NUR HEALTH NCLEX ASSESMENT ANSWERED TEST BANK
Q & AS BEST EXAM SOLUTION SATISFIED GUARANTEED
LATEST UPDATE 2024 GRADED A+
• After completing an initial assessment of a patient, the nurse has charted that
hisrespirations are eupneic and his pulse is 58 beats per minute. These types of datawould be:
a. Objective.
• A patient tells the nurse that he is very nervous, is nauseated, and “feels hot.”These types
of data would be:
a. Subjective.
• The patient’s record, laboratory studies, objective data, and subjective datacombine to
form the:
a. Data base.
• A visiting nurse is making an initial home visit for a patient who has many chronic
medical problems. Which type of data base is most appropriate to collectin this setting?
a. A follow-up data base to evaluate changes at appropriate intervals
b. An episodic data base because of the continuing, complex medicalproblems of this
patient
c. A complete health data base because of the nurse’s primary responsibilityfor monitoring
the patient’s health
d. An emergency data base because of the need to collect information andmake accurate
diagnoses rapidly
• Which situation is most appropriate during which the nurse performs a focused
orproblem-centered history?
a. Patient is admitted to the hospital for surgery the following day.
b. Patient in an outpatient clinic has cold and influenza-like symptoms.
• A patient is at the clinic to have her blood pressure checked. She has been comingto the
clinic weekly since she changed medications 2 months ago. The nurse should:
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a. Collect a follow-up data base and then check her blood pressure.
• A patient is brought by ambulance to the emergency department with multiple traumas
received in an automobile accident. He is alert and cooperative, but hisinjuries are quite severe.
How would the nurse proceed with data collection?
a. Simultaneously ask history questions while performing the examinationand initiating life-
saving measures.
• A 42-year-old patient of Asian descent is being seen at the clinic for an initial
examination. The nurse knows that including cultural information in his healthassessment is
important to:
a. Provide culturally sensitive and appropriate care.
• In the health promotion model, the focus of the health professional includes:
a. Helping the consumer choose a healthier lifestyle.
• The nurse has implemented several planned interventions to address the
nursingdiagnosis of acute pain. Which would be the next appropriate action?
a. Evaluate the individual’s condition, and compare actual outcomes withexpected outcomes.
• Which statement best describes a proficient nurse? A proficient nurse is one who:
a. Understands a patient situation as a whole rather than a list of tasks andrecognizes the long-
term goals for the patient.
• When listening to a patient’s breath sounds, the nurse is unsure of a sound that isheard.
The nurse’s next action should be to:
a. Validate the data by asking a coworker to listen to the breath sounds.
• The nurse is conducting a class for new graduate nurses. During the teaching session, the
nurse should keep in mind that novice nurses, without a backgroundof skills and experience from
which to draw, are more likely to make their decisions using:
a. A set of rules.
• Expert nurses learn to attend to a pattern of assessment data and act withoutconsciously
labeling it. These responses are referred to as:
a. Intuition.
• The nurse is reviewing information about evidence-based practice (EBP).
Whichstatement best reflects EBP?
a. EBP emphasizes the use of best evidence with the clinician’s experience.
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• The nursing process is a sequential method of problem solving that nurses use
andincludes which steps?
a. Assessment, diagnosis, outcome identification, planning, implementation,and evaluation
• A newly admitted patient is in acute pain, has not been sleeping well lately, and
ishaving difficulty breathing. How should the nurse prioritize these problems?
a. Breathing, pain, and sleep
• Which of these would be formulated by a nurse using diagnostic reasoning?
a. Diagnostic hypothesis
• Barriers to incorporating EBP include:
a. Nurses’ lack of research skills in evaluating the quality of research studies.
• What step of the nursing process includes data collection by health history,physical
examination, and interview?
a. Assessment
• During a staff meeting, nurses discuss the problems with accessing research
studies to incorporate evidence-based clinical decision making into their practice.Which
suggestion by the nurse manager would best help these problems?
a. Teach the nurses how to conduct electronic searches for research studies.
• When reviewing the concepts of health, the nurse recalls that the components
ofholistic health include which of these?
a. Holistic health views the mind, body, and spirit as interdependent.
• The nurse recognizes that the concept of prevention in describing health
isessential because:
a. Prevention places the emphasis on the link between health and personalbehavior.
• The nurse is performing a physical assessment on a newly admitted patient. Anexample
of objective information obtained during the physical assessment includes the:
a. 2 5 cm scar on the right lower forearm.
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• The nurse is conducting a class on priority setting for a group of new graduatenurses.
Which is an example of a first-level priority problem?
a. Individual with shortness of breath and respiratory distress
• When considering priority setting of problems, the nurse keeps in mind thatsecond-level
priority problems include which of these aspects?
a. Abnormal laboratory values
• Which critical thinking skill helps the nurse see relationships among the data?
a. Clustering related cues
• The nurse knows that developing appropriate nursing interventions for a patientrelies on
the appropriateness of the diagnosis.
a. Nursing
• MULTIPLE RESPONSE32.
1. The nurse is reviewing data collected after an assessment. Of the data listed below, which
would be considered related cues that would be clustered togetherduring data analysis? Select all
that apply.
a. Inspiratory wheezes noted in left lower lobes
b. Nonproductive cough
c. Patient reports dyspnea upon exertion
d. Rate of respirations 16 breaths per minute
2.
MATCHING
4. Put the following patient situations in order according to the level of priority.
a. .A teenager who was stung by a bee during a soccer match is havingtrouble breathing.
b. An older adult with a urinary tract infection is also showing signs ofconfusion and
agitation.
c. A patient newly diagnosed with type 2 diabetes mellitus does not knowhow to check his
own blood glucose levels with a glucometer
8. Chapter 04: The Complete Health History
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