Exam (elaborations)
PN 108 CHAPTER 13; PHYSICAL ASSESSMENT
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PN 108 CHAPTER 13; PHYSICAL ASSESSMENT...
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Which nursing action establishes an appropriate nurse-patientrelationship? Select all that apply. One, some, or all responses may be
correct.
Communicating trust and confidentiality to the patient.
Showing professionalism and competence to the patient.
Promising to return in 10 minutes, but returning in 20 minutes.
Entering the patient's rooms without knocking and offering very little
information.
Introducing yourself to the patient and answering any questions the
patient may have. - ANSWER Communicating trust and confidentiality
to the patient.
[The nurse communicating trust and confidentiality is an appropriate
action for a nurse to use to encourage a nurse-patient relationship.]
Showing professionalism and competence to the patient.
[The nurse showing professionalism and competence is an appropriate
action for a nurse to use to encourage a nurse-patient relationship.]
Introducing yourself to the patient and answering any questions the
patient may have.
[The nurse introducing himself or herself to patients and answering
questions is an appropriate action and response for a nurse to use to
encourage a nurse-patient relationship.]
Which question would the nurse ask a patient who presents with severe
back pain in the emergency department to provide data about
precipitating factors?
"What makes it worse?"
"How does it feel?"
"Does it interfere with your daily activities?"
, "Does the pain spread to anywhere else in your body?" - ANSWER
"What makes it worse?"
Precipitating factors can be assessed by asking the patient whether
there are things that make the pain worse or better.
Which physical assessment technique would be used to identify jaundice
in a patient with hepatitis?
Inspection
Palpation
Percussion
Auscultation - ANSWER Inspection
Inspection would be used to identify jaundice, a yellowing of the skin.
Why would a nurse interview a patient who has just been admitted to the
nursing unit? - ANSWER To identify the patient's major complaint
[When a patient is admitted to the nursing unit, the nurse performs a
data collection interview. The primary purpose of this interview is to
identify the patient's major complaint.]
What is the nurse's next step if the patient reports a positive finding
during a review of systems? - ANSWER Ask additional questions to
gather more information.
[Gathering more information should be the next step. After a patient
answers positively to a questions about a system, questions relating to
the more comprehensive and detailed areas of that system should
follow.]
Which statement by the nurse could hinder the communication that
takes place during an interview with a patient?
"When was your last checkup?"
"What brought you to the hospital?"
"Who is your primary health care provider?"
"Why did you wait to come in?" - ANSWER "Why did you wait to come
in?"
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