NR 222 Unit 3 Exam 1 Practice (Chapter 16: Nursing Assessment Potter et al.: Fundamentals of Nursing, 9th Edition ) (Latest version 2022 /2023 ) MULTIPLE CHOICE The nurse is using critical thinking skills during the first phase of the nursing process. Wh

NR 222 Unit 3 Exam 1 Practice (Chapter 16: Nursing Assessment Potter et al.: Fundamentals of Nursing, 9th Edition ) (Latest version 2022 /2023 ) MULTIPLE CHOICE The nurse is using critical thinking skills during the first phase of the nursing process. Which action indicates the nurse is in the first phase? A nurse is using the problem-oriented approach to data collection. Which action will the nurse take first? After reviewing the database, the nurse discovers that the patient’s vital signs have not been recorded by the nursing assistive personnel (NAP). Which clinical decision should the nurse make? The nurse is gathering data on a patient. Which data will the nurse report as objective data? A patient expresses fear of going home and being alone. Vital signs are stable and the incision is nearly completely healed. What can the nurse infer from the subjective data? Which method of data collection will the nurse use to establish a patient’s database? A nurse is gathering information about a patient’s habits and lifestyle patterns. Which method of data collection will the nurse use that will best obtain this information? While interviewing an older female patient of Asian descent, the nurse notices that the patient looks at the ground when answering questions. What should the nurse do? A nurse has already set the agenda during a patient-centered interview. What will the nurse do next? The nurse is attempting to prompt the patient to elaborate on the reports of daytime fatigue. Which question should the nurse ask? A nurse is conducting a nursing health history. Which component will the nurse address? While the patient’s lower extremity, which is in a cast, is assessed, the patient tells the nurse about an inability to rest at night. The nurse disregards this information, thinking that no correlation has been noted between having a leg cast and developing restless sleep. Which action would have been best for the nurse to take? The nurse begins a shift assessment by examining a surgical dressing that is saturated with serosanguineous drainage on a patient who had open abdominal surgery yesterday (or 1 day ago)……… type of assessment approach is the nurse using? Which statement by a nurse indicates a good understanding about the differences between data validation and data interpretation? Which scenario best illustrates the nurse using data validation when making a nursing clinical decision for a patient? While completing an admission database, the nurse is interviewing a patient who states “I am allergic to latex.” Which action will the nurse take first? A patient verbalizes a low pain level of 2 out of 10 but exhibits extreme facial grimacing while moving around in bed. What is the nurse’s initial action in response to these observations? The nurse is interviewing a patient with a hearing deficit. Which area should the nurse use to conduct this interview? A new nurse is completing an assessment on an 80-year-old patient who is alert and oriented. The patient’s daughter is present in the room. Which action by the nurse will require follow-up by the charge nurse? MULTIPLE RESPONSE A nurse is completing an assessment. Which findings will the nurse report as subjective data? (Select all that apply.) MATCHING A nurse is completing an assessment using the PQRST to obtain data about the patient’s chest pain. Match the questions to the components of the PQRST that the nurse will be using.