Nursing Health Assessment

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Questions and Answers

What type of questions should be used to obtain facts and focus on specific information?

CLOSED-ENDED QUESTIONS

When should closed-ended questions be used?

To clarify or obtain more accurate information

What should one assess before examining the client?

Own feelings and anxieties

What equipment is needed for a thoracic & lung examination?

<p>Specific equipment for thoracic &amp; lung examination</p> Signup and view all the answers

Why is it important to wash hands before beginning the examination?

<p>To prevent the transmission of infectious agents</p> Signup and view all the answers

What should be done if a pin is used to assess sensory perception?

<p>Discard the pin and use a new one for the next client</p> Signup and view all the answers

What are the three main components that a health assessment helps to identify?

<p>A. The strengths of the clients in promoting health. B. Client’s needs and clinical problems. C. Responses of each person to health problems and intervention.</p> Signup and view all the answers

According to Arkinson & Muray (1991), what role does assessment play in nursing?

<p>Assessment is a part of each activity the nurse does for and with the patient.</p> Signup and view all the answers

Where can obtaining the patient's history and performing physical assessment be carried out?

<p>a. Acute care setting b. Clinic or outpatient office c. School d. Long-term care facility e. Home</p> Signup and view all the answers

What are the cognitive skills required for health assessment?

<p>Critical thinking and clinical decision making - uses knowledge and experience.</p> Signup and view all the answers

What are the problem-solving skills required for health assessment?

<p>Scientific methods, experience, and intuition (with experience).</p> Signup and view all the answers

What type of skills are involved in the psychomotor aspect of health assessment?

<p>Assessment is doing.</p> Signup and view all the answers

What is the role of affective/interpersonal skills in health assessment?

<p>Assessment is feeling trust and mutual respect.</p> Signup and view all the answers

How should the nurse demonstrate ethical skills in health assessment?

<p>By being responsible and accountable for their practice.</p> Signup and view all the answers

What additional aspects should nursing assessment cover apart from the client's physical health?

<p>Client's perceived needs, health problems related experience, health practices values, and lifestyles.</p> Signup and view all the answers

What is the purpose of deep palpation in physical examination?

<p>Allows to feel very deep organs or structures covered by thick muscle</p> Signup and view all the answers

How is bimanual palpation performed?

<p>Use two hands, placing one on each side of the body part being palpated</p> Signup and view all the answers

What is the purpose of percussion in a physical examination?

<p>Eliciting pain, determining location, size, shape, density, and detecting abnormal masses</p> Signup and view all the answers

Describe the types of percussion techniques.

<p>Direct, blunt, indirect/mediate</p> Signup and view all the answers

What is the key aspect to keep in mind during percussion?

<p>Withdraw finger immediately to avoid damping the tone</p> Signup and view all the answers

What is auscultation in physical assessment?

<p>Listening with a stethoscope for heart sounds, blood movement, bowel sounds, and air movement</p> Signup and view all the answers

What are the components of nursing health history?

<p>Biographical data, Chief complaint, Present health concern, Past history, Family history, Review of systems, Patient profile</p> Signup and view all the answers

How has the nurse's role in health assessment evolved over time?

<p>From using senses to assess clients in the past to using communication and physical assessment techniques today.</p> Signup and view all the answers

What is critical thinking in health assessment?

<p>Reasonable reflective thinking focused on deciding what to believe or do.</p> Signup and view all the answers

Define culture and its role in health assessment.

<p>Culture is the totality of socially transmitted patterns, beliefs, and values that guide decision making. It influences beliefs about health &amp; illness.</p> Signup and view all the answers

What are the elements of critical thinking in health assessment?

<p>Keeping an open mind, using rationale for decisions, reflecting on thoughts, and building knowledge from past experiences.</p> Signup and view all the answers

What is the first and most critical phase of the nursing process?

<p>Assessment</p> Signup and view all the answers

What is the purpose of the initial comprehensive assessment?

<p>To collect subjective data about the client's perception of health when they first enter the health care system.</p> Signup and view all the answers

When is a focused or problem-oriented assessment done?

<p>For a patient with a specific problem that needs thorough assessment.</p> Signup and view all the answers

What is the role of the family in health assessment?

<p>The family's beliefs about health and illness can affect each member's behavior and health status.</p> Signup and view all the answers

What are the steps of the health assessment in the nursing process?

<p>Assessment, Diagnosis, Planning, Implementation, Evaluation</p> Signup and view all the answers

What is the purpose of tailoring a care plan to the unique characteristics and preferences of the client?

<p>To meet the specific needs of the client.</p> Signup and view all the answers

In a basic two-part nursing diagnosis statement, what does 'P' stand for?

<p>Problem (client's response).</p> Signup and view all the answers

What is the significance of including collaborative activities in a care plan?

<p>To facilitate coordinated care among healthcare professionals.</p> Signup and view all the answers

What key component is included in a basic three-part nursing diagnosis using the PES format?

<p>Signs and symptoms (S).</p> Signup and view all the answers

According to the ANA Code of Ethics, what is the nurse's duty regarding patient information?

<p>To maintain confidentiality of all patient information.</p> Signup and view all the answers

What is the purpose of a Problem-Oriented Medical Record (POMR)?

<p>To organize data, problem lists, and care plans.</p> Signup and view all the answers

What is the main focus of Focus Charting (FDAR) documentation system?

<p>Client concerns and strengths.</p> Signup and view all the answers

What does KARDEX primarily focus on in terms of organizing client information?

<p>Concise recording of client data and pertinent information.</p> Signup and view all the answers

What is the purpose of using flow sheets in nursing documentation?

<p>To record specific data like intake, output, medication administration, and progress.</p> Signup and view all the answers

Why is legal prudence important when documenting patient care?

<p>To ensure adherence to legal standards and protect patient privacy.</p> Signup and view all the answers

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