Practice 7th Edition by Susan Fickertt Wilson,
Jean Foret Giddens | All Chapters (1-24)
,Chapter 01: Introduction to Health Assessment b-g b-g b-g b-g b-g
MULTIPLE CHOICE b-g
1.Apatient comes to the emergencydepartment and tells the triage nurse that he
b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
is ―having a heart attack.‖ What is the nurse‘s top priority at this time?
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g
a. Determine the patient‘s personaldata and b-g b-g b-g b-g b-g b-
insurance coverage.
g b-g
b. Ask the patient to take a seat in the waiting
b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
room until his name is called.
g b-g b-g b-g b-g b-g
c. Request that a nurse collect data for a b-g b-g b-g b-g b-g b-g b-g b-
comprehensive history.
g b-g
d. Ask a nurse to start a focused assessment
b-g b-g b-g b-g b-g b-g b-g b-
of this patient now.
g b-g b-g b-g
ANSWER: D b-g
The nurse needs to begin an assessment as soon as possible that is focused on this
b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
patient‘s cardiovascular system. The type of health assessment performed by the nurse is
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
also driven by patient need. Personal data and insurance information will be obtained, but
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
in this situation, these data can wait until after the patient is assessed. Based also on
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
Maslow‘s hierarchy of needs, physiologic needs take precedence. Rather than asking the
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
patient to wait, the nurse needs to begin data collection, such as vital signs, immediately to
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
determine the patient‘s health status. Complications can be prevented if an immediate
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
assessment is made to analyze the patient‘s symptoms. A comprehensive history is not
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
indicated in this situation at this time. Some subjective data will be collected, such as
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
allergies and medical history related to cardiovascular disease. Eyes, ears, or a complete
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
musculoskeletal or mental health assessment is not a priority at this time.
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g
DIF: Cognitive Level: Apply
b - g REF: Box 1-3 | p. 3 b-g b-g b-g b-g b-g b-g b-g b-
TOP: Nursing Process: Assessment
g b-g b-g b-g
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:
b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
Establishing Priorities
g b-g
2. Which situation illustrates a screening assessment?
b-g b-g b-g b-g b-g
a. A patient visits an obstetric clinic for the b-g b-g b-g b-g b-g b-g b-g b-
first time and the nurse conducts a detailed g b-g b-g b-g b-g b-g b-g b-g b-
history and physical examination. g b-g b-g b-g
b. A hospital sponsors a health fair at a local b-g b-g b-g b-g b-g b-g b-g b-g b-
mall and provides cholesterol and blood g b-g b-g b-g b-g b-g b-
pressure checks to mall patrons. g b-g b-g b-g b-g
c. The nurse in an urgent care center checks b-g b-g b-g b-g b-g b-g b-g b-
the vital signs of a patient who is g b-g b-g b-g b-g b-g b-g b-g b-
complaining of leg pain. g b-g b-g b-g
, d. A patient newly diagnosed with diabetes
b-g b-g b-g b-g b-g b-
mellitus comes to test his fasting blood
g b-g b-g b-g b-g b-g b-g b-
glucose level.
g b-g
ANSWER: B b-g
A health fair at a local mall that provides cholesterol and blood pressure checks is an
b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
example of a screening assessment focused on disease detection. A detailed history and
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
physical examination conducted during a first-time visit to an obstetric clinic is an example
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
of a comprehensive assessment. Assessing a patient complaining of leg pain in the triage
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
area of an urgent care center is an example of a problem-based/focused assessment. A
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
patient‘s return appointment 1 month after today‘s office visit to report fasting blood
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
glucose levels is an example of an episodic or follow-up assessment.
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g
DIF: Cognitive Level: Understand
b - g REF: Box 1-3 | p. 3 b-g b-g b-g b-g b-g b-g b-g b-
TOP: Nursing Process: Assessment
g b-g b-g b-g
MSC: NCLEX Patient Needs: Health Promotion and Maintenance: Health Screening
b-g b-g b-g b-g b-g b-g b-g b-g b-g
3. For whichperson is a screening assessment indicated?
b-g b-g b-g b-g b-g b-g b-g
a. The person who had abdominal surgery b-g b-g b-g b-g b-g b-
yesterday g
b. The person who is unaware of his high b-g b-g b-g b-g b-g b-g b-g b-
serum glucose levels g b-g b-g
c. The person who is being admitted to a b-g b-g b-g b-g b-g b-g b-g b-
long-term care facility g b-g b-g
d. The person who is beginning rehabilitation b-g b-g b-g b-g b-g b-
after a knee replacement g b-g b-g b-g
ANSWER: B b-g
A screening assessment is performed for the purpose of disease detection. In this case this
b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
person may have diabetes mellitus. A shift assessment is most appropriate for the person
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
who is recovering in the hospital from surgery. A comprehensive assessment is performed
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
during admission to a facility to obtain a detailed history and complete physical
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
examination. An episodic or follow-up assessment is performed after knee replacement to
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
evaluate the outcome of the procedure.
g b-g b-g b-g b-g b-g
DIF: Cognitive Level: Understand
b - g REF: Box 1-3 | p. 3 b-g b-g b-g b-g b-g b-g b-g b-
TOP: Nursing Process: Assessment
g b-g b-g b-g
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:
b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
Establishing Priorities
g b-g
4. For whichperson is a shift assessment indicated?
b-g b-g b-g b-g b-g b-g b-g
a. The person who had abdominal surgery b-g b-g b-g b-g b-g b-
yesterday g
b. The person who is unaware of his high b-g b-g b-g b-g b-g b-g b-g b-
serum glucose levels g b-g b-g
c. The person who is being admitted to a b-g b-g b-g b-g b-g b-g b-g b-
long-term care facility g b-g b-g
d. The person who is beginning rehabilitation b-g b-g b-g b-g b-g
after a knee replacement b-g b-g b-g
ANSWER: A b-g
A shift assessment is most appropriate for the person who is recovering in the hospital
b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
from surgery. A screening assessment is performed for the purpose of disease detection,
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
in this case diabetes mellitus. A comprehensive assessment is performed during
g b-g b-g b-g b-g b - g b-g b-g b-g b-g b-g b-
admission to a
g b-g b-g
, facility to obtain a detailed history and complete physical examination. An episodic or
b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
follow-up assessment is performed after knee replacement to evaluate the outcome of the
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
procedure.
g
DIF: Cognitive Level: Understand
b - g REF: Box 1-3 | p. 4 b-g b-g b-g b-g b-g b-g b-g b-
TOP: Nursing Process: Assessment
g b-g b-g b-g
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:
b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
Establishing Priorities
g b-g
5. For which person is a comprehensive assessment indicated?
b-g b-g b-g b-g b-g b-g b-g
a. The person who had abdominal surgery b-g b-g b-g b-g b-g b-
yesterday g
b. The person who is unaware of his high b-g b-g b-g b-g b-g b-g b-g b-
serum glucose levels g b-g b-g
c. The person who is being admitted to a b-g b-g b-g b-g b-g b-g b-g b-
long-term care facility g b-g b-g
d. The person who is beginning rehabilitation b-g b-g b-g b-g b-g b-
after a knee replacement g b-g b-g b-g
ANSWER: C b-g
Acomprehensive assessment is performed during admission to a facilityto obtain a
-g
b b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g
detailed history and complete physical examination. A shift assessment is most appropriate
b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
for the person who is recovering in the hospital from surgery. A screening assessment is
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
performed for the purpose of disease detection, in this case diabetes mellitus. An
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
episodic or follow-up assessment is performed after knee replacement to evaluate the
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
outcome of the procedure.
g b-g b-g b-g
DIF: Cognitive Level: Understand
b - g REF: Box 1-3 | p. 3 b-g b-g b-g b-g b-g b-g b-g b-
TOP: Nursing Process: Assessment
g b-g b-g b-g
MSC: NCLEX Patient Needs: Safe and Effective Care Environment: Management of Care:
b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
Establishing Priorities
g b-g
6. For whichperson is an episodic or follow-up assessment indicated?
b-g b-g b-g b-g b-g b-g b-g b-g b-g
a. The person who had abdominal surgery b-g b-g b-g b-g b-g b-
yesterday g
b. The person who is unaware of his high b-g b-g b-g b-g b-g b-g b-g b-
serum glucose levels g b-g b-g
c. The person who is being admitted to a b-g b-g b-g b-g b-g b-g b-g b-
long-term care facility g b-g b-g
d. The person who is beginning rehabilitation b-g b-g b-g b-g b-g b-
after a knee replacement g b-g b-g b-g
ANSWER: D b-g
An episodic or follow-up assessment is performed after the knee replacement to evaluate
b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
the outcome of the procedure. A shift assessment is most appropriate for the person who is
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
recovering in the hospital from surgery. A screening assessment is performed for the
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
purpose of disease detection, in this case diabetes mellitus. A comprehensive assessment is
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
performed during admission to a facility to obtain a detailed history and complete physical
g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-g b-
examination.
g
DIF: Cognitive Level: Understand
b - g b-g b-g REF: Box 1-3 | p. 3b-g b-g b-g b-g b-g b-
TOP: Nursing Process: Assessment
g b-g b-g b-g