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Who is the person responsible for analyzing and interpreting data to arrive at a patient problem?
- A. Health care provider
- B. LPN/LVN
- C. RN
- D. Technician
Correct Answer: C
Rationale: The RN is responsible for analyzing and interpreting data.
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During an admission assessment the nurse collects objective and subjective data. What is an example of objective data?
- A. The patient is jaundiced.
- B. The patient states "I am nervous."
- C. The patient complains of palpitations.
- D. The patient denies dizziness when ambulating.
Correct Answer: A
Rationale: Objective data are observable and measurable signs. Objective data can be recorded. A camera can record a rash, a skin lesion, or puffy eyes. A tape recorder can give evidence of crying or slurred speech. A thermometer can record a temperature elevation. Other terms for objective data are signs and objective cues. The patient is jaundiced is an example of objective data. All other options are examples of subjective data.
Which is an example of a patient problem?
- A. Pneumonia
- B. Diabetes mellitus
- C. Impaired skin integrity
- D. Congestive heart failure
Correct Answer: C
Rationale: Impaired skin integrity is the only example of a patient problem; all other options are examples of medical diagnoses.
What is an important consideration when developing the care plan?
- A. Ensure the number of interventions is limited.
- B. Ensure the patient is involved in the process.
- C. Ensure interventions will be easy to implement.
- D. Ensure evaluation of the patient problems is possible.
Correct Answer: B
Rationale: Plans are more effective when the patient is involved in the process. The care plan is not limited in terms of the number of interventions, nor do they have to be easy. The patient problems are not evaluated; the patient's progress toward the outcome is.
Which is an example of a medical diagnosis?
- A. Constipation
- B. Diabetes mellitus
- C. Impaired skin integrity
- D. Altered nutrition: less than body requirements
Correct Answer: B
Rationale: Diabetes mellitus is the only example of a medical diagnosis; all other options are examples of patient problems.
What subjective data does the nurse record following a head-to-toe examination?
- A. Rash on back
- B. Prolonged nausea
- C. Blood pressure of 190/100
- D. White blood cell count of 19000
Correct Answer: B
Rationale: Another term for subjective data is symptoms, which cannot be observed or measured. This data must come from the patient.