Holistic Assessment Exam 1
Questions And 100% Verified Answers
\.What are the steps in the nursing process? - ANSWERS✔-assessment,
diagnosis, outcome & planning, implementation, evaluation
\.What is the correct way to assess the abdomen? - ANSWERS✔-
inspection, auscultation, palpation, (percussion?)
\.What is done in assessment? - ANSWERS✔-cluster data, gathering
data from subjective and objective data.
\.What assessments are done when gathering objective data? -
ANSWERS✔-Inspection, palpation, percussion, Auscultation
\.What is the highest priority in assessment? - ANSWERS✔-Airway,
breathing, circulation, vital signs
\.What is the secondary priority when assessing a patient? -
ANSWERS✔-safety, security, mental status, unrelated emergent, acute
pain, infection
, \.What is the third priority when assessing a patient? - ANSWERS✔-non
urgent, long term intervention
\.What is orthostatic hypotension? - ANSWERS✔-taking the blood
pressure at different positions (laying, sitting, standing). decrease in 20
or greater btw each bp. If the blood pressure continues to drop until
last phase, it is a positive test. if negative, may mean the symptoms are
from a different cause like vertigo.
\.What happens during a nursing diagnosis? - ANSWERS✔-assessment
of data- organization and prioritizing.
-actual vs potential risk
-collaborative medical and nursing interventions
\.What happens during outcome identification? - ANSWERS✔-identify
expected outcomes. goal related, broad statements regarding to
patient. realistic and measurable. a SMART goal
\.What happens during the orientation phase of the nurse client
relationship? - ANSWERS✔-introduction & purpose, set the contract;
time and duration, confidentiality. the goal is to develop trust and
security
Questions And 100% Verified Answers
\.What are the steps in the nursing process? - ANSWERS✔-assessment,
diagnosis, outcome & planning, implementation, evaluation
\.What is the correct way to assess the abdomen? - ANSWERS✔-
inspection, auscultation, palpation, (percussion?)
\.What is done in assessment? - ANSWERS✔-cluster data, gathering
data from subjective and objective data.
\.What assessments are done when gathering objective data? -
ANSWERS✔-Inspection, palpation, percussion, Auscultation
\.What is the highest priority in assessment? - ANSWERS✔-Airway,
breathing, circulation, vital signs
\.What is the secondary priority when assessing a patient? -
ANSWERS✔-safety, security, mental status, unrelated emergent, acute
pain, infection
, \.What is the third priority when assessing a patient? - ANSWERS✔-non
urgent, long term intervention
\.What is orthostatic hypotension? - ANSWERS✔-taking the blood
pressure at different positions (laying, sitting, standing). decrease in 20
or greater btw each bp. If the blood pressure continues to drop until
last phase, it is a positive test. if negative, may mean the symptoms are
from a different cause like vertigo.
\.What happens during a nursing diagnosis? - ANSWERS✔-assessment
of data- organization and prioritizing.
-actual vs potential risk
-collaborative medical and nursing interventions
\.What happens during outcome identification? - ANSWERS✔-identify
expected outcomes. goal related, broad statements regarding to
patient. realistic and measurable. a SMART goal
\.What happens during the orientation phase of the nurse client
relationship? - ANSWERS✔-introduction & purpose, set the contract;
time and duration, confidentiality. the goal is to develop trust and
security
