TEST BANK: PHYSICAL EX
j j j
AMINATION&HEALTH AS j j j
SESSMENT 7E (JARVIS 201
j j j
5)- GRADE BOOSTER -
j j j
2023-2024
, Table of Contents
j j
Tablej ofj Contents 1
Chapterj01:jEvidence- 2
BasedjAssessmentjChapterj02:j Culturalj Co 15
mpetencejChapterj03:jThejInterview 31
Chapterj04:jThejCompletejHealthjHistoryjC 49
hapterj05:jMentaljStatusjAssessmentjChapt 64
erj06:jSubstancejUsejAssessment 81
Chapterj 07:j Domesticj andj Familyj Violencej Assessments 87
Chapterj08:jAssessmentjTechniquesjandjSafetyjinjthejClinicaljSettingjCha 93
pterj09:jGeneraljSurvey,jMeasurement,jVitaljSigns 112
Chapterj10:jPainjAssessment:jThejFifthjVitaljSignjChapterj1 134
1:jNutritionaljAssessment 142
Chapterj 12:j Skin,j Hair,j andj Nails 156
Chapterj13:jHead,jFace,jandjNeck,jIncludingjRegionaljLymphaticsjChapte 177
rj14:jEyes 195
Chapterj 15:j Ears 212
Chapterj16:jNose,j Mouth,j andj Throatj Chapterj 229
17:jBreastsjandjRegionaljLymphaticsjChapterj1 247
8:jThoraxjandjLungs 267
Chapterj 19:j Heartj andj Neckj Vessels 285
Chapterj20:jPeripheraljVascularjSystemjandjLymphaticjSystemjChapterj2 304
1:jAbdomen 321
Chapterj22:jMusculoskeletaljSystemjChap 338
terj23:j Neurologicj Systemj Chapterj24:jM 359
alejGenitourinaryjSystemjChapterj25:jAnu 384
s,jRectum,jandjProstate 402
Chapterj 26:j Femalej Genitourinaryj System 416
Chapterj 27:j Thej Completej Healthj Assessment:j Adult 438
Chapterj28:jThejCompletejPhysicaljAssessment:jInfant,jChild,jandjAdolescentjCha 451
pterj29:jBedsidejAssessmentjofjthejHospitalizedjPatient 454
Chapterj 30:j Thej PregnantjWoman 460
Chapterj 31:j Functionalj Assessmentj ofj thej Olderj Adult 473
,Chapter 01: Evidence-Based Assessment
j j j
MULTIPLEj CHOICE
1. Afterjcompletingjanjinitialjassessmentjofjajpatient,jthejnursejhasjchartedjthatjhisjrespirationsjarejeupneicjandjhisjpul
sejisj58jbeatsjperjminute.jThesejtypesjofjdatajwouldjbe:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
ANS:j A
Objectivejdatajarejwhatjthejhealthjprofessionaljobservesjbyjinspecting,jpercussing,jpalpating,jandjauscultatingjdurin
gjthejphysicaljexamination.jSubjectivejdatajisjwhatjthejpersonjsaysjaboutjhimjorjherselfjduringjhistoryjtaking.jTh
ejtermsjreflectivejandjintrospectivejarejnotjusedjtojdescribejdata.
DIF:j Cognitivej Level:j Understandingj (Comprehension)j REF:j p.j 2
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
2. Ajpatientjtellsj thejnursejthatjhejisjveryjnervous,jisjnauseated,jandjfeelsjhot.jThesejtypesjofjdatajwouldjbe:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
ANS:j C
Subjectivejdatajarejwhatjthejpersonjsaysjaboutjhimjorjherselfjduringjhistoryjtaking.jObjectivejdatajarejwhatjthejhealthjpr
ofessionaljobservesjbyjinspecting,jpercussing,jpalpating,jandjauscultatingjduringjthejphysicaljexamination.jThejte
rmsjreflectivejandjintrospectivejarejnotjusedjtojdescribejdata.
DIF:j Cognitivej Level:j Understandingj (Comprehension)j REF:j p.j 2
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
3. Thejpatientsjrecord,jlaboratoryj studies,j objectivej data,jandj subjectivej datajcombinej toj formj the:
a. Datajbase.
b. Admittingj data.
, c. Financialj statement.
d. Dischargej summary.
ANS:j A
Togetherjwithjthejpatientsjrecordjandjlaboratoryjstudies,jthejobjectivejandjsubjectivejdatajformjthejdatajbase.jThejot
herjitemsjarejnotjpartjofjthejpatientsjrecord,jlaboratoryjstudies,jorjdata.
DIF:j Cognitivej Level:j Rememberingj (Knowledge)j REF:j p.j 2
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
4. Whenjlisteningjtojajpatientsjbreathjsounds,jthejnursejisjunsurejofjajsoundjthatjisjheard.jThejnursesjnextjactionjs
houldjbejto:
a. Immediatelyj notifyj thej patientsj physician.
b. Documentjthejsoundjexactlyj asjitjwasjheard.
c. Validatejthejdatajbyjaskingjajcoworkerjtojlistenjtojthejbreathjsounds.
d. Assessjagainjinj20jminutesjtojnotejwhetherj thejsoundjisjstilljpresent.
ANS:j C
Whenjunsurejofjajsoundjheardjwhilejlisteningjtojajpatientsjbreathjsounds,jthejnursejvalidatesjthejdatajtojensurejaccuracy.
jIfjthejnursejhasjlessjexperience jinjanjarea,jthenjhejorjshejasksjanjexpert jtojlisten.
DIF:jCognitivej Level:j Analyzingj (Analysis)j REF:j p.j 2
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
5. Thejnursejisjconductingjajclassjforjnewjgraduatejnurses.jDuringjthejteachingjsession,jthejnursejshouldjkeepjinj mi
ndjthatjnovicejnurses,j withoutj ajbackgroundj ofjskillsj andjexperiencej fromj whichjtojdraw,j arej morejlikelyjtojmakejthe
irjdecisionsjusing:
a. Intuition.
b. Ajsetjofjrules.
c. Articlesjinjjournals.
d. Advicejfromj supervisors.
ANS:j B
Novicejnursesjoperatejfromjajsetjofjdefined,jstructuredjrules.jThejexpertjpractitionerjusesjintuitivejlinks.jDIF:jCo
gnitivejLevel:jUnderstandingj(Comprehension)jREF:jp.j3
j j j
AMINATION&HEALTH AS j j j
SESSMENT 7E (JARVIS 201
j j j
5)- GRADE BOOSTER -
j j j
2023-2024
, Table of Contents
j j
Tablej ofj Contents 1
Chapterj01:jEvidence- 2
BasedjAssessmentjChapterj02:j Culturalj Co 15
mpetencejChapterj03:jThejInterview 31
Chapterj04:jThejCompletejHealthjHistoryjC 49
hapterj05:jMentaljStatusjAssessmentjChapt 64
erj06:jSubstancejUsejAssessment 81
Chapterj 07:j Domesticj andj Familyj Violencej Assessments 87
Chapterj08:jAssessmentjTechniquesjandjSafetyjinjthejClinicaljSettingjCha 93
pterj09:jGeneraljSurvey,jMeasurement,jVitaljSigns 112
Chapterj10:jPainjAssessment:jThejFifthjVitaljSignjChapterj1 134
1:jNutritionaljAssessment 142
Chapterj 12:j Skin,j Hair,j andj Nails 156
Chapterj13:jHead,jFace,jandjNeck,jIncludingjRegionaljLymphaticsjChapte 177
rj14:jEyes 195
Chapterj 15:j Ears 212
Chapterj16:jNose,j Mouth,j andj Throatj Chapterj 229
17:jBreastsjandjRegionaljLymphaticsjChapterj1 247
8:jThoraxjandjLungs 267
Chapterj 19:j Heartj andj Neckj Vessels 285
Chapterj20:jPeripheraljVascularjSystemjandjLymphaticjSystemjChapterj2 304
1:jAbdomen 321
Chapterj22:jMusculoskeletaljSystemjChap 338
terj23:j Neurologicj Systemj Chapterj24:jM 359
alejGenitourinaryjSystemjChapterj25:jAnu 384
s,jRectum,jandjProstate 402
Chapterj 26:j Femalej Genitourinaryj System 416
Chapterj 27:j Thej Completej Healthj Assessment:j Adult 438
Chapterj28:jThejCompletejPhysicaljAssessment:jInfant,jChild,jandjAdolescentjCha 451
pterj29:jBedsidejAssessmentjofjthejHospitalizedjPatient 454
Chapterj 30:j Thej PregnantjWoman 460
Chapterj 31:j Functionalj Assessmentj ofj thej Olderj Adult 473
,Chapter 01: Evidence-Based Assessment
j j j
MULTIPLEj CHOICE
1. Afterjcompletingjanjinitialjassessmentjofjajpatient,jthejnursejhasjchartedjthatjhisjrespirationsjarejeupneicjandjhisjpul
sejisj58jbeatsjperjminute.jThesejtypesjofjdatajwouldjbe:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
ANS:j A
Objectivejdatajarejwhatjthejhealthjprofessionaljobservesjbyjinspecting,jpercussing,jpalpating,jandjauscultatingjdurin
gjthejphysicaljexamination.jSubjectivejdatajisjwhatjthejpersonjsaysjaboutjhimjorjherselfjduringjhistoryjtaking.jTh
ejtermsjreflectivejandjintrospectivejarejnotjusedjtojdescribejdata.
DIF:j Cognitivej Level:j Understandingj (Comprehension)j REF:j p.j 2
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
2. Ajpatientjtellsj thejnursejthatjhejisjveryjnervous,jisjnauseated,jandjfeelsjhot.jThesejtypesjofjdatajwouldjbe:
a. Objective.
b. Reflective.
c. Subjective.
d. Introspective.
ANS:j C
Subjectivejdatajarejwhatjthejpersonjsaysjaboutjhimjorjherselfjduringjhistoryjtaking.jObjectivejdatajarejwhatjthejhealthjpr
ofessionaljobservesjbyjinspecting,jpercussing,jpalpating,jandjauscultatingjduringjthejphysicaljexamination.jThejte
rmsjreflectivejandjintrospectivejarejnotjusedjtojdescribejdata.
DIF:j Cognitivej Level:j Understandingj (Comprehension)j REF:j p.j 2
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
3. Thejpatientsjrecord,jlaboratoryj studies,j objectivej data,jandj subjectivej datajcombinej toj formj the:
a. Datajbase.
b. Admittingj data.
, c. Financialj statement.
d. Dischargej summary.
ANS:j A
Togetherjwithjthejpatientsjrecordjandjlaboratoryjstudies,jthejobjectivejandjsubjectivejdatajformjthejdatajbase.jThejot
herjitemsjarejnotjpartjofjthejpatientsjrecord,jlaboratoryjstudies,jorjdata.
DIF:j Cognitivej Level:j Rememberingj (Knowledge)j REF:j p.j 2
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
4. Whenjlisteningjtojajpatientsjbreathjsounds,jthejnursejisjunsurejofjajsoundjthatjisjheard.jThejnursesjnextjactionjs
houldjbejto:
a. Immediatelyj notifyj thej patientsj physician.
b. Documentjthejsoundjexactlyj asjitjwasjheard.
c. Validatejthejdatajbyjaskingjajcoworkerjtojlistenjtojthejbreathjsounds.
d. Assessjagainjinj20jminutesjtojnotejwhetherj thejsoundjisjstilljpresent.
ANS:j C
Whenjunsurejofjajsoundjheardjwhilejlisteningjtojajpatientsjbreathjsounds,jthejnursejvalidatesjthejdatajtojensurejaccuracy.
jIfjthejnursejhasjlessjexperience jinjanjarea,jthenjhejorjshejasksjanjexpert jtojlisten.
DIF:jCognitivej Level:j Analyzingj (Analysis)j REF:j p.j 2
MSC:jClientj Needs:j Safej andj Effectivej Carej Environment:j Managementj ofj Care
5. Thejnursejisjconductingjajclassjforjnewjgraduatejnurses.jDuringjthejteachingjsession,jthejnursejshouldjkeepjinj mi
ndjthatjnovicejnurses,j withoutj ajbackgroundj ofjskillsj andjexperiencej fromj whichjtojdraw,j arej morejlikelyjtojmakejthe
irjdecisionsjusing:
a. Intuition.
b. Ajsetjofjrules.
c. Articlesjinjjournals.
d. Advicejfromj supervisors.
ANS:j B
Novicejnursesjoperatejfromjajsetjofjdefined,jstructuredjrules.jThejexpertjpractitionerjusesjintuitivejlinks.jDIF:jCo
gnitivejLevel:jUnderstandingj(Comprehension)jREF:jp.j3
