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A client is arriving at the clinic for the first time. The nurse provides an introduction and establishes an initial rapport with the client. What phase of the interview process is this?
- A. Introductory phase
- B. Working phase
- C. Summary phase
- D. Closing phase
Correct Answer: A
Rationale: The introductory phase establishes initial rapport with the client and family members and informs the client about the nurse's need to ask questions and gather information. When making introductions, the nurse should address the client by surname. The working phase is the second part of the process, and the summary and closing phase is the last.
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The nurse at the clinic asks the client about what brought them in to see the health care provider today. What is the purpose of asking the client about their primary health concern?
- A. To discover what the client perceives as the health problem that needs treatment
- B. To determine if the client really needs to see the health care provider today
- C. To determine if the insurance company will pay for the visit
- D. To see if a prescription can be called in without having to see the health care provider
Correct Answer: A
Rationale: The purpose of asking the client about their primary health concern is to discover what the client perceives as the health problem that needs treatment. Recording information in the client's own words is best. The nurse cannot determine if the client should see the health care provider today and whether the client should be denied treatment based on the insurance company's willingness to pay. The client can opt to pay for the visit out of pocket. Health care providers do not generally give prescriptions any longer without seeing the clients.
The nurse provides a comprehensive initial assessment on a newly admitted client. What is the benefit to establishing this database from the client?
- A. It will help determine wh
- B. It will inform the healthcare team about what medications are best for the client.
- C. It will give the healthcare team all of the information about the client.
- D. It will be a yardstick for measuring effectiveness of care.
Correct Answer: D
Rationale: Findings from this comprehensive initial assessment establish a database that gives all team members relevant client information and becomes a yardstick for measuring effectiveness of care. The physician will make the determination about what unit the client will require according to the acuity of care. The physician will determine what medications are best for the client. The information obtained will not be conclusive, and further assessment of the client's condition and information will be obtained during the hospital stay.
Which of the following are statements clients make about how they feel?
- A. Objective data
- B. Cultural data
- C. Cognitive data
- D. Subjective data
Correct Answer: D
Rationale: Subjective data include statements clients make about what they feel. Objective data are facts obtained through observation, physical examination, and diagnostic testing. Cultural data include cultural background and health beliefs.
The nurse is assessing a client and determines that the vital signs are not within normal range for the client. With the results of the objective data being abnormal, what does the nurse document these findings as?
- A. Symptoms
- B. Subjective data
- C. Physical assessment
- D. Signs
Correct Answer: D
Rationale: When objective data are abnormal, they are called signs. Symptoms refer to feelings of discomfort felt by the client. Subjective data is what the client states to the nurse. Physical assessment is a general term used regarding the assessment of the client.
Which of the following is important to do at the end of an interview with the client?
- A. Call the client's family members to give them information.
- B. Call the physician to discuss findings and establish a plan of care.
- C. Conduct a physical examination immediately after the interview.
- D. Summarize the information and thank the client for cooperating.
Correct Answer: D
Rationale: A nurse should end an interview with the client by summarizing what occurred and thanking the client for cooperating. The nurse should not discuss the information obtained through the interview with the client's family. It may not be necessary to call the doctor for further consultation or to conduct a physical examination immediately after the interview.