Assessment 2nd Edition by Thompson
All Chapters Complete
, Essential Health Assessment 2nd Edition Thompson Test Bank
Chapter 1. Understanding Health Assessment
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Question 1 j1
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The nurse is obtaining a health history from a client who reports that he is healthy and
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j1 has no health concerns. As part of the health history, the nurse documents that the client
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j 1 reported that hehas high blood pressure and suffers from a leg ulcer that remains
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j1 unhealed j 1 after 6 months. Whichof the following statements would be the best choice for
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j1 the nurse to
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1. I feel that you may be in denial about your health status.
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2. Tell me about your definition of being healthy.
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3. Do you understand what hypertension is?
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4. Is there anything else you are not telling me?
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Correct Answer: 2 j1 j1
Rationale 1: More information would be needed before the nurse could attribute the
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Rationale 2: A client will have his or her own definition of health, illness, and wellness.
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j 1 The individuals concept of health and wellness is influenced by many factors, including
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j 1 age, gender,race,family, culture, religion, socioeconomic conditions, environment, previous
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Rationale 3: The clients history of hypertension is a valid area requiring further
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,Rationale 4: There is not enough information to determine the clients withholding of
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Global Rationale: A client will have his or her own definition of health, illness, and
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j 1 wellness. The individuals concept of health and wellness is influenced by many
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j1 factors, including age, gender, race, family, culture, religion, socioeconomic conditions,
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j 1 environment, previous experiences, and self-expectations. More information would be j1 j1 j1 j1 j1 j1 j1 j1
j 1 needed before the nurse could attribute the clients viewpoint as denial or lack of
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j 1 knowledge. The clients history of hypertensionis a valid area requiring further
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j 1 investigation but the nurse must first ascertain the clients definition of healthy. There
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j1 is j 1 also not enough information to determine the clients withholding of information
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j1 to the nurse.
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Cognitive Level: Analyzing j1 j1
Client Need: Health Promotion and Maintenance
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Client Need Sub: j1 j1
Nursing/Integrated Concepts: NursingProcess:Assessment j1 j1 1
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Learning Outcome: 1.4: Identify the factors to consider in health assessment
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Question 2 j1
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The nurse is documenting in the clients medical record and wishes to use SOAP
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j 1 charting. Thenurse includes which of the following under the assessment category?
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1. The clients blood pressure was 177/93.
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2. The recent loss of employment and insurance have prevented the client from being
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3. The client reports having lost her job and insurance 3 months ago.
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, 4. Referrals have been made to social services to determine financial assistance
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Correct Answer: 2 j1 j1
Rationale 1: This is the O component, objective data.
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Rationale 2: The A component of the SOAP note refers to conclusions drawn
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Rationale 3: This is subjective data. j1 1
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Rationale 4: This is the P component, plan. j1 1
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Global Rationale: The A component of the SOAP note refers to conclusions drawn from
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j 1 thesubjective and objective data obtained. The clients recent loss of employment and the
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j 1 potentialthat this was a contributing factor in the inability to afford medications is an
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j 1 example of a conclusion. The clients reported blood pressure would be an example of
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Objective data is information that can be measured by the examiner. Blood pressure is not
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j 1 employmentand insurance is an example of subjective data. The statement does not j1 j1 j1 j1 j1 j1 j1 j1 j1 j1 j1 j1
j 1 include conclusions as tothe results of these events. Making referrals to social services is
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j1 an j 1 example of an intervention. Itis not a conclusion. j1 j1 j1 j1 j1 j1 j1
Cognitive Level: Applying j1 j1
Client Need: Health Promotion and Maintenance
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Nursing/Integrated Concepts: Nursing Process: Assessment j1 j1 1
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Learning Outcome: 1.4: Identify the factors to consider in health assessment.
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Question 3 j1
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