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Nursing Diagnoses and Health Assessments, Exams of Nursing

Harrisburg Area Community College (HACC) - LancasterNursing

Various nursing diagnoses and health assessments covering topics such as databases, sore throat, pain, prevention, language barriers, cultural competency, mental status assessment, and alcohol use. It also touches upon critical thinking, communication skills, and patient interviewing.

Typology: Exams

2023/2024

Available from 04/11/2024

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Nur HAP Final practice
questions (answered) correctly
1. Nursing is best exemplified by which of the following definitions
of health? a) Biomedical
b)
Prevention
c) Holistic
d) Wellness Answer- c
1. According to the holistic model, a narrow definition of holistic health
includes: a) An optimal functioning of mind, body, and spirit within the
environment.
b) The absence of disease.
c) The response of the whole person to actual or potential
problems. d) The internal and external environment.
Answer- c
What type of database is most appropriate when rapid collection of data is
required and often compiled concurrently with lifesaving measures?
a) Episodic
b) Follow-up
c)
Emergency
d) Complete Answer- c
1. A medical diagnosis is used to evaluate:
a) A person's state of health
b) The response of the whole person to actual or potential health
problems c) A person's culture
d) The cause of disease Answer- d
1. An example of subjective data is:
a) Decreased range of motion
b) Crepitation in the left knee joint
c) Left knee has been swollen and hot for the past
3 days d) Arthritis Answer- c
1. What type of database is most appropriate for an individual who is
admitted to a long-term care facility?
a) Episodic
b) Follow-up
c)
Emergency
d) Complete Answer- d
1. Which situation is most appropriate during which the nurse performs a
focused or problem-centered history?
a) Patient is admitted to a long-term care facility
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Nur HAP Final practice

questions (answered) correctly

  1. Nursing is best exemplified by which of the following definitions of health? a) Biomedical b) Prevention c) Holistic d) Wellness Answer- c
  2. According to the holistic model, a narrow definition of holistic health includes: a) An optimal functioning of mind, body, and spirit within the environment. b) The absence of disease. c) The response of the whole person to actual or potential problems. d) The internal and external environment. Answer- c What type of database is most appropriate when rapid collection of data is required and often compiled concurrently with lifesaving measures? a) Episodic b) Follow-up c) Emergency d) Complete Answer- c
  3. A medical diagnosis is used to evaluate: a) A person's state of health b) The response of the whole person to actual or potential health problems c) A person's culture d) The cause of disease Answer- d
  4. An example of subjective data is: a) Decreased range of motion b) Crepitation in the left knee joint c) Left knee has been swollen and hot for the past 3 days d) Arthritis Answer- c
  5. What type of database is most appropriate for an individual who is admitted to a long-term care facility? a) Episodic b) Follow-up c) Emergency d) Complete Answer- d
  6. Which situation is most appropriate during which the nurse performs a focused or problem-centered history? a) Patient is admitted to a long-term care facility

b) Patient in an outpatient clinic has cold and influenza-like symptoms

loss b) Breast lump c) Food intolerance d) Pain Answer- d

  1. The nurse recognizes that the concept of prevention in describing health is essential because: a) Disease can be prevented by treating the external environment b) The majority of deaths among Americans under age 65 years are not preventable c) Prevention places the emphasis on the link between health and personal behavior d) The means to prevention is through treatment provided by primary health care practitioners Answer- c
  2. Which of the following statements regarding language barriers and health care is true? a) There is a law that addresses language barriers and health care b) Limited English proficiency is associated with a higher quality of care c) English proficiency is associated with a lower quality of care d) Patients with language barriers have a decreased risk of nonadherence to medication regimens Answer- a
  3. The first step to cultural competency by a nurse is to: a) Identify the meaning of health to the patient b) Understand how a health care delivery system works c) Develop a frame of reference as to traditional healing practices d) Understand his or her own heritage and cultural values Answer- d
  4. During an assessment, the nurse notices that a patient is handling a small charm that is tied to a leather strip around his neck. Which action by the nurse is appropriate? a) Ask the patient about the item and its significance b)Ask the patient to lock the item with other valuables in the hospital's safe c) Tell the patient that a family member should take valuables home d) No action is necessary Answer- A
  5. When preparing the physical setting for an interview, the interviewer should: a) Set the room temperature between 64° F and 66° F b) Reduce noise by turning the volume on the television or radio down c) Conduct the interview at eye level and at a distance of 4 to 5 feet d) Stand next to the patient to convey a professional demeanor Answer- c
  6. Viewing the world from another person's inner frame of reference is called: a) Reflection b) Empathy c) Sympathy d) Clarification Answer- b
  7. Parents or caretakers accompany children to the health care setting. Starting at years of age, the interviewer asks the child directly about his or her presenting symptoms. a) 5
  1. Which of the following statements made by the interviewer would be an appropriate response? a) "I know just how you feel." b) "If I were you, I would have the surgery." c) "Why did you wait so long to make an appointment?" d) "Tell me what you mean by 'bad blood.'" Answer- d
  2. When addressing a toddler during the interview, the health care provider should: a) Ask the child, before the caretaker, about symptoms b) Use nonverbal communication c) Use short, simple, concrete sentences d) Use detailed explanations Answer- c
  3. An example of an open-ended question or statement is: a) "Tell me about your pain." b) "On a scale of 1 to 10, how would you rate your pain?" c) "I can see that you are quite uncomfortable." d) "You are upset about the level of pain, right?" Answer- a
  4. The most appropriate introduction to use to start an interview with an older adult patient is: a) "Mr. Jones, I want to ask you some questions about your health so that we can plan your care." b) "David, I am here to ask you questions about your illness; we want to determine what is wrong." c) "Mr. Jones, is it okay if I ask you several questions this morning about your health?" d) "Because so many people have already asked you questions, I will just get the information from the chart." Answer- a
  5. When taking a history from a newly admitted patient, the nurse notices that he often pauses and expectantly looks at the nurse. What would be the nurse's best response to this behavior? a) Be silent, and allow him to continue when he is ready b) Smile at him and say, "Don't worry about all of this. I'm sure we can find out why you're having these pains." c) Lean back in the chair and ask, "You are looking at me kind of funny; there isn't anything wrong is there?" d) Stand up and say, "I can see that this interview is uncomfortable for you. We can continue it another time." Answer- a
  6. Which of the following is included in documenting a history source? a) Appearance, dress, and hygiene b) Cognition and literacy level c) Documented relationship of support systems d) Reliability of informant Answer- d
  7. A patient seeks care for "debilitating headaches that cause excessive absences at work." On further exploration, the nurse asks, "What makes the headaches worse?" With this question, the nurse is seeking

information about:

  1. As the nurse enters a patient's room, the nurse finds her crying. The patient states that she has just found out that the lump in her breast is cancer and says, "I'm so afraid of, um, you know." The nurse's most therapeutic response would be to say in a gentle manner: a) "You're afraid you might lose your breast?" b) "No, I'm not sure what you are talking about." c) "I'll wait here until you get yourself under control, and then we can talk." d) "I can see that you are very upset. Perhaps we should discuss this later." Answer- a
  2. A nurse is taking complete health histories on all of the patients attending a wellness workshop. On the history form, one of the written questions asks, "You don't smoke, drink, or take drugs, do you?" This question is an example of: a) Talking too much b) Using confrontation c) Using biased or leading questions d) Using blunt language to deal with distasteful topics Answer- c
  3. A 16-year-old boy has just been admitted to the unit for overnight observation after being in an automobile accident. What is the nurse's best approach to communicating with him? a) Use periods of silence to communicate respect for him b) Be totally honest with him, even if the information is unpleasant c) Tell him that everything that is discussed will be kept totally confidential d) Use slang language when possible to help him open up Answer- b
  4. The nurse makes this comment to a patient, "I know it may be hard, but you should do what the doctor ordered because she is the expert in this field." Which statement is correct about the nurse's comment? a) This comment is inappropriate because it shows the nurse's bias b) This comment is appropriate because members of the health care team are experts in their area of patient care c) This type of comment promotes dependency and inferiority on the part of the patient and is best avoided in an interview situation d) Using authority statements when dealing with patients, especially when they are undecided about an issue, is necessary at times Answer- c
  5. A patient tells the nurse that she has had abdominal pain for the past week. What would be the nurse's best response? a) "Can you point to where it hurts?" b) "We'll talk more about that later in the interview." c) "What have you had to eat in the last 24 hours?" d) "Have you ever had any surgeries on your abdomen?" Answer- a
  6. A patient tells the nurse that he is allergic to penicillin. What would be the nurse's best response to this information? a) "Are you allergic to any other drugs?" b) "How often have you received penicillin?"

c) "I'll write your allergy on your chart so you won't receive any penicillin." d) "Describe what happens to you when you take penicillin." Answer- d

  1. What information is included in greater detail when taking a health history on an infant? a) Nutritional data

b) History of present illness c) Family history d) Environmental hazards Answer- a

  1. Which of these responses might the nurse expect during a functional assessment of a patient whose leg is in a cast? a) "I broke my right leg in a car accident 2 weeks ago." b) "The pain is decreasing, but I still need to take acetaminophen." c) "I check the color of my toes every evening just like I was taught." d) "I'm able to transfer myself from the wheelchair to the bed without help." Answer- d
  2. The nurse is preparing to do a functional assessment. Which statement best describes the purpose of a functional assessment? a) The functional assessment assesses how the individual is coping with life at home b) It determines how children are meeting developmental milestones c) The functional assessment can identify any problems with memory the individual may be experiencing d) It helps determine how a person is managing day-to-day activities Answer- d
  3. The nurse is preparing to complete a health assessment on a 16-year- old girl whose parents have brought her to the clinic. Which instruction would be appropriate for the parents before the interview begins? a) "While I interview your daughter, will you step out to the waiting room and complete these family health history questionnaires?" b) "Please stay during the interview; you can answer for her if she does not know the answer." c) "It would help to interview the three of you together." d) "While I interview your daughter, will you please stay in the room and complete these family health history questionnaires?" Answer- a
  4. Which of the following examples is typically exhibited by a novice nursing student? a) Weighs benefits and risks before acting b) Trusts intuition c) Individualizes care d) Follows a concrete set of rules Answer- d
  5. A student nurse is taking public transportation home after clinical. When she sees a friend, she immediately takes a seat next to her and begins a conversation, saying, "You know that older man who lives in the apartment next to you? Well, I took care of him today in the hospital." The student nurse is not respecting which of the following principles? a) Fidelity b) Veracity c) Confidentiality d) Benevolence Answer- c
  6. Expert nurses learn to attend to a pattern of assessment data and act without consciously labeling it. These responses are referred to as:

b) The nursing process c) Clinical knowledge d) Diagnostic reasoning Answer- a

  1. The nurse is reviewing information about evidence-based practice (EBP). Which statement best reflects EBP? a) EBP relies on tradition for support of best practices b) EBP is simply the use of best practice techniques for the treatment of patients c) EBP emphasizes the use of best evidence with the clinician's experience d) The patient's own preferences are not important with EBP Answer- c
  2. Which phase of the interview uses communication techniques to collect data? a) Pre-interaction phase b) Working phase c) Closing phase d) Beginning phase Answer- b
  3. During an examination, the nurse can assess mental status by which activity? a) Examining the patient's electroencephalogram b) Observing the patient as he or she performs an IQ test c) Observing the patient and inferring health or dysfunction d) Examining the patient's response to a specific set of questions Answer- c
  4. Mental status assessment documents: a) Emotional and cognitive functioning b) Intelligence and educational level c) Artistic or writing ability in the mentally ill person d) Schizophrenia or other mental health disorders Answer- a
  5. Although a full mental status examination may not be required for every patient, the health care provider must address the four main components during a health history and physical examination. The four components are: a) Memory, attention, thought content, and perceptions b) Language, orientation, attention, and abstract reasoning c) Appearance, behavior, cognition, and thought processes d) Mood, affect, consciousness, and orientation Answer- c
  6. A full mental status examination should be completed if the patient: a) Has a change in behavior and the family is concerned b) Developed dysphagia c) Has a new diagnosis of type 2 diabetes mellitus d) Complains of insomnia Answer- a
  7. The nurse is assessing a 75-year-old man. As the nurse begins the

mental status portion of the assessment, the nurse expects that this patient: a) Will have no decrease in any of his abilities, including response time b) Will have difficulty on tests of remote memory because this ability typically decreases with age c) May take a little longer to respond, but his general knowledge and abilities should not have declined

b) Coarse tremor of the hands c) Transient hallucinations d) Somnolence e) Sweating Answer- b,c,e

  1. One of the most frequently abused prescription opioid pain medications is: a) Oxycodone b) Meperidine c) Morphine d) Propoxyphene Answer- a
  2. A female patient asks the nurse about the safe use of alcohol before and during pregnancy. The best response by the nurse is to instruct the patient to: a) Talk about alcohol use with the physician. b)Avoid alcohol before conception and during pregnancy. c) Reduce alcohol intake before pregnancy and to avoid alcohol after a positive pregnancy test. d) Limit alcoholic beverages to two or fewer drinks per week during pregnancy. Answer- b
  3. Patients should be instructed to consume alcohol in moderation. To consume at a moderate drinking pattern, a female patient should be instructed to consume no more than: a) Two drinks per day b) One drink per day c) Three drinks per week d) Six drinks per week Answer- b
  4. If a patient admits not being able to quit drinking, having to have more drinks to get the same effect, and having withdrawal symptoms, the patient meets criteria for: a) At-risk drinking b) Alcohol dependence c) Hazardous drinking d) Harmful drinking Answer- b
  5. Dehydration and malnutrition can be manifestations of in the elderly. a) Intimate partner violence b) Physical abuse c) Neglect d) Psychological abuse Answer- c
  6. Abused women have been found to have significantly more health problems, including: a) Cardiovascular disease b) Cancer c) Chronic pain d) Chronic anemia Answer- c
  1. The nurse caring for an older adult suspects elder abuse. Which action is appropriate?