Answers | Chamberlain
1.** The nursing process is a five-step framework that includes:
A) Assessment, Diagnosis, Planning, Implementation, Evaluation
B) Admission, Discharge, Transfer, Screening, Referral
C) Observation, Documentation, Reporting, Evaluation, Discharge
D) Screening, Triage, Referral, Follow-up, Discharge
**Correct Answer:** A) Assessment, Diagnosis, Planning, Implementation,
Evaluation
**Rationale:** The nursing process (ADPIE) is the foundational framework for
nursing practice. Assessment is the first and most critical step, during which
the nurse collects comprehensive data about the patient's health status.
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**2.** After completing an initial assessment of a patient, the nurse charts
that the patient's respirations are eupneic and pulse is 58 beats per minute.
These types of data are:
A) Objective
B) Reflective
C) Subjective
D) Introspective
**Correct Answer:** A) Objective
,**Rationale:** Objective data are observable and measurable data that can
be seen, heard, or felt by someone other than the person experiencing them.
Respirations (eupneic) and pulse rate (58 bpm) are objective findings
obtained through physical examination.
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**3.** A patient tells the nurse that he is very nervous, nauseated, and "feels
hot." These types of data are:
A) Objective
B) Reflective
C) Subjective
D) Introspective
**Correct Answer:** C) Subjective
**Rationale:** Subjective data are what the patient says about himself or
herself during history taking. These data include feelings, perceptions, and
descriptions of symptoms. The patient's statements about being nervous,
nauseated, and feeling hot are subjective.
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**4.** A nurse is conducting a health history interview. Which statement is an
example of an open-ended question?
A) "Are you having any pain?"
B) "Tell me about your usual daily activities."
, C) "Do you take any medications?"
D) "Is your appetite good?"
**Correct Answer:** B) "Tell me about your usual daily activities."
**Rationale:** Open-ended questions invite the patient to share information
in their own words and cannot be answered with "yes" or "no." "Tell me about
your usual daily activities" encourages the patient to elaborate.
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**5.** Which of the following is an example of a closed-ended question?
A) "How are you feeling today?"
B) "What brought you to the hospital?"
C) "Have you had any headaches in the past week?"
D) "Can you tell me more about your symptoms?"
**Correct Answer:** C) "Have you had any headaches in the past week?"
**Rationale:** Closed-ended questions can be answered with "yes," "no," or
a short, specific response. "Have you had any headaches in the past week?"
limits the response to a simple answer. Open-ended questions invite
elaboration.
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**6.** What is the correct order of physical assessment techniques for most
body systems?