Newlyj diagnosedj patientj withj diabetesj whoj needsj diabeticjteaching
MULTIPLE CHOICE
1. Afterjcompletingjanjinitialjassessmentjofjajpatient,jthejnursejhasjchartedjthatjhisjrespirationsjarejeupneicjandjhisj p
ulsej isj 58j beatsj perj minute.j Thesej typesj ofj dataj wouldbe:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
ANS:j A
Objectivejdatajarejwhatjthejhealthjprofessionaljobservesjbyjinspecting,jpercussing,jpalpating,jandjauscultatingjduring
jthejphysicaljexamination.jSubjectivejdatajisjwhatjthejpersonjsaysjaboutjhimjorjherselfjduringjhistoryjtaking.j Thej ter
msj reflectivej andj introspectivej arej notj usedj toj describej data.
DIF:j Cognitivej Level:j Understandingj (Comprehension)
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
2. Ajpatientjtellsjthejnursejthatjhejisj veryjnervous,jisjnauseated,j andjfeelsj hot.jThesejtypesj ofj datajwouldjbe:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
ANS:j C
Subjectivejdatajarejwhatjthejpersonjsaysjaboutjhimjorjherselfjduringjhistoryjtaking.jObjectivejdatajarejwhatjthejhealt
hj professionalj observesj byj inspecting,j percussing,j palpating,j andj auscultatingj duringj thej physicaljexaminatio
n.j Thej termsj reflectivej andj introspectivej arej notj usedjtoj describej data.
DIF:j Cognitivej Level:j Understandingj (Comprehension)
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
3. Thej patientsj record,j laboratoryj studies,j objectivej data,j andjsubjectivej dataj combinej tojformjthe:
a. Datajbase.
b. Admittingj data.
,c. Financialj statement.
d. Dischargej summary.
ANS:j A
Togetherjwithjthejpatientsjrecordjandjlaboratoryjstudies,jthejobjectivejandjsubjectivejdatajformjthejdatajbase.jThej ot
herj itemsj arej notj partj ofj thej patientsj record,j laboratoryj studies,j orj data.
DIF:j Cognitivej Level:j Rememberingj (Knowledge)
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
4. Whenjlisteningjtojajpatientsjbreathjsounds,jthejnursejisjunsurejofjajsoundjthatjisjheard.jThejnursesjnextjactio
njshouldjbejto:
a. Immediatelyj notifyj thej patientsj physician.
b. Documentj thej soundjexactlyj asj itj wasjheard.
c. Validatejthejdataj byjaskingjajcoworkerjtojlistenjtojthejbreathjsounds.
d. Assessjagainjinj20jminutesjtojnotejwhetherjthejsoundjisjstilljpresent.
ANS:j C
Whenjunsurejofjajsoundjheardjwhilejlisteningjtojajpatientsjbreathjsounds,jthejnursejvalidatesjthejdatajtojensurejaccur
acy.j Ifj thej nursej hasj lessjexperiencej inj anj area,j thenj hej orj shej asksj anj expertj toj listen.
DIF:j Cognitivej Level:j Analyzingj (Analysis)
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
5. Thejnursejisjconductingj ajclassjforjnewj graduatejnurses.j Duringjthejteachingjsession,jthejnursejshouldj keepj inj mi
ndj thatj novicejnurses,j withoutj aj backgroundj ofjskillsj andjexperiencej fromjwhichj tojdraw,j arej morej likelyjtojmakejth
eirjdecisionsjusing:
a. Intuition.
b. Ajsetjofjrules.
c. Articlesj injjournals.
d. Advicej fromjsupervisors.
ANS:j B
Novicejnursesjoperatejfromjajsetjofjdefined,jstructuredjrules.jThejexpertjpractitionerjusesjintuitivejlinks.jDIF:jCo
gnitivej Level:j Understandingj(Comprehension)
, MSC:j Clientj Needs:j General
6. Expertjnursesjlearnjtojattendjtojajpatternjofjassessmentjdatajandjactjwithoutjconsciouslyjlabelingjit.jThesejresp
onsesjarejreferredjtojas:
a. Intuition.
b. Thej nursingj process.
c. Clinicalj knowledge.
d. Diagnosticj reasoning.
ANS:j A
Intuitionjisjcharacterizedjbyjpatternjrecognitionexpertjnursesjlearnjtojattendjtojajpatternjofjassessmentjdatajandjactj
withoutj consciouslyj labelingj it.j Thej otherj optionsj arej notjcorrect.
DIF:jCognitivejLevel:jUnderstandingj(Comprehension)j
MSC:jClientjNeeds:jGeneral
7. Thejnursejisjreviewingjinformationjaboutjevidence-
basedjpracticej(EBP).jWhichjstatementjbestjreflectsjEBP?
a. EBPjreliesj onj traditionj forj supportj ofj bestjpractices.
b. EBPjisjsimplyjthej usejofjbestj practicej techniquesj forjthej treatmentj ofjpatients.
c. EBPjemphasizesj thej usej ofjbestj evidencej withjthejcliniciansj experience.
d. ThejpatientsjownjpreferencesjarejnotjimportantjwithjEBP.
ANS:jC
EBPjisjajsystematicjapproachjtojpracticejthatjemphasizesjthejusejofjbestjevidencejinjcombinationjwithjthejclinici
ansjexperience,jasjwelljasjpatientjpreferencesjandjvalues,jwhenjmakingjdecisionsjaboutjcarejandjtreatment.jEBPj
isjmorejthanjsimplyjusingjthejbestjpracticejtechniquesjtojtreatjpatients,jandjquestioningjtraditionj isj importantj w
henj noj compellingj andj supportivej researchj evidencej exists.
DIF:j Cognitivej Level:j Applyingj (Application)
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
8. Thejnursejisjconductingjajclassjonjpriorityjsettingjforjajgroupjofjnewjgraduatejnurses.jWhichjisjanjexamplejofjajfi
rst-leveljpriorityjproblem?
a. Patientj withj postoperativej pain
b. Newlyj diagnosedj patientj withj diabetesj whoj needsj diabeticjteaching
