Table Of Contents
Chapter 01: Introduction To Health Assessment
Chapter 02: Obtaining A Health History
Chapter 03: Techniques And Equipment For Physical Assessment
Chapter 04: General Inspection And Measurement Of Vital Signs
Chapter 05: Cultural Assessment
Chapter 06: Pain Assessment
Chapter 07: Mental Health Assessment
Chapter 08: Nutritional Assessment
Chapter 09: Skin, Hair, And Nails
Chapter 10: Head, Eyes, Ears, Nose, And Throat
Chapter 11: Lungs And Respiratory System
Chapter 12: Heart And Peripheral Vascular System
Chapter 13: Abdomen And Gastrointestinal System
Chapter 14: Musculoskeletal System
Chapter 15: Neurologic System
Chapter 16: Breasts And Axillae
Chapter 17: Reproductive System And The Perineum
Chapter 18: Developmental Assessment Throughout The Life Span
Chapter 19: Assessment Of The Infant, Child, And Adolescent
Chapter 20: Assessment Of The Pregnant Patient
Chapter 21: Assessment Of The Older Adult
Chapter 22: Conducting A Head-To-Toe Examination
Chapter 23: Documenting The Comprehensive Health Assessment
Chapter 24: Adapting Health Assessment To The Hospitalized Patient
,Table Of Contents
Chapter 01: Introduction To Health Assessment
Chapter 02: Obtaining A Health History
Chapter 03: Techniques And Equipment For Physical Assessment
Chapter 04: General Inspection And Measurement Of Vital Signs
Chapter 05: Cultural Assessment
Chapter 06: Pain Assessment
Chapter 07: Mental Health Assessment
Chapter 08: Nutritional Assessment
Chapter 09: Skin, Hair, And Nails
Chapter 10: Head, Eyes, Ears, Nose, And Throat
Chapter 11: Lungs And Respiratory System
Chapter 12: Heart And Peripheral Vascular System
Chapter 13: Abdomen And Gastrointestinal System
Chapter 14: Musculoskeletal System
Chapter 15: Neurologic System
Chapter 16: Breasts And Axillae
Chapter 17: Reproductive System And The Perineum
Chapter 18: Developmental Assessment Throughout The Life Span
Chapter 19: Assessment Of The Infant, Child, And Adolescent
Chapter 20: Assessment Of The Pregnant Patient
Chapter 21: Assessment Of The Older Adult
Chapter 22: Conducting A Head-To-Toe Examination
Chapter 23: Documenting The Comprehensive Health Assessment
Chapter 24: Adapting Health Assessment To The Hospitalized Patient
, Franklyn A Plus Pass
Chapter 1: Importance of Health Assessment
MULTIPLE CHOICE
1. A patient comes to the emergency department and tells the triage nurse that he is ―having a heart
attack.‖ What is the nurse‘s top priority at this time?
a. Determine the patient‘s personal data and insurance coverage.
b. Ask the patient to take a seat in the waiting room until his name is called.
c. Request that a nurse collect data for a comprehensive history.
d. Ask a nurse to start a focused assessment of this patient now.
Fr
CORRECT ANSWER: D
a nk
Feedback
ly
A Personal data and insurance information will be obtained, but in this situation, these data can wait
until after the patient is assessed.
ne
B Rather than asking the patient to wait, the nurse needs to begin data collection, such as vital signs,
immediately to determine the patient‘s health status.
A
C A comprehensive history is not indicated in this situation at this time. Some subjective data will
be collected, such as allergies and medical history related to cardiovascular disease.
pl
D The nurse needs to begin an assessment as soon as possible that is focused on
us
this patient‘s cardiovascular system. The type of health assessment performed by the nurse is also driven
by patient need.
Pa
DIF: Cognitive Level: Apply REF: 3 TOP: Nursing Process: Assessment
ss
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care: Establishing
Priorities
2. Which situation illustrates a screening assessment?
a. A patient visits an obstetric clinic for the first time and the nurse conducts a detailed history and
physical examination.
b. A hospital sponsors a health fair at a local mall and provides cholesterol and blood pressure
checks to mall patrons.
2|Page
, Franklyn A Plus Pass
c. The nurse in an urgent care center checks the vital signs of a patient who is complaining of leg
pain.
d. A patient newly diagnosed with diabetes mellitus comes to test his fasting blood glucose level.
CORRECT ANSWER: B
Feedback
A A detailed history and physical examination conducted during a first-time visit to an obstetric
clinic is an example of a comprehensive assessment.
Fr
B A health fair at a local mall that provides cholesterol and blood pressure checks is an example of
a
a screening assessment focused on disease detection.
nk
C Assessing a patient complaining of leg pain in the triage area of an urgent care center is an
example of a problem-based/focused assessment.
ly
D A patient‘s return appointment 1 month after today‘s office visit to report fasting blood glucose
ne
levels is an example of an episodic or follow-up assessment.
DIF: Cognitive Level: Understand REF: 3 TOP: Nursing Process: Assessment
A
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Screening
pl
us
3. For which person is a screening assessment indicated?
a. The person who had abdominal surgery yesterday
Pa
b. The person who is unaware of his high serum glucose levels
ss
c. The person who is being admitted to a long-term care facility
d. The person who is beginning rehabilitation after a knee replacement
CORRECT ANSWER: B
Feedback
A A shift assessment is most appropriate for the person who is recovering in the hospital from
surgery.
3|Page
Chapter 01: Introduction To Health Assessment
Chapter 02: Obtaining A Health History
Chapter 03: Techniques And Equipment For Physical Assessment
Chapter 04: General Inspection And Measurement Of Vital Signs
Chapter 05: Cultural Assessment
Chapter 06: Pain Assessment
Chapter 07: Mental Health Assessment
Chapter 08: Nutritional Assessment
Chapter 09: Skin, Hair, And Nails
Chapter 10: Head, Eyes, Ears, Nose, And Throat
Chapter 11: Lungs And Respiratory System
Chapter 12: Heart And Peripheral Vascular System
Chapter 13: Abdomen And Gastrointestinal System
Chapter 14: Musculoskeletal System
Chapter 15: Neurologic System
Chapter 16: Breasts And Axillae
Chapter 17: Reproductive System And The Perineum
Chapter 18: Developmental Assessment Throughout The Life Span
Chapter 19: Assessment Of The Infant, Child, And Adolescent
Chapter 20: Assessment Of The Pregnant Patient
Chapter 21: Assessment Of The Older Adult
Chapter 22: Conducting A Head-To-Toe Examination
Chapter 23: Documenting The Comprehensive Health Assessment
Chapter 24: Adapting Health Assessment To The Hospitalized Patient
,Table Of Contents
Chapter 01: Introduction To Health Assessment
Chapter 02: Obtaining A Health History
Chapter 03: Techniques And Equipment For Physical Assessment
Chapter 04: General Inspection And Measurement Of Vital Signs
Chapter 05: Cultural Assessment
Chapter 06: Pain Assessment
Chapter 07: Mental Health Assessment
Chapter 08: Nutritional Assessment
Chapter 09: Skin, Hair, And Nails
Chapter 10: Head, Eyes, Ears, Nose, And Throat
Chapter 11: Lungs And Respiratory System
Chapter 12: Heart And Peripheral Vascular System
Chapter 13: Abdomen And Gastrointestinal System
Chapter 14: Musculoskeletal System
Chapter 15: Neurologic System
Chapter 16: Breasts And Axillae
Chapter 17: Reproductive System And The Perineum
Chapter 18: Developmental Assessment Throughout The Life Span
Chapter 19: Assessment Of The Infant, Child, And Adolescent
Chapter 20: Assessment Of The Pregnant Patient
Chapter 21: Assessment Of The Older Adult
Chapter 22: Conducting A Head-To-Toe Examination
Chapter 23: Documenting The Comprehensive Health Assessment
Chapter 24: Adapting Health Assessment To The Hospitalized Patient
, Franklyn A Plus Pass
Chapter 1: Importance of Health Assessment
MULTIPLE CHOICE
1. A patient comes to the emergency department and tells the triage nurse that he is ―having a heart
attack.‖ What is the nurse‘s top priority at this time?
a. Determine the patient‘s personal data and insurance coverage.
b. Ask the patient to take a seat in the waiting room until his name is called.
c. Request that a nurse collect data for a comprehensive history.
d. Ask a nurse to start a focused assessment of this patient now.
Fr
CORRECT ANSWER: D
a nk
Feedback
ly
A Personal data and insurance information will be obtained, but in this situation, these data can wait
until after the patient is assessed.
ne
B Rather than asking the patient to wait, the nurse needs to begin data collection, such as vital signs,
immediately to determine the patient‘s health status.
A
C A comprehensive history is not indicated in this situation at this time. Some subjective data will
be collected, such as allergies and medical history related to cardiovascular disease.
pl
D The nurse needs to begin an assessment as soon as possible that is focused on
us
this patient‘s cardiovascular system. The type of health assessment performed by the nurse is also driven
by patient need.
Pa
DIF: Cognitive Level: Apply REF: 3 TOP: Nursing Process: Assessment
ss
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care: Establishing
Priorities
2. Which situation illustrates a screening assessment?
a. A patient visits an obstetric clinic for the first time and the nurse conducts a detailed history and
physical examination.
b. A hospital sponsors a health fair at a local mall and provides cholesterol and blood pressure
checks to mall patrons.
2|Page
, Franklyn A Plus Pass
c. The nurse in an urgent care center checks the vital signs of a patient who is complaining of leg
pain.
d. A patient newly diagnosed with diabetes mellitus comes to test his fasting blood glucose level.
CORRECT ANSWER: B
Feedback
A A detailed history and physical examination conducted during a first-time visit to an obstetric
clinic is an example of a comprehensive assessment.
Fr
B A health fair at a local mall that provides cholesterol and blood pressure checks is an example of
a
a screening assessment focused on disease detection.
nk
C Assessing a patient complaining of leg pain in the triage area of an urgent care center is an
example of a problem-based/focused assessment.
ly
D A patient‘s return appointment 1 month after today‘s office visit to report fasting blood glucose
ne
levels is an example of an episodic or follow-up assessment.
DIF: Cognitive Level: Understand REF: 3 TOP: Nursing Process: Assessment
A
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Screening
pl
us
3. For which person is a screening assessment indicated?
a. The person who had abdominal surgery yesterday
Pa
b. The person who is unaware of his high serum glucose levels
ss
c. The person who is being admitted to a long-term care facility
d. The person who is beginning rehabilitation after a knee replacement
CORRECT ANSWER: B
Feedback
A A shift assessment is most appropriate for the person who is recovering in the hospital from
surgery.
3|Page
