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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.
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The nurse is completing a physical examination on a client who reports abdominal pain. Which are facts the nurse will obtain during the physical examination?
- A. Symptoms
- B. Objective data
- C. Subjective data
- D. Complaints
Correct Answer: B
Rationale: Objective data are facts obtained through observation, physical examination, and diagnostic testing. Feelings related to subjective data are symptoms. Subjective data are statements clients make about what they feel. Complaints are reasons the client is seeking care.
The RN is precepting an LPN who is new to the medical unit. The RN begins to assess a newly admitted client to the unit and is demonstrating an assessment technique that is used that assesses each body system separately. What type of assessment method is the RN using?
- A. Systems method
- B. Head-to-toe method
- C. Inspection
- D. Focused assessment
Correct Answer: A
Rationale: The systems method approaches the examination by assessing each body system separately. The head-to-toe method of assessment begins at the top of the body and progresses downward. Sometimes, healthcare providers use parts of both methods. Inspection is the systematic and thorough observation of the client and specific areas of the body. A focused assessment concentrates on the area of the body that is the chief complaint.
The client is being interviewed by the nurse and is asked what symptoms they have had to bring them to the clinic. Which of the following data collected is considered subjective?
- A. Blood pressure of 110/60 mm Hg
- B. Client states, 'My chest feels tight.'
- C. Bowel sounds present in 4 quadrants
- D. Client's skin is warm and dry.
Correct Answer: B
Rationale: Subjective data are statements clients make about what they feel. The other data are objective because they are facts that are obtained through observation.
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.
The nurse is admitting a client to the medical unit with a diagnosis of chronic obstructive pulmonary disease (COPD). When should the nurse perform the assessment of the client?
- A. When the client is admitted to the healthcare system
- B. Prior to the client receiving the first dose of medication
- C. After the physician has made their first visit to examine the client
- D. Within 24 hours of the initial admission interview
Correct Answer: A
Rationale: The nurse performs assessment when the client is first admitted to the healthcare system. Waiting until the client has received medication, seen a physician, and within 24-hours of initial interview will delay the assessment and can delay appropriate care and treatment.