Test Bank for Health Assessment for Nursing Practice 7th Edition by Wilson | Chapters 1-24 | Complete Questions & Answers | Rationales Included

Test Bank for Health Assessment for Nursing Practice 7th
t t t t t t t tt t




Edition by Wilson Chapter 1 - 24
t t t t t t

,Chapter 01: Introduction to Health Assessment M
t t t t t t



ULTIPLE CHOICE t




1. A patient comes to the emergency department and tells t
t t t t t t t t t



he triage nurse that heis “having a heart attack.” What is the nurs
t t t t t t t t t t t t



e’s top priority at this time?
t t t t t




a. Determine the patient’s t t



personal data andinsurance cov t t t



erage.
b. Ask the patient to take a seat in
t t t t t t t



the waitingroom until his name i
t t t t t



s called.
t




c. Request that a nurse collec t t t t



t data for a
t t t



comprehensive history. t




d. Ask a nurse to start a focused ass
t t t t t t t



essmentof this patient t t



now.
ANSWER: D t




The nurse needs to begin an assessment as soon as possible that is
t t t t t t t t t t t t t



focused on this patient’scardiovascular system. The type of health
t t t t t t t t



assessment performed by the nurse is also drivenby patient need.
t t t t t t t t t t



Personal data and insurance information will be obtained, but in t
t t t t t t t t t t t



his situation, these data can wait until after the patient is assessed.
t t t t t t t t t t t



Based also on Maslow’s hierarchy of needs, physiologic needs tak
t t t t t t t t t t



e precedence. Rather than asking the patient to wait, the nurse ne
t t t t t t t t t t t



eds to begin data collection, such as vital signs, immediately to det
t t t t t t t t t t t



erminethe patient’s health status. Complications can be prevente
t t t t t t t



d if an immediate assessment is made to analyze the patient’s sym
t t t t t t t t t t t



ptoms. A comprehensive t t

,history is not indicated in this situation at this time. Some subjecti
t t t t t t t t t t t



ve data will be collected, such as allergies and medical history rel
t t t t t t t t t t t



ated to cardiovascular disease. Eyes, ears, or a complete musculo
t t t t t t t t t



skeletal or mental health assessment is not a priority at this time.
t t t t t t t t t t t




DIF: Cognitive Level: Apply
tt t t REF: Box 1-3
t t



| p. 3TOP: Nursing Process: Assessment
t t t t t



MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Managemen
t t t t t t t t t



t of Care:Establishing Priorities
t t t




2. Which situation illustrates a screening assessment?
t t t t t




a. A patient visits an obstetric clini
t t t t t



c for the first time and the nurse c
t t t t t t t t



onducts a detailed history and p t t t t t



hysical
examination.
b. A hospital sponsors a health fai
t t t t t



r at a localmall and provides ch
t t t t t t



olesterol and blood pressure c t t t t



hecks to mall t t



patrons.
c. The nurse in an urgent care c t t t t t t



enter checksthe vital signs o t t t t



f a patient who is
t t t t



complaining of leg pain. t t t

, d. A patient newly diagnosed w
t t t t



ith diabetesmellitus comes t
t t t



o test his fasting blood
t t t t



glucose level. t




ANSWER: B t




A health fair at a local mall that provides cholesterol and blood pres
t t t t t t t t t t t t



sure checks is an example of a screening assessment focused on dis
t t t t t t t t t t t



ease detection. A detailed history and physical examination conduc
t t t t t t t t



ted during a first-
t t t



time visit to an obstetric clinic is an exampleof a comprehensive ass
t t t t t t t t t t t



essment. Assessing a patient complaining of leg pain in the triage ar
t t t t t t t t t t t



ea of an urgent care center is an example of a problem-
t t t t t t t t t t t



based/focused assessment. A patient’s return appointment 1 mont t t t t t t t



h after today’s office visit to report fasting blood glucose levels is an
t t t t t t t t t t t t t



example of an episodic or follow-up assessment.
t t t t t t




DIF: Cognitive Level: Understand
tt t t REF:
Box 1-3 | p. 3TOP: Nursing Process:
t t t t t t



Assessment
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Scree
t t t t t t t t t



ning


3. For which person is a screening assessment indicated?
t t t t t t t




a. The person who had t t t



abdominal surgery yester t t



day
b. The person who is unaware
t t t t



of his highserum glucose le
t t t t



vels
c. The person who is being admitte
t t t t t



d to along-term
t t



care facility t