Physical Examination and Health
Assessment Canadian Edition 4th by
Jarvis | 2024 Edition Test Bank
Comprehensive Q&A with
Rationales, Latest Version
Contents
1 Chapter 1: Evidence-Based Assessment 2
2 Chapter 2: Cultural Assessment 5
3 Chapter 3: A Relational Approach to Cultural and Social Consider-
ations in Health Assessment 9
4 Chapter 4: The Complete Health History 10
5 Chapter 5: Percussion and Palpation 14
6 Additional Questions for Comprehensive Review 15
1
,1 Chapter 1: Evidence-Based Assessment
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.
d. Introspective.
Answer: a
Rationale: Objective data are measurements or observations made by the nurse.
2. A patient tells the nurse that he is very nervous, is nauseated, and feels hot. These
types of data would be:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
Answer: c
Rationale: Subjective data are what the patient reports.
3. The patient’s record, laboratory studies, objective data, and subjective data com-
bine to form the:
a. Data base.
b. Admitting data.
c. Financial statement.
d. Discharge summary.
Answer: a
Rationale: All collected information forms the database.
4. When listening to a patient’s breath sounds, the nurse is unsure of a sound that is
heard. The nurse’s next action should be to:
a. Immediately notify the patient’s physician.
b. Document the sound exactly as it was heard.
c. Validate the data by asking a coworker to listen to the breath sounds.
d. Assess again in 20 minutes to note whether the sound is still present.
Answer: c
Rationale: Validation ensures accuracy by confirming with another professional.
2
,5. The nurse is conducting a class for new graduate nurses. During the teaching
session, the nurse should keep in mind that novice nurses, without a background of
skills and experience from which to draw, are more likely to make their decisions
using:
a. Intuition.
b. A set of rules.
c. Articles in journals.
d. Advice from supervisors.
Answer: b
Rationale: Novice nurses rely on rules and guidelines.
6. Expert nurses learn to attend to a pattern of assessment data and act without
consciously labeling it. These responses are referred to as:
a. Intuition.
b. The nursing process.
c. Clinical knowledge.
d. Diagnostic reasoning.
Answer: a
Rationale: Intuition comes from experience and pattern recognition.
7. The nurse is reviewing information about evidence-based practice (EBP). Which
statement best reflects EBP?
a. EBP relies on tradition for support of best practices.
b. EBP is simply the use of best practice techniques for the treatment of patients.
c. EBP emphasizes the use of best evidence with the clinician’s experience.
d. The patient’s own preferences are not important with EBP.
Answer: c
Rationale: EBP integrates evidence, expertise, and patient values.
8. The nurse is conducting a class on priority setting for a group of new graduate
nurses. Which is an example of a first-level priority problem?
a. Patient with postoperative pain.
b. Newly diagnosed patient with diabetes who needs diabetic teaching.
c. Individual with a small laceration on the sole of the foot.
d. Individual with shortness of breath and respiratory distress.
Answer: d
Rationale: First-level priorities involve airway, breathing, or circulation issues.
9. When considering priority setting of problems, the nurse keeps in mind that second-
level priority problems include which of these aspects?
3
, a. Low self-esteem.
b. Lack of knowledge.
c. Abnormal laboratory values.
d. Severely abnormal vital signs.
Answer: c
Rationale: Second-level priorities include mental status changes or abnormal labs.
10. Which critical thinking skill helps the nurse see relationships among the data?
a. Validation.
b. Clustering related cues.
c. Identifying gaps in data.
d. Distinguishing relevant from irrelevant.
Answer: b
Rationale: Clustering cues identifies patterns.
11. The nurse knows that developing appropriate nursing interventions for a patient
relies on the appropriateness of the __ diagnosis.
a. Nursing.
b. Medical.
c. Admission.
d. Collaborative.
Answer: a
Rationale: Nursing diagnoses guide interventions.
12. The nursing process is a sequential method of problem solving that nurses use and
includes which steps?
a. Assessment, treatment, planning, evaluation, discharge, and follow-up.
b. Admission, assessment, diagnosis, treatment, and discharge planning.
c. Admission, diagnosis, treatment, evaluation, and discharge planning.
d. Assessment, diagnosis, outcome identification, planning, implementation, and
evaluation.
Answer: d
Rationale: This is the standard nursing process.
13. A newly admitted patient is in acute pain, has not been sleeping well lately, and is
having difficulty breathing. How should the nurse prioritize these problems?
a. Breathing, pain, and sleep.
b. Breathing, sleep, and pain.
c. Sleep, breathing, and pain.
4
Assessment Canadian Edition 4th by
Jarvis | 2024 Edition Test Bank
Comprehensive Q&A with
Rationales, Latest Version
Contents
1 Chapter 1: Evidence-Based Assessment 2
2 Chapter 2: Cultural Assessment 5
3 Chapter 3: A Relational Approach to Cultural and Social Consider-
ations in Health Assessment 9
4 Chapter 4: The Complete Health History 10
5 Chapter 5: Percussion and Palpation 14
6 Additional Questions for Comprehensive Review 15
1
,1 Chapter 1: Evidence-Based Assessment
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.
d. Introspective.
Answer: a
Rationale: Objective data are measurements or observations made by the nurse.
2. A patient tells the nurse that he is very nervous, is nauseated, and feels hot. These
types of data would be:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
Answer: c
Rationale: Subjective data are what the patient reports.
3. The patient’s record, laboratory studies, objective data, and subjective data com-
bine to form the:
a. Data base.
b. Admitting data.
c. Financial statement.
d. Discharge summary.
Answer: a
Rationale: All collected information forms the database.
4. When listening to a patient’s breath sounds, the nurse is unsure of a sound that is
heard. The nurse’s next action should be to:
a. Immediately notify the patient’s physician.
b. Document the sound exactly as it was heard.
c. Validate the data by asking a coworker to listen to the breath sounds.
d. Assess again in 20 minutes to note whether the sound is still present.
Answer: c
Rationale: Validation ensures accuracy by confirming with another professional.
2
,5. The nurse is conducting a class for new graduate nurses. During the teaching
session, the nurse should keep in mind that novice nurses, without a background of
skills and experience from which to draw, are more likely to make their decisions
using:
a. Intuition.
b. A set of rules.
c. Articles in journals.
d. Advice from supervisors.
Answer: b
Rationale: Novice nurses rely on rules and guidelines.
6. Expert nurses learn to attend to a pattern of assessment data and act without
consciously labeling it. These responses are referred to as:
a. Intuition.
b. The nursing process.
c. Clinical knowledge.
d. Diagnostic reasoning.
Answer: a
Rationale: Intuition comes from experience and pattern recognition.
7. The nurse is reviewing information about evidence-based practice (EBP). Which
statement best reflects EBP?
a. EBP relies on tradition for support of best practices.
b. EBP is simply the use of best practice techniques for the treatment of patients.
c. EBP emphasizes the use of best evidence with the clinician’s experience.
d. The patient’s own preferences are not important with EBP.
Answer: c
Rationale: EBP integrates evidence, expertise, and patient values.
8. The nurse is conducting a class on priority setting for a group of new graduate
nurses. Which is an example of a first-level priority problem?
a. Patient with postoperative pain.
b. Newly diagnosed patient with diabetes who needs diabetic teaching.
c. Individual with a small laceration on the sole of the foot.
d. Individual with shortness of breath and respiratory distress.
Answer: d
Rationale: First-level priorities involve airway, breathing, or circulation issues.
9. When considering priority setting of problems, the nurse keeps in mind that second-
level priority problems include which of these aspects?
3
, a. Low self-esteem.
b. Lack of knowledge.
c. Abnormal laboratory values.
d. Severely abnormal vital signs.
Answer: c
Rationale: Second-level priorities include mental status changes or abnormal labs.
10. Which critical thinking skill helps the nurse see relationships among the data?
a. Validation.
b. Clustering related cues.
c. Identifying gaps in data.
d. Distinguishing relevant from irrelevant.
Answer: b
Rationale: Clustering cues identifies patterns.
11. The nurse knows that developing appropriate nursing interventions for a patient
relies on the appropriateness of the __ diagnosis.
a. Nursing.
b. Medical.
c. Admission.
d. Collaborative.
Answer: a
Rationale: Nursing diagnoses guide interventions.
12. The nursing process is a sequential method of problem solving that nurses use and
includes which steps?
a. Assessment, treatment, planning, evaluation, discharge, and follow-up.
b. Admission, assessment, diagnosis, treatment, and discharge planning.
c. Admission, diagnosis, treatment, evaluation, and discharge planning.
d. Assessment, diagnosis, outcome identification, planning, implementation, and
evaluation.
Answer: d
Rationale: This is the standard nursing process.
13. A newly admitted patient is in acute pain, has not been sleeping well lately, and is
having difficulty breathing. How should the nurse prioritize these problems?
a. Breathing, pain, and sleep.
b. Breathing, sleep, and pain.
c. Sleep, breathing, and pain.
4
