Evidence-Based Physical Examination Best Practices for
p p p p p
Health & Well-Being Assessment 2nd Edition Test Bank
p p p p p p p p
,Chapter 1. APPROACH TO EVIDENCE-BASED ASSESSMENT OF HEALTH AND WELL-
p p p p p p p p p
BEING
p
MULTIPLE CHOICE p
1. After completing an initial assessment of a patient, the nurse has charted that his respirations
p p p p p p p p p p p p p p
are eupneic and his pulse is 58 beats per minute. These types of data would be:
p p p p p p p p p p p p p p p p
a Objective.
.
b Reflective.
.
c Subjective.
.
d Introspective.
.
ANS: A p
Objective data are what the health professional observes by inspecting, percussing, palpating,
p p p p p p p p p p p
and auscultating during the physical examination. Subjective data is what the person says about
p p p p p p p p p p p p p p
him or herself during history taking. The terms reflective and introspective are not used to
p p p p p p p p p p p p p p p
describe data.
p p
DIF: Cognitive Level: Understanding (Comprehension) REF: z. 2
p p p p p p p
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
p p p p p p p p p p
2. A patient tells the nurse that he is very nervous, is nauseated, and feels hot. These types of
p p p p p p p p p p p p p p p p p
data would be:
p p p
a Objective.
.
b Reflective.
.
c Subjective.
.
d Introspective.
.
ANS: C p
Subjective data are what the person says about him or herself during history taking. Objective
p p p p p p p p p p p p p p
,data are what the health professional observes by inspecting, percussing, palpating, and
p p p p p p p p p p p
auscultating during the physical examination. The terms reflective and introspective are not used
p p p p p p p p p p p p p
to describe data.
p p p
DIF: Cognitive Level: Understanding (Comprehension) REF: z. 2
p p p p p p p
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
p p p p p p p p p p
3. The patients record, laboratory studies, objective data, and subjective data combine to form
p p p p p p p p p p p p
the:
p
a Data base. p
.
b Admitting data. p
.
c Financial statement. p
.
d Discharge summary. p
.
ANS: A p
Together with the patients record and laboratory studies, the objective and subjective data form
p p p p p p p p p p p p p
the data base. The other items are not part of the patients record, laboratory studies, or data.
p p p p p p p p p p p p p p p p p
DIF: Cognitive Level: Remembering (Knowledge) REF: z. 2
p p p p p p p
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
p p p p p p p p p p
4. When listening to a patients breath sounds, the nurse is unsure of a sound that is heard. The
p p p p p p p p p p p p p p p p p
nurses next action should be to:
p p p p p p
a Immediately notify the patients physician. p p p p
.
b Document the sound exactly as it was heard. p p p p p p p
.
c Validate the data by asking a coworker to listen to the breath sounds.
p p p p p p p p p p p p
.
d Assess again in 20 minutes to note whether the sound is still present.
p p p p p p p p p p p p
.
ANS: C p
When unsure of a sound heard while listening to a patients breath sounds, the nurse validates the
p p p p p p p p p p p p p p p p
data to ensure accuracy. If the nurse has less experience in an area, then he or she asks an expert
p p p p p p p p p p p p p p p p p p p p
to listen.
p p
, DIF: Cognitive Level: Analyzing (Analysis) REF: z. 2
p p p p p p p
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
p p p p p p p p p p
5. The nurse is conducting a class for new graduate nurses. During the teaching session, the
p p p p p p p p p p p p p p
nurse should keep in mind that novice nurses, without a background of skills and experience
p p p p p p p p p p p p p p p
from which to draw, are more likely to make their decisions using:
p p p p p p p p p p p p
a Intuition.
.
b A set of rules.
p p p
.
c Articles in journals. p p
.
d Advice from supervisors. p p
.
ANS: B p
Novice nurses operate from a set of defined, structured rules. The expert practitioner uses
p p p p p p p p p p p p p
intuitive links.
p p
DIF: Cognitive Level: Understanding (Comprehension) REF: z. 3
p p p p p p p
MSC: Client Needs: General
p p p p
6. Expert nurses learn to attend to a pattern of assessment data and act without consciously
p p p p p p p p p p p p p p
labeling it. These responses are referred to as:
p p p p p p p p
a Intuition.
.
b The nursing process. p p
.
c Clinical knowledge. p
.
d Diagnostic reasoning. p
.
ANS: A p
Intuition is characterized by pattern recognitionexpert nurses learn to attend to a pattern of
p p p p p p p p p p p p p
passessment data and act without consciously labeling it. The other options are not correct.
p p p p p p p p p p p p p
DIF: Cognitive Level: Understanding (Comprehension) REF: z. 4
p p p p p p p
MSC: Client Needs: General
p p p p
7. The nurse is reviewing information about evidence-based practice (EBP). Which statement
p p p p p p p p p p
best reflects EBP?
p p p
p p p p p
Health & Well-Being Assessment 2nd Edition Test Bank
p p p p p p p p
,Chapter 1. APPROACH TO EVIDENCE-BASED ASSESSMENT OF HEALTH AND WELL-
p p p p p p p p p
BEING
p
MULTIPLE CHOICE p
1. After completing an initial assessment of a patient, the nurse has charted that his respirations
p p p p p p p p p p p p p p
are eupneic and his pulse is 58 beats per minute. These types of data would be:
p p p p p p p p p p p p p p p p
a Objective.
.
b Reflective.
.
c Subjective.
.
d Introspective.
.
ANS: A p
Objective data are what the health professional observes by inspecting, percussing, palpating,
p p p p p p p p p p p
and auscultating during the physical examination. Subjective data is what the person says about
p p p p p p p p p p p p p p
him or herself during history taking. The terms reflective and introspective are not used to
p p p p p p p p p p p p p p p
describe data.
p p
DIF: Cognitive Level: Understanding (Comprehension) REF: z. 2
p p p p p p p
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
p p p p p p p p p p
2. A patient tells the nurse that he is very nervous, is nauseated, and feels hot. These types of
p p p p p p p p p p p p p p p p p
data would be:
p p p
a Objective.
.
b Reflective.
.
c Subjective.
.
d Introspective.
.
ANS: C p
Subjective data are what the person says about him or herself during history taking. Objective
p p p p p p p p p p p p p p
,data are what the health professional observes by inspecting, percussing, palpating, and
p p p p p p p p p p p
auscultating during the physical examination. The terms reflective and introspective are not used
p p p p p p p p p p p p p
to describe data.
p p p
DIF: Cognitive Level: Understanding (Comprehension) REF: z. 2
p p p p p p p
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
p p p p p p p p p p
3. The patients record, laboratory studies, objective data, and subjective data combine to form
p p p p p p p p p p p p
the:
p
a Data base. p
.
b Admitting data. p
.
c Financial statement. p
.
d Discharge summary. p
.
ANS: A p
Together with the patients record and laboratory studies, the objective and subjective data form
p p p p p p p p p p p p p
the data base. The other items are not part of the patients record, laboratory studies, or data.
p p p p p p p p p p p p p p p p p
DIF: Cognitive Level: Remembering (Knowledge) REF: z. 2
p p p p p p p
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
p p p p p p p p p p
4. When listening to a patients breath sounds, the nurse is unsure of a sound that is heard. The
p p p p p p p p p p p p p p p p p
nurses next action should be to:
p p p p p p
a Immediately notify the patients physician. p p p p
.
b Document the sound exactly as it was heard. p p p p p p p
.
c Validate the data by asking a coworker to listen to the breath sounds.
p p p p p p p p p p p p
.
d Assess again in 20 minutes to note whether the sound is still present.
p p p p p p p p p p p p
.
ANS: C p
When unsure of a sound heard while listening to a patients breath sounds, the nurse validates the
p p p p p p p p p p p p p p p p
data to ensure accuracy. If the nurse has less experience in an area, then he or she asks an expert
p p p p p p p p p p p p p p p p p p p p
to listen.
p p
, DIF: Cognitive Level: Analyzing (Analysis) REF: z. 2
p p p p p p p
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
p p p p p p p p p p
5. The nurse is conducting a class for new graduate nurses. During the teaching session, the
p p p p p p p p p p p p p p
nurse should keep in mind that novice nurses, without a background of skills and experience
p p p p p p p p p p p p p p p
from which to draw, are more likely to make their decisions using:
p p p p p p p p p p p p
a Intuition.
.
b A set of rules.
p p p
.
c Articles in journals. p p
.
d Advice from supervisors. p p
.
ANS: B p
Novice nurses operate from a set of defined, structured rules. The expert practitioner uses
p p p p p p p p p p p p p
intuitive links.
p p
DIF: Cognitive Level: Understanding (Comprehension) REF: z. 3
p p p p p p p
MSC: Client Needs: General
p p p p
6. Expert nurses learn to attend to a pattern of assessment data and act without consciously
p p p p p p p p p p p p p p
labeling it. These responses are referred to as:
p p p p p p p p
a Intuition.
.
b The nursing process. p p
.
c Clinical knowledge. p
.
d Diagnostic reasoning. p
.
ANS: A p
Intuition is characterized by pattern recognitionexpert nurses learn to attend to a pattern of
p p p p p p p p p p p p p
passessment data and act without consciously labeling it. The other options are not correct.
p p p p p p p p p p p p p
DIF: Cognitive Level: Understanding (Comprehension) REF: z. 4
p p p p p p p
MSC: Client Needs: General
p p p p
7. The nurse is reviewing information about evidence-based practice (EBP). Which statement
p p p p p p p p p p
best reflects EBP?
p p p
