Health Assessment For Nursing Practice
by Susan Wilson, Jean Foret Giddens
8th Edition
,TABLE OF CONTENT
I. Foundations For Health Assessment
1. Importance Of Health Assessment
2. Interviewing Patients To Obtain A Health History
3. Techniques And Equipment For Physical Assessment
4. General Inspection And Measurement Of Vital Signs
5. Ethnic, Cultural, And Spiritual Considerations
6. Pain Assessment
7. Mental Health And Abusive Behavior Assessment
8. Nutritional Assessment
II. Health Assessment Of The Adult
9. Skin, Hair, And Nails
10. Head, Eyes, Ears, Nose, And Throat
11. Lungs And Respiratory System
12. Heart And Peripheral Vascular System
13. Abdomen And Gastrointestinal System
14. Musculoskeletal System
15. Neurologic System
16. Breasts And Axillae
17. Reproductive System And The Perineum
III. Health Assessment Across The Life Span
18. Developmental Assessment Throughout The Life Span
19. Assessment Of The Infant, Child, And Adolescent
20. Assessment Of The Pregnant Patient
21. Assessment Of The Older Adult
IV. Synthesis And Application Of Health Assessment
22. Conducting A Head-To-Toe Examination
23. Documenting The Head-To-Toe Health Assessment
24. Adapting Health Assessment To An Ill Patient
,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.
ANS: D
Feedback
A Personal Data And Insurance Information Will Be Obtained, But In This Situation, These Data
Can Wait Until After The Patient Is Assessed.
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.
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.
D The Nurse Needs To Begin An Assessment As Soon As Possible That Is Focused On
This Patient’s Cardiovascular System. The Type Of Health Assessment Performed By The Nurse Is
Also Driven By Patient Need.
DIF: Cognitive Level: Apply REF: 3 TOP: Nursing Process: Assessment
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.
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.
ANS: 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.
B A Health Fair At A Local Mall That Provides Cholesterol And Blood Pressure Checks Is An
Example Of A Screening Assessment Focused On Disease Detection.
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.
D A Patient’s Return Appointment 1 Month After Today’s Office Visit To Report Fasting Blood
Glucose Levels Is An Example Of An Episodic Or Follow-Up Assessment.
DIF: Cognitive Level: Understand REF: 3 TOP: Nursing Process: Assessment
MSC: NCLEX Patient Needs: Health Promotion And Maintenance: Health Screening
3. For Which Person Is A Screening Assessment Indicated?
a. The Person Who Had Abdominal Surgery Yesterday
b. The Person Who Is Unaware Of His High Serum Glucose Levels
c. The Person Who Is Being Admitted To A Long-Term Care Facility
d. The Person Who Is Beginning Rehabilitation After A Knee Replacement
ANS: B
Feedback
A A Shift Assessment Is Most Appropriate For The Person Who Is Recovering In The Hospital
From Surgery.
B A Screening Assessment Is Performed For The Purpose Of Disease Detection. In This Case
This Person May Have Diabetes Mellitus.
C A Comprehensive Assessment Is Performed During Admission To A Facility To Obtain A
Detailed History And Complete Physical Examination.
D An Episodic Or Follow-Up Assessment Is Performed After Knee Replacement To Evaluate The
Outcome Of The Procedure.