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A nurse performs an assessment of a patient in a long-term care facility and records baseline data. The nurse reassesses the patient a month later and makes revisions in the plan of care. What type of assessment is the second assessment?
- A. comprehensive
- B. focused
- C. time-lapsed
- D. emergency
Correct Answer: C
Rationale: A time-lapsed assessment compares current data to baseline data collected earlier to evaluate changes.
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A nurse in the emergency department is completing an emergency assessment for a teenager just admitted from a car crash. Which of the following is objective data?
- A. My leg hurts so bad. I cant stand it.
- B. Appears anxious and frightened.
- C. I am so sick; I am about to throw up.
- D. Unable to palpate femoral pulse in left leg.
Correct Answer: D
Rationale: Objective data are measurable findings, such as the inability to palpate a pulse.
A nurse is assisting with lunch at a nursing home. Suddenly, one of the residents begins to choke and is unable to breathe. The nurse assesses the residents ability to breathe and then begins CPR. Why did the nurse assess respiratory status?
- A. to identify a life-threatening problem
- B. to establish a database for medical care
- C. to practice respiratory assessment skills
- D. to facilitate the residents ability to breathe
Correct Answer: A
Rationale: Assessing respiratory status in this scenario identifies a life-threatening issue requiring immediate intervention.
Mrs. James comes to her healthcare providers office because she is having abdominal pain. She has been seen for this problem before. What type of assessment would the nurse do?
- A. initial assessment
- B. focused assessment
- C. emergency assessment
- D. time-lapsed assessment
Correct Answer: B
Rationale: A focused assessment targets a specific problem, such as abdominal pain, especially when the patient has a history of the issue.
Of the following data, what type would be collected during a physical assessment?
- A. color, moisture, and temperature of the skin
- B. type, amount, and duration of pain
- C. foods eaten that cause nausea
- D. specific allergies resulting in itching
Correct Answer: A
Rationale: Physical assessment involves observable data like skin characteristics.
Which of the following questions or statements would be an appropriate termination of the health history interview?
- A. Well, I cant think of anything else to ask you right now.
- D. I'm going to step out for a moment, but I'll be back to discuss next steps.
Correct Answer: B
Rationale: A professional closing statement maintains rapport and sets expectations for follow-up.