Essential Health Assessment 2nd Edition Thompson Test Bank
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Chapter 1. Understanding Health Assessment
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Question 1 v
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The nurse is obtaining a health history from a client who reports that he is healthy and has no
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v health concerns. As part of the health history, the nurse documents that the client reported that he
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v has high blood pressure and suffers from a leg ulcer that remains unhealed after 6 months. Which
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v of the following statements would be the best choice for the nurse to use at this point in the
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v interview?
1. I feel that you may be in denial about your health status.
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2. Tell me about your definition of being healthy.
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3. Do you understand what hypertension is?
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4. Is there anything else you are not telling me?
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Correct Answer: 2 v v
Rationale 1: More information would be needed before the nurse could attribute the clients
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v viewpoint as denial or lack of knowledge. v v v v v v
Rationale 2: A client will have his or her own definition of health, illness, and wellness. The
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v individuals concept of health and wellness is influenced by many factors, including age, gender,
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v race, family, culture, religion, socioeconomic conditions, environment, previous experiences, and
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v self-expectations.
Rationale 3: The clients history of hypertension is a valid area requiring further investigation but
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v the nurse must first ascertain the clients definition of healthy.
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,Rationale 4: There is not enough information to determine the clients withholding of information
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v to the nurse.
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Global Rationale: A client will have his or her own definition of health, illness, and wellness.
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v The individuals concept of health and wellness is influenced by many factors, including age,
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v gender, race, family, culture, religion, socioeconomic conditions, environment, previous
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v experiences, and self-expectations. More information would be needed before the nurse could
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v attribute the clients viewpoint as denial or lack of knowledge. The clients history of hypertension
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v is a valid area requiring further investigation but the nurse must first ascertain the clients
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v definition of healthy. There is also not enough information to determine the clients withholding
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v of information to the nurse.
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Cognitive Level: Analyzing v v
Client Need: Health Promotion and Maintenance
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Client Need Sub: v v
Nursing/Integrated Concepts: Nursing Process: Assessment v v v v
Learning Outcome: 1.4: Identify the factors to consider in health assessment
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Question 2 v
v Type: MCSA v
The nurse is documenting in the clients medical record and wishes to use SOAP charting. The
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v nurse includes which of the following under the assessment category?
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1. The clients blood pressure was 177/93.
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2. The recent loss of employment and insurance have prevented the client from being able to
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v afford prescription medications.
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3. The client reports having lost her job and insurance 3 months ago.
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,4. Referrals have been made to social services to determine financial assistance programs
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v available.
Correct Answer: 2 v v
Rationale 1: This is the O component, objective data.
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Rationale 2: The A component of the SOAP note refers to conclusions drawn from the
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v subjective and objective data obtained.
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Rationale 3: This is subjective data. v v v v v
Rationale 4: This is the P component, plan.
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Global Rationale: The A component of the SOAP note refers to conclusions drawn from the
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v subjective and objective data obtained. The clients recent loss of employment and the potential
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v that this was a contributing factor in the inability to afford medications is an example of a
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v conclusion. The clients reported blood pressure would be an example of objective data.
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Objective data is information that can be measured by the examiner. Blood pressure is not an
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v example of subjective information nor is it a conclusion. The clients reported loss of employment
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v and insurance is an example of subjective data. The statement does not include conclusions as to
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v the results of these events. Making referrals to social services is an example of an intervention. It
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v is not a conclusion.
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Cognitive Level: Applying v v
Client Need: Health Promotion and Maintenance
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Client Need Sub: v v
Nursing/Integrated Concepts: Nursing Process: Assessment v v v v
Learning Outcome: 1.4: Identify the factors to consider in health assessment.
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Question 3 v
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, The nurse is presenting a workshop on wellness and health promotion and the initiatives of
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v Healthy People 2020 as a resource for this topic. After the session, which of the following
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v statements by a participant indicates an understanding concerning the initiatives proposed?
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1. It will allow health care providers to lobby legislators for more funding.
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2. The primary goal of Healthy People 2020 is to assist health care providers in determining risk
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v factors for premature birth.
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3. Healthy People 2020 seeks to promotes health, prevent illness, disability, and premature death.
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4. The initiatives will outline standards of care for providers in managing diseases.
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Correct Answer: 3 v v
Rationale 1: Health care providers and other persons interested in programs to promote health
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v have found the document to be a useful source of information in their efforts to gain funding.
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Rationale 2: The Healthy People 2020 initiative is a 10-year strategy intended to promote
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v health, prevent illness, disability, and premature death. The document identifies leading health
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v indicators that reflect public health concerns. Risk factors for premature birth may be part of
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v those health indicators, but the scope of the document covers broad areas of concern.
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Rationale 3: The Healthy People 2020 initiative is a 10-year strategy intended to promote health,
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v prevent illness, disability, and premature death.
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Rationale 4: Standards of care in disease management is not a component of the document.
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Global Rationale: The Healthy People 2020 initiative is a 10-year strategy intended to promote
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v health, prevent illness, disability, and premature death. The document identifies leading health
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v indicators that reflect public health concerns. Risk factors for premature birth may be part of
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v those health indicators, but the scope of the document covers broad areas of concern. Health care
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v providers and other persons interested in programs to promote health have found the document to
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v be a useful source of information in their efforts to gain funding. Standards of care in disease
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v management is not a component of the document. v v v v v v v
