Test Bank Bates Guide To Physical
Examination and History taking 13th
Edition Bickley’s UPDATED Questions
and Answers
CHAPTER 1 Foundations for Clinical Proficiency
1. A patient tells the nurse that he is very nervous, is nauseated, and feels hot. These
types of data would be: a. Objective.
b. Reflective.
c. Subjective.
d. Introspective. - ANSWER ANS: C
Subjective data are what the person says about him or herself during history taking.
Objective data are what the health professional observes by inspecting, percussing,
palpating, and auscultating during the physical examination. The terms reflective and
introspective are not used to describe data.
,11. After completing an initial assessment of a patient, the nurse has charted that his
respirations are eupneic and his pulse is 58 beats per minute. These types of data
would be:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective. - ANSWER ANS: A
Objective data are what the health professional observes by inspecting, percussing,
palpating, and auscultating during the physical examination. Subjective data is what
the person says about him or herself during history taking. The terms reflective and
introspective are not used to describe data.
3. The patients record, laboratory studies, objective data, and subjective data combine
to form the:
a. Data base.
b. Admitting data.
c. Financial statement.
d. Discharge summary. - ANSWER ANS: A
Together with the patients record and laboratory studies, the objective and subjective
data form the data base. The other items are not part of the patients record, laboratory
studies, or data.
4. When listening to a patients breath sounds, the nurse is unsure of a sound that is
heard. The nurses next action should be to:
a. Immediately notify the patients physician.
b. Document the sound exactly as it was heard.
c. Validate the data by asking a coworker to listen to the breath sounds.
d. Assess again in 20 minutes to note whether the sound is still present. - ANSWER
ANS: C
When unsure of a sound heard while listening to a patients breath sounds, the nurse
validates the data to ensure accuracy. If the nurse has less experience in an area,
then he or she asks an expert to listen.
5. The nurse is conducting a class for new graduate nurses. During the teaching
session, the nurse should keep in mind that novice nurses, without a
background of skills and experience from which to draw, are more likely to make
their decisions using: a Intuition. b A set of rules. c Articles in journals.
d Advice from supervisors. - ANSWER ANS: B
,Novice nurses operate from a set of defined, structured rules. The expert practitioner
uses intuitive links.
6. Expert nurses learn to attend to a pattern of assessment data and act without
consciously labeling it. These responses are referred to as: a Intuition. b The
nursing process. c Clinical knowledge.
d Diagnostic reasoning. - ANSWER ANS: A
Intuition is characterized by pattern recognition expert nurses learn to attend to a
pattern of assessment data and act without consciously labeling it. The other options
are not correct.
7. The nurse is reviewing information about evidence-based practice (EBP). Which
statement best reflects EBP? a EBP relies on tradition for support of best
practices. b EBP is simply the use of best practice techniques for the treatment of
patients. c EBP emphasizes the use of best evidence with the clinicians
experience.
d The patients own preferences are not important with EBP. - ANSWER ANS: C EBP
is a systematic approach to practice that emphasizes the use of best evidence in
combination with the clinicians experience, as well as patient preferences and values,
when making decisions about care and treatment. EBP is more than simply using the
best practice techniques to treat patients, and questioning tradition is important when
no compelling and supportive research evidence exists.
8. The nurse is conducting a class on priority setting for a group of new graduate
nurses. Which is an example of a first-level priority problem?
a Patient with postoperative pain b Newly diagnosed patient with
diabetes who needs diabetic teaching c Individual with a small
laceration on the sole of the foot
d Individual with shortness of breath and respiratory distress - ANSWER ANS: D
First-level priority problems are those that are emergent, life threatening, and immediate
(e.g., establishing an airway, supporting breathing, maintaining circulation,
monitoring abnormal vital signs) (see Table 1-1).
9. When considering priority setting of problems, the nurse keeps in mind that second-
level priority problems include which of these aspects?
a Low self-esteem b Lack of knowledge c
Abnormal laboratory values d Severely abnormal
vital signs - ANSWER ANS: C Second-level priority
problems are those that require prompt intervention
to forestall further deterioration (e.g., mental status
, change, acute pain, abnormal laboratory values,
risks to safety or security) (see Table 1-1).
10. Which critical thinking skill helps the nurse see relationships among the data?
a Validation b Clustering related cues c Identifying gaps in data
d Distinguishing relevant from irrelevant - ANSWER ANS: B
Clustering related cues helps the nurse see relationships among the data.
11. The nurse knows that developing appropriate nursing interventions for a patient
relies on the appropriateness of the diagnosis.
a Nursing b
Medical c
Admission
d Collaborative - ANSWER ANS: A
An accurate nursing diagnosis provides the basis for the selection of nursing
interventions to achieve outcomes for which the nurse is accountable. The other items
do not contribute to the development of appropriate nursing interventions.
12. The nursing process is a sequential method of problem solving that nurses use and
includes which steps?
a Assessment, treatment, planning, evaluation, discharge, and follow-up b
Admission, assessment, diagnosis, treatment, and discharge planning c
Admission, diagnosis, treatment, evaluation, and discharge planning d
Assessment, diagnosis, outcome identification, planning, implementation, and
evaluation - ANSWER ANS: D
The nursing process is a method of problem solving that includes assessment,
diagnosis, outcome identification, planning, implementation, and evaluation.
13. A newly admitted patient is in acute pain, has not been sleeping well lately, and is
having difficulty breathing. How should the nurse prioritize these problems?
a Breathing, pain, and sleep b Breathing, sleep,
and pain c Sleep, breathing, and pain d Sleep,
pain, and breathing - ANSWER ANS: A First-
level priority problems are immediate priorities,
remembering the ABCs (airway, breathing, and
circulation), followed by second-level problems,
and then third-level problems.
14. Which of these would be formulated by a nurse using diagnostic reasoning?
Examination and History taking 13th
Edition Bickley’s UPDATED Questions
and Answers
CHAPTER 1 Foundations for Clinical Proficiency
1. A patient tells the nurse that he is very nervous, is nauseated, and feels hot. These
types of data would be: a. Objective.
b. Reflective.
c. Subjective.
d. Introspective. - ANSWER ANS: C
Subjective data are what the person says about him or herself during history taking.
Objective data are what the health professional observes by inspecting, percussing,
palpating, and auscultating during the physical examination. The terms reflective and
introspective are not used to describe data.
,11. After completing an initial assessment of a patient, the nurse has charted that his
respirations are eupneic and his pulse is 58 beats per minute. These types of data
would be:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective. - ANSWER ANS: A
Objective data are what the health professional observes by inspecting, percussing,
palpating, and auscultating during the physical examination. Subjective data is what
the person says about him or herself during history taking. The terms reflective and
introspective are not used to describe data.
3. The patients record, laboratory studies, objective data, and subjective data combine
to form the:
a. Data base.
b. Admitting data.
c. Financial statement.
d. Discharge summary. - ANSWER ANS: A
Together with the patients record and laboratory studies, the objective and subjective
data form the data base. The other items are not part of the patients record, laboratory
studies, or data.
4. When listening to a patients breath sounds, the nurse is unsure of a sound that is
heard. The nurses next action should be to:
a. Immediately notify the patients physician.
b. Document the sound exactly as it was heard.
c. Validate the data by asking a coworker to listen to the breath sounds.
d. Assess again in 20 minutes to note whether the sound is still present. - ANSWER
ANS: C
When unsure of a sound heard while listening to a patients breath sounds, the nurse
validates the data to ensure accuracy. If the nurse has less experience in an area,
then he or she asks an expert to listen.
5. The nurse is conducting a class for new graduate nurses. During the teaching
session, the nurse should keep in mind that novice nurses, without a
background of skills and experience from which to draw, are more likely to make
their decisions using: a Intuition. b A set of rules. c Articles in journals.
d Advice from supervisors. - ANSWER ANS: B
,Novice nurses operate from a set of defined, structured rules. The expert practitioner
uses intuitive links.
6. Expert nurses learn to attend to a pattern of assessment data and act without
consciously labeling it. These responses are referred to as: a Intuition. b The
nursing process. c Clinical knowledge.
d Diagnostic reasoning. - ANSWER ANS: A
Intuition is characterized by pattern recognition expert nurses learn to attend to a
pattern of assessment data and act without consciously labeling it. The other options
are not correct.
7. The nurse is reviewing information about evidence-based practice (EBP). Which
statement best reflects EBP? a EBP relies on tradition for support of best
practices. b EBP is simply the use of best practice techniques for the treatment of
patients. c EBP emphasizes the use of best evidence with the clinicians
experience.
d The patients own preferences are not important with EBP. - ANSWER ANS: C EBP
is a systematic approach to practice that emphasizes the use of best evidence in
combination with the clinicians experience, as well as patient preferences and values,
when making decisions about care and treatment. EBP is more than simply using the
best practice techniques to treat patients, and questioning tradition is important when
no compelling and supportive research evidence exists.
8. The nurse is conducting a class on priority setting for a group of new graduate
nurses. Which is an example of a first-level priority problem?
a Patient with postoperative pain b Newly diagnosed patient with
diabetes who needs diabetic teaching c Individual with a small
laceration on the sole of the foot
d Individual with shortness of breath and respiratory distress - ANSWER ANS: D
First-level priority problems are those that are emergent, life threatening, and immediate
(e.g., establishing an airway, supporting breathing, maintaining circulation,
monitoring abnormal vital signs) (see Table 1-1).
9. When considering priority setting of problems, the nurse keeps in mind that second-
level priority problems include which of these aspects?
a Low self-esteem b Lack of knowledge c
Abnormal laboratory values d Severely abnormal
vital signs - ANSWER ANS: C Second-level priority
problems are those that require prompt intervention
to forestall further deterioration (e.g., mental status
, change, acute pain, abnormal laboratory values,
risks to safety or security) (see Table 1-1).
10. Which critical thinking skill helps the nurse see relationships among the data?
a Validation b Clustering related cues c Identifying gaps in data
d Distinguishing relevant from irrelevant - ANSWER ANS: B
Clustering related cues helps the nurse see relationships among the data.
11. The nurse knows that developing appropriate nursing interventions for a patient
relies on the appropriateness of the diagnosis.
a Nursing b
Medical c
Admission
d Collaborative - ANSWER ANS: A
An accurate nursing diagnosis provides the basis for the selection of nursing
interventions to achieve outcomes for which the nurse is accountable. The other items
do not contribute to the development of appropriate nursing interventions.
12. The nursing process is a sequential method of problem solving that nurses use and
includes which steps?
a Assessment, treatment, planning, evaluation, discharge, and follow-up b
Admission, assessment, diagnosis, treatment, and discharge planning c
Admission, diagnosis, treatment, evaluation, and discharge planning d
Assessment, diagnosis, outcome identification, planning, implementation, and
evaluation - ANSWER ANS: D
The nursing process is a method of problem solving that includes assessment,
diagnosis, outcome identification, planning, implementation, and evaluation.
13. A newly admitted patient is in acute pain, has not been sleeping well lately, and is
having difficulty breathing. How should the nurse prioritize these problems?
a Breathing, pain, and sleep b Breathing, sleep,
and pain c Sleep, breathing, and pain d Sleep,
pain, and breathing - ANSWER ANS: A First-
level priority problems are immediate priorities,
remembering the ABCs (airway, breathing, and
circulation), followed by second-level problems,
and then third-level problems.
14. Which of these would be formulated by a nurse using diagnostic reasoning?
