ny ny ny ny ny ny
Examination and History Taking 13th
ny ny ny ny ny
Edition by Lynn S. Bickley
ny ny ny ny ny
ALL CHAPTERS 1-20 WITH RATIONALES| A+ GRADE
ny ny ny ny ny ny
1 | P a g
ny ny ny ny
e
, CHAPTER 1 Foundations for Clinical
ny ny ny
ny Proficiency MULTIPLE CHOICE ny ny
1. After completing an initial assessment of a patient, the nurse has charted that his
ny ny ny ny ny ny ny ny ny ny ny ny ny
respirations are eupneic and his pulse is 58 beats per minute. These types of data
ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny
would be:
ny ny
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
ANS: A ny
Objective data are what the health professional observes by inspecting, percussing, palpating,
ny ny ny ny ny ny ny ny ny ny ny
and auscultating during the physical examination. Subjective data is what the person says about
ny ny ny ny ny ny ny ny ny ny ny ny ny ny
him or herself during history taking. The terms reflective and introspective are not used to
ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny
describe data.
ny ny
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 2
ny ny ny ny ny ny ny
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
ny ny ny ny ny ny ny ny ny ny
2. A patient tells the nurse that he is very nervous, is nauseated, and feels hot. These types of
ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny
data would be:
ny ny ny
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
ANS: C ny
Subjective data are what the person says about him or herself during history taking.
ny ny ny ny ny ny ny ny ny ny ny ny ny
Objective data are what the health professional observes by inspecting, percussing, palpating,
ny ny ny ny ny ny ny ny ny ny ny ny
and auscultating during the physical examination. The terms reflective and introspective are
ny ny ny ny ny ny ny ny ny ny ny ny
not used to describe data.
ny ny ny ny ny
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 2
ny ny ny ny ny ny ny
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
ny ny ny ny ny ny ny ny ny ny
2 | P a g
ny ny ny ny
e
,3. The patients record, laboratory studies, objective data, and subjective data combine to form the:
ny ny ny ny ny ny ny ny ny ny ny ny ny
a. Data base. ny
b. Admitting data. ny
c. Financial statement. ny
d. Discharge summary. ny
ANS: A ny
Together with the patients record and laboratory studies, the objective and subjective data form
ny ny ny ny ny ny ny ny ny ny ny ny ny
the data base. The other items are not part of the patients record, laboratory studies, or data.
ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny
DIF: Cognitive Level: Remembering (Knowledge) REF: p. 2
ny ny ny ny ny ny ny
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
ny ny ny ny ny ny ny ny ny ny
4. When listening to a patients breath sounds, the nurse is unsure of a sound that is heard. The
ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny
nurses next action should be to:
ny ny ny ny ny ny
a. Immediately notify the patients physician. ny ny ny ny
b. Document the sound exactly as it was heard. ny ny ny ny ny ny ny
c. Validate the data by asking a coworker to listen to the breath sounds.
ny ny ny ny ny ny ny ny ny ny ny ny
d. Assess again in 20 minutes to note whether the sound is still present.
ny ny ny ny ny ny ny ny ny ny ny ny
ANS: C ny
When unsure of a sound heard while listening to a patients breath sounds, the nurse validates
ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny
the data to ensure accuracy. If the nurse has less experience in an area, then he or she asks
ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny
an expert to listen.
ny ny ny ny
DIF: Cognitive Level: Analyzing (Analysis) REF: p. 2
ny ny ny ny ny ny ny
MSC: Client Needs: Safe and Effective Care Environment: Management of Care
ny ny ny ny ny ny ny ny ny ny
5. The nurse is conducting a class for new graduate nurses. During the teaching session, the
ny ny ny ny ny ny ny ny ny ny ny ny ny ny
nurse should keep in mind that novice nurses, without a background of skills and experience
ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny
from which to draw, are more likely to make their decisions using:
ny ny ny ny ny ny ny ny ny ny ny ny
a. Intuition.
b. A set of rules.
ny ny ny
3 | P a g
ny ny ny ny
e
, c. Articles in journals. ny ny
d. Advice from supervisors. ny ny
ANS: B ny
Novice nurses operate from a set of defined, structured rules. The expert practitioner uses
ny ny ny ny ny ny ny ny ny ny ny ny ny
intuitive links. DIF: Cognitive Level: Understanding (Comprehension) REF: p. 3 MSC: Client
ny ny ny ny ny ny ny ny ny ny ny ny
ny Needs: General ny
6. Expert nurses learn to attend to a pattern of assessment data and act without consciously
ny ny ny ny ny ny ny ny ny ny ny ny ny ny
labeling it. These responses are referred to as:
ny ny ny ny ny ny ny ny
a. Intuition.
b. The nursing process.
ny ny
c. Clinical knowledge. ny
d. Diagnostic reasoning. ny
ANS: A ny
Intuition is characterized by pattern recognition expert nurses learn to attend to a pattern of
ny ny ny ny ny ny ny ny ny ny ny ny ny ny
assessment data and act without consciously labeling it. The other options are not correct.
ny ny ny ny ny ny ny ny ny ny ny ny ny ny
DIF: Cognitive Level: Understanding (Comprehension) REF: p. 4 MSC: Client Needs: General
ny ny ny ny ny ny ny ny ny ny ny
7. The nurse is reviewing information about evidence-based practice (EBP). Which statement best
ny ny ny ny ny ny ny ny ny ny ny
reflects EBP?
ny ny
a. EBP relies on tradition for support of best practices.
ny ny ny ny ny ny ny ny
b. EBP is simply the use of best practice techniques for the treatment of patients.
ny ny ny ny ny ny ny ny ny ny ny ny ny
c. EBP emphasizes the use of best evidence with the clinicians experience.
ny ny ny ny ny ny ny ny ny ny
d. The patients own preferences are not important with
ny ny ny ny ny ny ny
EBP. ANS: C
ny ny ny
EBP is a systematic approach to practice that emphasizes the use of best evidence in combination
ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny
with the clinicians experience, as well as patient preferences and values, when making decisions
ny ny ny ny ny ny ny ny ny ny ny ny ny ny
about care and treatment. EBP is more than simply using the best practice techniques to treat
ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny ny
patients, and questioning tradition is important when no compelling and supportive research
ny ny ny ny ny ny ny ny ny ny ny ny
evidence exists.
ny ny
4 | P a g
ny ny ny ny
e