Exam 64: Nursing Assessment

A nursing student is completing an assessment on an 80-year-old patient who is alert and oriented.The patient's daughter is present in the room.Which of the following actions made by the nursing student requires the nursing professor to intervene?

Subjective data include

The nurse begins a shift assessment by examining a surgical dressing that is saturated with serosanguineous drainage on a patient who had open abdominal surgery yesterday (or 1 day ago).The nurse is performing what type of assessment approach in this situation?

A nurse using the problem-oriented approach to data collection will first

The nurse is attempting to prompt the patient to elaborate on her complaints of daytime fatigue.Which question should the nurse ask?

A patient verbalizes a low pain level of 2 out of 10 but exhibits extreme facial grimacing while moving around in bed.What is the nurse's best action in response to her observation?

While the patient's lower extremity,which is in a cast,is assessed,the patient tells the nurse about an inability to rest at night.The nurse disregards this complaint,thinking that no correlation has been noted between having a leg cast and developing restless sleep.A more theoretically sound approach would be to first

After reviewing the database,the nurse discovers that the patient's vital signs have not been recorded by the nursing assistant.With this in mind,what clinical decision should the nurse make?

Which of the following are examples of subjective data?

The nurse is assessing a patient with a hearing deficit.Where is the best place to conduct this interview?

Components of a nursing health history include

The use of critical thinking skills during the assessment phase of the nursing process ensures that the nurse

While interviewing an older female patient of Asian descent,the nurse notices that the patient looks at the ground when answering questions.This nurse should

While completing an admission database,the nurse is interviewing a patient who states that he is allergic to latex.The most appropriate nursing action is to first

A patient expresses fear of going home and being alone.Her vital signs are stable and her incision is nearly completely healed.The nurse can infer from the subjective data that

After setting the agenda during a patient-centered interview,what will the nurse do?

Which of the following methods of data collection is utilized to establish a patient's nursing database?

Which scenario best illustrates the use of data validation when making an independent nursing clinical decision?

A nurse comparing data validation and data interpretation correctly explains the difference with which statement?

To gather information about a patient's home and work surroundings,the nurse will need to utilize which method of data collection?