Podcast
Questions and Answers
Which type of nursing assessment is most appropriate for identifying life-threatening problems?
Which type of nursing assessment is most appropriate for identifying life-threatening problems?
- Focused assessment
- Emergency assessment (correct)
- Time-lapsed assessment
- Initial comprehensive assessment
A nurse is comparing a patient's current lab results to their baseline values from a week ago. Which type of assessment is the nurse performing?
A nurse is comparing a patient's current lab results to their baseline values from a week ago. Which type of assessment is the nurse performing?
- Emergency assessment
- Initial comprehensive assessment
- Time-lapsed assessment (correct)
- Focused assessment
What is the primary focus of a nursing assessment?
What is the primary focus of a nursing assessment?
- The patient's response to health problems (correct)
- Identifying pathologic conditions
- Evaluating diagnostic test results
- Collecting comprehensive medical history
A patient reports feeling anxious and having difficulty sleeping. Which type of data is this considered?
A patient reports feeling anxious and having difficulty sleeping. Which type of data is this considered?
During an assessment, a nurse observes a patient grimacing and holding their abdomen. The patient denies being in pain. Which action should the nurse take?
During an assessment, a nurse observes a patient grimacing and holding their abdomen. The patient denies being in pain. Which action should the nurse take?
A nurse is preparing to perform a physical assessment on a newly admitted patient. What should the nurse prioritize before starting the assessment?
A nurse is preparing to perform a physical assessment on a newly admitted patient. What should the nurse prioritize before starting the assessment?
A patient is admitted with pneumonia. Which assessment finding requires immediate intervention?
A patient is admitted with pneumonia. Which assessment finding requires immediate intervention?
Which of the following is an example of objective data?
Which of the following is an example of objective data?
A patient is being assessed for their ability to manage their diabetes. Which source of data would be most valuable?
A patient is being assessed for their ability to manage their diabetes. Which source of data would be most valuable?
A patient reports difficulty breathing. The nurse notes audible wheezing and use of accessory muscles. Which type of assessment should the nurse prioritize?
A patient reports difficulty breathing. The nurse notes audible wheezing and use of accessory muscles. Which type of assessment should the nurse prioritize?
Which of the following actions demonstrates effective data validation during a nursing assessment?
Which of the following actions demonstrates effective data validation during a nursing assessment?
A nurse is assessing a patient who had surgery yesterday. Which assessment finding would indicate a potential complication?
A nurse is assessing a patient who had surgery yesterday. Which assessment finding would indicate a potential complication?
When conducting a nursing assessment, what is the primary benefit of obtaining information from family members or significant others?
When conducting a nursing assessment, what is the primary benefit of obtaining information from family members or significant others?
A patient reports being allergic to penicillin. What is the most important follow-up question for the nurse to ask?
A patient reports being allergic to penicillin. What is the most important follow-up question for the nurse to ask?
During an initial assessment, the nurse notes that the patient's chart indicates a diagnosis of heart failure. What information obtained during the interview is most important?
During an initial assessment, the nurse notes that the patient's chart indicates a diagnosis of heart failure. What information obtained during the interview is most important?
Flashcards
Nursing Assessment
Nursing Assessment
Focuses on the patient's response to health problems.
Medical Assessment
Medical Assessment
Targets data pointing to pathologic conditions.
Initial comprehensive assessment
Initial comprehensive assessment
A first assessment that provides a complete patient database.
Focused assessment
Focused assessment
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Emergency assessment
Emergency assessment
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Time-lapsed assessment
Time-lapsed assessment
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Subjective information
Subjective information
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Objective information
Objective information
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Observation of Data
Observation of Data
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Best sources of data
Best sources of data
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Study Notes
Nursing Process: Recognizing Cues/Assessment
- Nursing assessments focus on the patient's response to health problems.
- Medical assessments target data pointing to pathologic conditions
Types of Assessments
- Initial Comprehensive assessment creates a complete database.
- Focused assessments target a specific, already identified problem.
- Emergency assessments identify life-threatening problems
- Time-lapsed assessments are used to compare a patient's current status to their baseline.
Initial Assessment
- Remember Patient’s response to health problems.
- Look at pertinent information
- Chart: diagnosis, MD H&P, lab tests, radiology tests, medications (all)
- Physical Assessment completed
- Interview the patient and family
- Use this Data to decide what matters most
- Choose the appropriate Focused assessment
Emergency and Time-Lapsed Assessment
- Emergency assessment identifies life-threatening problems.
- Information for emergency assessments primarily comes from observation and interviews instead of the patient's chart.
- Time Lapsed assessments compare current information to a patient's recent baseline.
Subjective vs Objective Information
- Subjective information can't be validated
- Subjective information can be influenced by belief, personal feelings, and opinions
- Subjective information includes what the patient tells you
- Objective information is based on what you see
- Objective information shouldn't be influenced by personal feelings, opinions, or bias
Sources of Data
- Data collection determines a patient's ability to manage care using Interviewing
- Data collection determines a patient's current physical and emotional responses using physical assessment
- Data collection determines the immediate environment and its safety using observation
- Observation determines the larger environment (hospital or community)
- Observation relates to ability to obtain care, drugs, and proper diet
Best Sources of Data
- The patient
- Family and significant others
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