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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.
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What type of patient record data would the nurse find in the medical history and progress notes?
- A. findings of the physicians assessment and treatment
- B. results of laboratory and diagnostic studies
- C. nursing documentation and plan of care
- D. information from other members of the healthcare team
Correct Answer: A
Rationale: Medical history and progress notes contain physician assessments and treatment plans.
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.
A nurse is collecting information from Mr. Koeppe, a patient with dementia. The patients daughter, Sarah, accompanies the patient. Which of the following statements by the nurse would recognize the patients value as an individual?
- A. Sarah, can you tell me how long your father has been this way?
- B. Sarah, I have to go and read your fathers old charts before we talk.
- C. Mr. Koeppe, tell me what you do to take care of yourself.
- D. Mr. Koeppe, I know you cant answer my questions, but its okay.
Correct Answer: C
Rationale: Addressing the patient directly respects their individuality and encourages their participation.
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.
On admission, a physician diagnoses a patient with rheumatoid arthritis. The nurse uses assessments to make the nursing diagnosis of Chronic Pain. What is the nurse diagnosing?
- A. the pathology of the illness
- B. the response of the patient to the illness
- C. information from a nursing textbook
- D. knowledge from more experienced nurses
Correct Answer: B
Rationale: Nursing diagnoses focus on the patient's response to health conditions, such as chronic pain, rather than the medical pathology.