1 With Correct Verified And Detailed
Answers
When is the best time for a nurse to take a client's health history?
As soon as possible after a client presents for care
Within 24 hours of admission
Anytime before the client is discharged
After the client is settled and feels ready - ANSWERS-
Which action by the nurse while interviewing a new client would indicate to the charge
nurse the need for further training?
The nurse asks the client what name the client would like to be called.
The nurse verifies the client's name.
The nurse introduces oneself to the client by pointing to the nurse's name badge.
The nurse sits on eye level with the client. - ANSWERS-The nurse introduces oneself to
the client by pointing to the nurse's name badge.
The nursing instructor is teaching students about assessment and the importance of
having baseline data when caring for clients. The instructor should inform the students
that the best place to get baseline data is:
the health record from a previous admission.
the initial comprehensive client assessment.
the client record from the health care provider's office.
the focus assessment done when admitted to the ER. - ANSWERS-the initial
comprehensive client assessment.
The nurse is gathering subjective data from a client during an interview after a suicide
attempt. Which assessment data gathered by the nurse would be documented as
subjective data? Select all that apply.
Clothes visibly soiled and hair greasy
Client states, "I am in pain."
Blood pressure 140/82 mm Hg
Client states, "I feel so sad all of the time."
Ecchymosis on upper left arm - ANSWERS-Client states, "I feel so sad all of the time."
Client states, "I am in pain."
, Which is the most appropriate reason for a nurse to ask a client what the client would
like to be called?
It signifies that the nurse wants to be friendly.
It communicates respect for the client.
It allows the client to control the situation.
It ignores the policies of the facility. - ANSWERS-It communicates respect for the client.
While performing an assessment, the nurse recognizes that the nurse's own personal
biases may be interfering with the collection of data. What step should the nurse take to
ensure that the information is factual and accurate?
Consult with another nurse for that colleague's description of the assessment or
observations.
Document on the client's chart that the assessment data may be biased.
Inform the client of these potential biases and obtain the client's opinion.
Verify the information with one or two family members without informing the client. -
ANSWERS-Consult with another nurse for that colleague's description of the
assessment or observations.
The nurse is performing an assessment on a newly admitted client and understands the
importance of validating all data. When is the best time to validate such data?
During the collection of data only
At the end of the data-gathering process
Both during the collection and at the end of the collection
In the middle of the data-gathering process - ANSWERS-Both during the collection and
at the end of the collection
Which nursing skill uses all five senses?
Listening
Observation
Caring
Documentation - ANSWERS-Observation
A nurse is providing care to a client with a history of intimate partner violence. During
the last visit, the client stated an intent to leave the spouse. In this visit, the nurse
reassesses the client's commitment to this intended change. What type of assessment
is the nurse practitioner implementing?
emergency
focused
time-lapse
complete - ANSWERS-time-lapse
Which statements accurately describe the unique focus of nursing assessments? Select
all that apply.
Nursing assessments focus on the client's responses to health problems.
An initial assessment establishes a complete database for problem solving and care
planning.