WGU FUNDAMENTALS QUESTIONS AND
ANSWERS WITH COMPLETE
SOLUTIONS 100% CORRECT RATED A+
Strategies for Effective Data Collection
1. Pacing and Energy Management
Segmented Sessions: Instead of one exhaustive exam, perform assessments
in shorter, multiple sessions. This prevents patient fatigue and ensures the
data collected remains accurate.
Response Latency: Allow additional time for the patient to process
questions and formulate answers. Rushing the interview can lead to
incomplete or incorrect medical histories. ✔✔
2. Physical Safety and Comfort
Position Changes: Move slowly when asking the patient to transition (e.g.,
from lying to sitting). This accounts for decreased mobility and the risk of
orthostatic hypotension.
Elimination Needs: Offer the patient the opportunity to use the restroom
before the exam begins. This increases comfort during abdominal palpation
and provides an efficient time to collect any necessary specimens. ✔✔
3. Optimizing Sensory Input
Sensory Aids: Verify that the patient is wearing their glasses and
functioning hearing aids before starting. Assessment data is only as good as
the patient's ability to perceive the nurse's instructions.
Environment: Minimize background noise (turn off the TV, close the door).
Older adults often struggle to filter out ambient sounds, which can lead to
confusion or missed communication. ✔✔
Nursing Fundamentals Part 2
Physical assessment:
,Inspection
Palpation
Percussion
Auscultation
When do you go out of order?
Nursing Fundamentals Part 2
Physical assessment
Inspection: Use sight to assess for size, shape, color, symmetry.
Palpation: Use touch to assess for temperature, texture, tenderness, size. Assess
most tender areas last. Dorsal surface of hand is best for assessing temperature.
Palmar surface of hand is best for assessing vibration.
Percussion: Tap body parts assess for size, tenderness, and density of tissue.
Auscultation: Listen for sounds: assess amplitude, intensity, frequency, quality.
Examples: bowel, lung, heart sounds.
Normal order: Inspect, palpate, percuss, auscultate
,Order for abdomen: Inspect, auscultate, percuss, palpate (to avoid altering bowel
sounds).
Nursing Fundamentals Part 2
General Survey:
What is included?
Nursing Fundamentals Part 2
General Survey
Physical Appearance: age, race, gender, level of consciousness (LOC), signs of
substance abuse, signs of distress.
Body Structure: height, weight, nutritional status, posture, obvious abnormalities
(amputations).
Mobility: gait, ROM, movement
Behavior: mood, speech, grooming
Vital Signs: Temperature, pulse, respiratory rate, blood pressure, O2 saturation
, Nursing Fundamentals Part 2
Temperature:
Expected ranges for:
Oral, rectal, axillary, temporal temperatures
Factors that impact body temperature
Nursing Fundamentals Part 2
Temperature
Oral: 36-38 degrees C ( average 37 degrees C)
Rectal: 0.5 degrees higher (36.5-38.5 degrees C)
Axillary: 0.5 degrees lower (35.5-37.5 degrees C)
Temporal: 0.5 degrees higher (36.5-38.5 degrees C)
Factor that impact body temperature:
-Newborns have lower temps (36-37.5 degrees C)
-Older adults have lower temps (average 36 degrees C)
ANSWERS WITH COMPLETE
SOLUTIONS 100% CORRECT RATED A+
Strategies for Effective Data Collection
1. Pacing and Energy Management
Segmented Sessions: Instead of one exhaustive exam, perform assessments
in shorter, multiple sessions. This prevents patient fatigue and ensures the
data collected remains accurate.
Response Latency: Allow additional time for the patient to process
questions and formulate answers. Rushing the interview can lead to
incomplete or incorrect medical histories. ✔✔
2. Physical Safety and Comfort
Position Changes: Move slowly when asking the patient to transition (e.g.,
from lying to sitting). This accounts for decreased mobility and the risk of
orthostatic hypotension.
Elimination Needs: Offer the patient the opportunity to use the restroom
before the exam begins. This increases comfort during abdominal palpation
and provides an efficient time to collect any necessary specimens. ✔✔
3. Optimizing Sensory Input
Sensory Aids: Verify that the patient is wearing their glasses and
functioning hearing aids before starting. Assessment data is only as good as
the patient's ability to perceive the nurse's instructions.
Environment: Minimize background noise (turn off the TV, close the door).
Older adults often struggle to filter out ambient sounds, which can lead to
confusion or missed communication. ✔✔
Nursing Fundamentals Part 2
Physical assessment:
,Inspection
Palpation
Percussion
Auscultation
When do you go out of order?
Nursing Fundamentals Part 2
Physical assessment
Inspection: Use sight to assess for size, shape, color, symmetry.
Palpation: Use touch to assess for temperature, texture, tenderness, size. Assess
most tender areas last. Dorsal surface of hand is best for assessing temperature.
Palmar surface of hand is best for assessing vibration.
Percussion: Tap body parts assess for size, tenderness, and density of tissue.
Auscultation: Listen for sounds: assess amplitude, intensity, frequency, quality.
Examples: bowel, lung, heart sounds.
Normal order: Inspect, palpate, percuss, auscultate
,Order for abdomen: Inspect, auscultate, percuss, palpate (to avoid altering bowel
sounds).
Nursing Fundamentals Part 2
General Survey:
What is included?
Nursing Fundamentals Part 2
General Survey
Physical Appearance: age, race, gender, level of consciousness (LOC), signs of
substance abuse, signs of distress.
Body Structure: height, weight, nutritional status, posture, obvious abnormalities
(amputations).
Mobility: gait, ROM, movement
Behavior: mood, speech, grooming
Vital Signs: Temperature, pulse, respiratory rate, blood pressure, O2 saturation
, Nursing Fundamentals Part 2
Temperature:
Expected ranges for:
Oral, rectal, axillary, temporal temperatures
Factors that impact body temperature
Nursing Fundamentals Part 2
Temperature
Oral: 36-38 degrees C ( average 37 degrees C)
Rectal: 0.5 degrees higher (36.5-38.5 degrees C)
Axillary: 0.5 degrees lower (35.5-37.5 degrees C)
Temporal: 0.5 degrees higher (36.5-38.5 degrees C)
Factor that impact body temperature:
-Newborns have lower temps (36-37.5 degrees C)
-Older adults have lower temps (average 36 degrees C)
