D’Amico/Barbarito Health & Physical Assessment in Nursing, 3/e Chapter 1 Question 1 Type: MCSA While conducting a health history, a client states, “I am healthy, I don’t know why I have to be here to get a check-up.” However, the client reports, type 2 diabetes mellitus and an unhealed ulcer on the left foot. Based on this information, which statement by the nurse is the most appropriate? 1. “I feel that you are in denial about your health status.” 2. “Tell me about your definition of being healthy.” 3. “Do you understand what diabetes is?” 4. “Is there anything else you are not telling me?” Correct Answer: 2 Rationale 1: More information would be needed before the nurse could attribute the client’s viewpoint as denial or lack of knowledge. Rationale 2: A client will have his or her own definition of health, illness, and wellness. The individual’s concept of health and wellness is influenced by many factors, including age, gender, race, family, culture, religion, socioeconomic conditions, environment, previous experiences, and self-expectations. Rationale 3: The client’s history of type 2 diabetes is a valid area requiring further investigation but the nurse must first ascertain the client’s definition of healthy. Rationale 4: There is not enough information to determine the client’s withholding of information to the nurse. Global Rationale: A client will have his or her own definition of health, illness, and wellness. The individual’s concept of health and wellness is influenced by many factors, including age, gender, race, family, culture, religion, socioeconomic conditions, environment, previous experiences, and self-expectations. More information would be needed before the nurse could attribute the client’s viewpoint as denial or lack of knowledge. The client’s history of type 2 diabetes is a valid area requiring further investigation but the nurse must first ascertain the client’s definition of healthy. There is also not enough information to determine the client’s withholding of information to the nurse. Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.4: Identify the key components of health assessment in nursing. MNL Learning Outcome: 2.1.2. Distinguish the phases of conducting the health history interview of a client. Page Number: p. 3
Question 2 Type: MCSA Which information would the nurse include in the assessment category when using SOAP to documents in the medical record? 1. The client’s blood pressure was 177/93. 2. The recent loss of employment and insurance has prevented the client from being able to afford prescription medications. 3. The client reports having lost her job and insurance 3 months ago. 4. Referrals have been made to social services to determine financial assistance programs available. Correct Answer: 2 Rationale 1: This is the “O” component; objective data. Rationale 2: The “A” component of the SOAP note refers to conclusions drawn from the subjective and objective data obtained. Rationale 3: This is subjective data (“S” component). Rationale 4: This is the “P” component, plan. Global Rationale: The “A” component of the SOAP note refers to conclusions drawn from the subjective and objective data obtained. The client’s recent loss of employment and the potential that this was a contributing factor in the inability to afford medications is an example of a conclusion. The client’s reported blood pressure would be an example of objective data. Objective data is information that can be measured by the examiner. Blood pressure is not an example of subjective information nor is it a conclusion. The client’s reported loss of employment and insurance is an example of subjective data. The statement does not include conclusions as to the results of these events. Making referrals to social services is an example of an intervention. It is not a conclusion. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.4: Identify the key components of health assessment in nursing. MNL Learning Outcome: 2.1.2. Distinguish the phases of conducting the health history interview of a client. Page Number: pp. 5–8 Question 3 Type: MCSA
The nurse is conducting a workshop on wellness and health promotion using the initiatives of Healthy People 2020. After the session, which statement by a participant indicates an understanding of the initiatives? 1. “It will allow health care providers to lobby legislators for more funding.” 2. “The primary goal of Healthy People 2020 is to assist health care providers in determining risk factors for premature birth.” 3. “Healthy People 2020 seeks to promote health, prevent illness, disability, and premature death.” 4. “The initiatives will outline standards of care for providers in managing diseases.” Correct Answer: 3 Rationale 1: Health care providers and other persons interested in programs to promote health have found the document to be a useful source of information in their efforts to gain funding. Rationale 2: The Healthy People 2020 initiative is a 10-year strategy intended to promote health, prevent illness, disability, and premature death. The document identifies leading health indicators that reflect public health concerns. Risk factors for premature birth may be part of those health indicators, but the scope of the document covers broad areas of concern. Rationale 3: The Healthy People 2020 initiative is a 10-year strategy intended to promote health, prevent illness, disability, and premature death. Rationale 4: Standards of care in disease management is not a component of the document. Global Rationale: The Healthy People 2020 initiative is a 10-year strategy intended to promote health, prevent illness, disability, and premature death. The document identifies leading health indicators that reflect public health concerns. Risk factors for premature birth may be part of those health indicators, but the scope of the document covers broad areas of concern. Health care providers and other persons interested in programs to promote health have found the document to be a useful source of information in their efforts to gain funding. Standards of care in disease management are not a component of the document. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. AACN Essentials Competencies: VII.1. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities and populations. NLN Competencies: Knowledge and Practice: Health promotion/disease prevention. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.2: Relate the goals and objectives of Healthy People 2020 to health assessment in nursing. MNL Learning Outcome: Page Number: pp. 2–3 Question 4 Type: MCSA The nurse is developing a handout for clients in a healthcare provider’s office. The nurse includes which focus area in this handout to emphasize current changes in the health care delivery system?
1. Class recommendations for diabetics concerning insulin administration A2.Guidelines from the Centers for Disease Control outlining plans to manage outbreaks of disease, eradicating the use of toxins. 2. Guidelines from the Centers for Disease Control outlining plans to manage outbreaks of disease, eradicating the use of toxins. 3. Resources available to treat chronic pain. 4. Class listings for exercise classes available in the community. Correct Answer: 4 Rationale 1: Symptom management, illness care, and pain management are addressed by the health care delivery system but are not the primary focus, as clients are taking a more active role in managing their own care. Rationale 2: Management of outbreaks of disease is a function of governmental organizations and health care providers in the community, but is not a focus of individual care. Rationale 3: Symptom management, illness care, and pain management are addressed by the health care delivery system but are not the primary focus, as clients are taking a more active role in managing their own care. Rationale 4: The focus of health care in the United States today is wellness, prevention of disease, health promotion, and health maintenance, for which a listing of exercise classes is appropriate. Global Rationale: The focus of health care in the United States today is wellness, prevention of disease, health promotion, and health maintenance, for which a listing of exercise classes is appropriate. Symptom management, illness care, and pain management are addressed by the health care delivery system but are not the primary focus, as clients are taking a more active role in managing their own care. Management of outbreaks of disease is a function of governmental organizations and health care providers in the community, but is not a focus of individual care. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: III.B.3. Base individualized care plan on patient values, clinical expertise, and evidence. AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. NLN Competencies: Relationship Centered Care: Learn cooperatively, facilitate the learning of others. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1.7: Outline the key elements of an effective teaching plan. MNL Learning Outcome: Page Number: p. 20 Question 5 Type: MCSA The nurse conducts a health history while admitting a client to the acute care facility. When collecting primary subjective data, which is an appropriate source for the nurse to use? 1. The client’s physical assessment. 2. The client’s self-reports.
3. The client’s healthcare provider. 4. The client’s significant other. Correct Answer: 2 Rationale 1: The physical assessment will be recorded as objective data. Rationale 2: Subjective data are gathered from the interview. The interview includes the health history and focused interview. Data will come from primary and secondary sources. Rationale 3: The client’s healthcare provider and significant other may contribute in the data collection process. The information obtained from friends and family members is considered subjective. This source of information is termed secondary. Rationale 4: The client’s significant other may contribute in the data collection process but that input is classified as secondary. Global Rationale: Subjective data are gathered from the interview. The interview includes the health history and focused interview. Data will come from primary and secondary sources. The client is considered the primary source of subjective information. Family members and healthcare providers are examples of secondary sources of subjective information. The physical assessment will be recorded as objective data. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: II.B.4. Function competently within own scope of practice as a member of the health care team. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.5: Explain the role of the professional nurse in health assessment. MNL Learning Outcome: 2.1.1. Apply appropriate communication skills required to conduct the health history interview of a client; 2.1.3. Apply the components of conducting the health history interview of a client. Page Number: p. 12 Question 6 Type: MCSA The nurse is reviewing a client’s medical records and notes various forms of information. Which is an example of subjective data from this client’s medical record? 1. The client states, “My abdomen hurts on the left side after eating.” 2. The nurse notes the client’s abdomen is tender on the left side during palpation. 3. The CAT scan reveals a large mass in the left lower quadrant of the abdomen. 4. The client’s hemoglobin is 14.1 gm/dL. Correct Answer: 1 Rationale 1: Subjective reports by the client are those feelings or symptoms that cannot be observed by others, of which “My abdomen hurts” is an example. Rationale 2: Physical examination findings, laboratory analysis reports, and radiographic findings are objective data.
Rationale 3: Physical examination findings, laboratory analysis reports, and radiographic findings are objective data. Rationale 4: Physical examination findings, laboratory analysis reports, and radiographic findings are objective data. Global Rationale: Subjective reports by the client are those feelings or symptoms that cannot be observed by others. Objective reports are those factors that are based upon observations of others. Physical examination findings, laboratory analysis reports, and radiographic findings are objective data. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.4: Identify the key components of health assessment in nursing. MNL Learning Outcome: 2.1.2. Distinguish the phases of conducting the health history interview of a client. Page Number: p. 12 Question 7 Type: MCSA The nurse is reviewing a client’s medical record while planning care. Which data from the medical record is an example of objective data? 1. “I hurt my head.” 2. “I am 6 years old and I’m here because I fell.” 3. “Six-year-old Hispanic female sitting on examination table holding a towel to her forehead.” 4. “Client states that she fell at the playground.” Correct Answer: 3 Rationale 1: Statements the client makes are subjective data. Rationale 2: Statements the client makes are subjective data. Rationale 3: Objective data are data that can be observed or measured by the nurse. The nurse can see the child holding the towel to her head and can use her birth date to determine her age. Rationale 4: Statements the client makes are subjective data. Global Rationale: Objective data are data that can be observed or measured by the nurse. The nurse can see the child holding the towel to her head and can use her birth date to determine her age. Statements the client makes are subjective data. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care.
AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.4: Identify the key components of health assessment in nursing. MNL Learning Outcome: 2.1.2. Distinguish the phases of conducting the health history interview of a client. Page Number: p. 12 Question 8 Type: MCSA The nurse is evaluating the plan of care and notes that none of the goals have been met for the client with impaired gas exchange. Which action by the nurse is the most appropriate? 1. Report the lack of achievement of the goals to the healthcare provider. 2. Review the data and modify the plan. 3. Reformulate the nursing diagnosis to a more realistic one. 4. Request a consult for the client to be seen by a pulmonologist. Correct Answer: 2 Rationale 1: Reporting the lack of achievement of the goals to the healthcare provider is not appropriate, though reporting undesirable client physiologic responses may be. Rationale 2: The plan of care should be evaluated periodically, at the established time frames, to determine achievement of the goals. If goals are not achieved, then the data need to be further assessed and the plan modified. Rationale 3: Reformulating the nursing diagnosis to a more realistic one is not the best course of action, as the diagnosis established came from subjective and objective data specific to that diagnosis. Rationale 4: There are no data to support the need for additional medical consultations. Global Rationale: The plan of care should be evaluated periodically, at the established time frames, to determine achievement of the goals. If goals are not achieved, then the data need to be further assessed and the plan modified. Reporting the lack of achievement of the goals to the healthcare provider is not appropriate, though reporting undesirable client physiologic responses may be. Reformulating the nursing diagnosis to a more realistic one is not the best course of action, as the diagnosis established came from subjective and objective data specific to that diagnosis. There are no data to support the need for additional medical consultations. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement.
Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1.3: Explain the steps of the nursing process. MNL Learning Outcome: Page Number: pp. 11–14 Question 9 Type: MCSA The community health nurse is preparing to conduct a program for a group of nursing students concerning health and wellness. Which statement by a participant indicates the most comprehensive and accurate understanding of health? 1. “Health is the absence of illness, disease, and symptoms.” 2. “Health is a state of well-being and the use of every power the person possesses to the fullest extent.” 3. “Health is the state when a person is viewed as a holistic being.” 4. “Health is a state of complete physical, mental, and social well-being.” Correct Answer: 4 Rationale 1: Health is much more than the absence of illness and disease. Rationale 2: Defining health as a state of well-being is limiting as it does not encompass the elements of an individual’s being such as physical, mental, and social. Rationale 3: While health does require a holistic approach, this definition does not explore the elements with the same clarity of the correct answer. Rationale 4: Health is defined as a state of complete physical, mental, and social well-being (WHO, 1947). Global Rationale: Health is defined as a state of complete physical, mental, and social wellbeing (WHO, 1947). Health is much more than the absence of illness and disease. Defining health as a state of well-being is limiting as it does not encompass the elements of an individual’s being such as physical, mental, and social. While health does require a holistic approach, this definition does not explore the elements with the same clarity of the correct answer. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: I.1. Integrate theories and concepts from liberal education into nursing practice. NLN Competencies: Knowledge and Practice: Health promotion/disease prevention Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1.1: Distinguish various definitions of health. MNL Learning Outcome: Page Number: pp. 3–4 Question 10 Type: MCSA The nurse is caring for a client who is recovering from abdominal surgery. Which goal statement is most appropriate for the nurse to include in this client’s plan of care? 1. The client will verbalize pain relief using an intensity rating in 4 hours.
2. The client will state that he feels fine in 4 hours. 3. The nurse will observe fewer signs of pain in the client’s demeanor. 4. The nurse will reevaluate the client’s pain level every 2 hours. Correct Answer: 1 Rationale 1: The goal statement is directly related to the nursing diagnosis. Goal statements are stated in a positive fashion, and have measurable criteria. Rationale 2: This statement is not related directly related to the diagnosis and is not measurable. Rationale 3: A goal statement must be reflective of client activities. This is an incorrect answer because it reflects activities of the nurse and not the client. Rationale 4: A goal statement must be reflective of the client’s activities. This is an incorrect answer because it reflects activities of the nurse and is not client directed. Although there is a time frame listed it is not correct as it is related to nursing actions. Global Rationale: The goal statement is directly related to the nursing diagnosis. Goal statements are stated in a positive fashion, and have measurable criteria. Verbalization of the client of pain relief using a rating scale within a specified time period is an appropriately formatted, measurable statement. Statements by the client indicating he is feeling fine are not reflective of a measurable criteria. Statements indicating actions by the nurse are not correctly formatted goals for the client. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1.3: Explain the steps of the nursing process. MNL Learning Outcome: Page Number: pp. 11–14 Question 11 Type: MCSA The nurse is developing the plan of care for a client who is recovering from abdominal surgery. Which intervention is most appropriate to address this client’s pain? 1. The healthcare provider will prescribe additional analgesics. 2. The client will have reduced pain after administration of analgesics. 3. The client will vocalize reduced levels of pain within 3 hours. 4. Assist the client with guided imagery to manage pain levels. Correct Answer: 4 Rationale 1: The prescribing of additional analgesics does not determine the characteristics of the pain and does not offer patient-driven information. Rationale 2: This is a goal statement, not an intervention. Rationale 3: This is a goal statement, not an intervention.
Rationale 4: Nursing interventions, such as assisting the client with guided imagery, are geared to assist in meeting client goals. The interventions are derived from the second part of the diagnosis, which is the etiology. The defining characteristics provide the background support for the diagnosis. The diagnostic label is global and requires specification before attempting to determine a goal. The client’s stated wishes are an important component of planning, and may be included in the list of interventions as appropriate. The interventions are based upon nursing actions. Global Rationale: Nursing interventions are geared to assist in meeting client goals. The interventions are derived from the second part of the diagnosis, which is the etiology. The defining characteristics provide the background support for the diagnosis. The diagnostic label is global and requires specification before attempting to determine a goal. The client’s stated wishes are an important component of planning, and may be included in the list of interventions as appropriate. The interventions are based upon nursing actions. The prescribing of additional analgesics does not determine the characteristics of the pain and does not offer patient driven information. The reduction of pain and vocalization of pain levels within 3 hours are goal statements, not interventions. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: III.C.5. Value the need for continuous improvement in clinical practice based on new knowledge. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1.6: Apply the critical thinking process to health assessment in nursing. MNL Learning Outcome: 2.1.3. Apply the components of conducting the health history interview of a client. Page Number: pp. 14–17 Question 12 Type: MCSA The nurse educator is discussing Healthy People 2020 with a group of nursing students. One of the students questions the instructor how this work will impact hospitalization. Which response by the educator is the most appropriate? 1. “Healthy People 2020 is a tool for the healthcare providers to offer information to their clients.” 2. “Healthy People 2020 seeks to improve health and prevent illness, disability, and premature death.” 3. “The purpose of Healthy People 2020 is to reduce health care costs for hospitalized clients.” 4. “Healthy People 2020 is seen as a tool by hospitals to reduce length of stay.” Correct Answer: 2 Rationale 1: Healthy People 2020 is a resource tool for all health care professionals but its purpose is not to provide patient education between the healthcare provider and client.
Rationale 2: Healthy People 2020 presents a 10-year strategy with objectives intended to enhance health and prevent illness, disability, and premature death. Rationale 3: Reduction of hospital costs is the not the primary purpose of Healthy People 2020. Rationale 4: Reduction of length of stay is the not the primary purpose of Healthy People 2020. Global Rationale: Healthy People 2020 presents a 10-year strategy with objectives intended to enhance health and prevent illness, disability, and premature death. Healthy People 2020 is a resource tool for all health care professionals but its purpose is not to provide patient education between the healthcare provider and client. Reduction of hospital costs is the not the primary purpose of Healthy People 2020. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. AACN Essentials Competencies: VII.1. Assess protective and predictive factors, including genetics, which influence the health of individuals, families, groups, communities, and populations. NLN Competencies: Knowledge and Practice: Health promotion/disease prevention. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1.2: Relate the goals and objectives of Healthy People 2020 to health assessment in nursing. MNL Learning Outcome: Page Number: p. 2 Question 13 Type: MCSA The novice nurse working on a medical-surgical unit is preparing a plan of care for a client admitted for irritable bowel syndrome. The goal statement is, “The client will resume normal bowel elimination patterns.” When reviewing the plan of care with the novice nurse, which statement by the preceptor is the most appropriate? 1. “This plan of care has an appropriate goal statement which meets criteria.” 2. “This goal statement requires a time frame to be appropriate.” 3. “This goal statement is not reflective of the client’s admitting diagnosis.” 4. “This care plan is accurate and will be placed in the client’s medical record.” Correct Answer: 2 Rationale 1: This goal statement does not meet criteria as it lacks a time frame. Rationale 2: Time frames are an important component of goal statements and provide guidelines for when to evaluate the achievement of the goal. Rationale 3: The defining characteristics of the diagnosis and the etiology of the diagnosis are components of the diagnostic statement. Rationale 4: This goal statement does not meet criteria as it lacks a time frame. Global Rationale: This goal statement does not meet criteria as it lacks a time frame. Time frames are an important component of goal statements and provide guidelines for when to evaluate the achievement of the goal. The defining characteristics of the diagnosis and the etiology of the diagnosis are components of the diagnostic statement. The nurse’s role in achieving the goal is not a component of the goal statement.
Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1.3: Explain the steps of the nursing process. MNL Learning Outcome: Page Number: pp. 11–14 Question 14 Type: MCMA The nurse is caring for a newly admitted client with Methicillin-resistant Staphylococcus Aureus (MRSA). Which are appropriate goals for the initial health assessment? Standard Text: Select all that apply. 1. Determine the client’s current state of health and ongoing health-promotion activities. 2. Predict risks to current health status. 3. Use only objective data to determine client allergies. 4. Determine how frequently the client is able to change positions. 5. Identify health-promoting activities. Correct Answer: 1, 5 Rationale 1: Health assessment goals are to determine the client’s current state of health and ongoing health-promotion activities. Rationale 2: Health assessment activities are used to predict risks to health, and identify health status both current and future. This includes physical, social, cultural, environmental, and emotional factors including wellness behaviors, illness signs and symptoms, client strengths and weaknesses, and risk factors. Rationale 3: The initial health assessment includes both objective and subjective information. Rationale 4: The initial health assessment includes both objective and subjective information and seeks to determine the potential an individual has to implement health-promoting activities. Health assessment activities are used to predict risks to health, and identify health status. This includes physical, social, cultural, environmental, and emotional factors including wellness behaviors, illness signs and symptoms, client strengths and weaknesses, and risk factors. The ability of the client to change positions is not a part of the initial health assessment. Rationale 5: The health assessment seeks to determine the potential an individual has to implement health-promoting activities. Global Rationale: Health assessment goals are to determine the client’s current state of health and ongoing health-promotion activities. The initial health assessment includes both objective and subjective information and seeks to determine the potential an individual has to implement health-promoting activities. Health assessment activities are used to predict risks to health, and
identify health status. This includes physical, social, cultural, environmental, and emotional factors including wellness behaviors, illness signs and symptoms, client strengths and weaknesses, and risk factors. The initial health assessment does not include using objective data to determine client allergies and is not part of the initial health assessment. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.3: Explain the steps of the nursing process. MNL Learning Outcome: Page Number: pp.11–14 Question 15 Type: MCSA While conducting a physical assessment for a client with asthma, the nurse notes that the client is wheezing and documents this finding in the medical record. Which phase of critical thinking is represented by this nurse’s actions? 1. Collection of information. 2. Evaluation. 3. Generation of alternatives. 4. Analysis of the situation. Correct Answer: 1 Rationale 1: Collection of information is the initial step in the process. During this phase the nurse will assess available information and document the findings in the medical record. Rationale 2: Evaluation is the final step in the process. During evaluation the nurse will determine the effectiveness of actions taken. Rationale 3: When generating alternatives for action the nurse will use critical thinking skills to determine available options for action. Rationale 4: Analysis of the situation occurs when the nurse employs assessment skills to review and analyze the situation. The analysis will provide the nurse with the understanding of what the best plan of action will be. Global Rationale: Collection of information is the initial step in the process. During this phase the nurse will assess available information. Evaluation is the final step in the process. During evaluation the nurse will determine the effectiveness of actions taken. When generating alternatives for action the nurse will use critical thinking skills to determine available options for action. Analysis of the situation occurs when the nurse employs assessment skills to review and analyze the situation. The analysis will provide the nurse with the understanding of what the best plan of action will be. Cognitive Level: Applying
Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: III.C.5. Value the need for continuous improvement in clinical practice based on new knowledge. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1.6: Apply the critical thinking process to health assessment in nursing. MNL Learning Outcome: 2.1.3. Apply the components of conducting the health history interview of a client. Page Number: pp. 14–17 Question 16 Type: MCMA The nurse is completing an admission assessment. The assessment form allows for the separation of subjective and objective data. Which data is considered subjective? Standard Text: Select all that apply. 1. The client’s mother informs the nurse that her daughter has not been sleeping due to pain. 2. The client states, “I have pain in my belly that is 7 out of 10.” 3. Abdominal assessment reveals a firm, hard abdomen. 4. The client is weak and looks very pale. 5. The client appears nervous during the data collection period. Correct Answer: 1, 2 Rationale 1: Subjective data is information the client experiences and communicates to the nurse. This information can be provided by either the client or other individuals. Rationale 2: Subjective data is information the client experiences and communicates to the nurse. Rationale 3: Data that are observed by the examiner are termed objective data. Rationale 4: Data that are observed by the examiner are termed objective data. Rationale 5: Data that are observed by the examiner are termed objective data. Global Rationale: Subjective data is information the client experiences and communicates to the nurse. This information can be provided by either the client or other individuals. Primary subjective data is information the client experiences and communicates to the nurse. Information provided by family is also considered subjective but is termed secondary. Assessment data that are observed by the examiner are termed objective data. Reports by the client’s mother are considered secondary subjective information. The statements made by the client are referred to as primary subjective data. The characteristics of the abdomen, the client’s strength level, color, and psychosocial assessment are termed objective data. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care.
AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.4: Identify the key components of health assessment in nursing. MNL Learning Outcome: 2.1.2. Distinguish the phases of conducting the health history interview of a client. Page Number: p. 12 Question 17 Type: MCSA The nurse is admitting a client to a mental health unit for an exacerbation of bipolar disorder. When conducting the health history for this client, which is important to keep in mind regarding the client’s confidentiality? 1. Confidentiality means that information sharing is limited to those directly involved in the client care. 2. Complete client confidentiality means that all members of the health care team may have access to the chart. 3. The Health Insurance Portability and Accountability Act (HIPAA) helps to maintain client confidentiality and dictates who is to be communicating with the client. 4. The medical records are open to any hospital employee, including administration. Correct Answer: 1 Rationale 1: Confidentiality means that information sharing is limited to those directly involved in the client care. Rationale 2: Not all members of the health care team have access to the chart, only those who are directly caring for the client. Rationale 3: The Health Insurance Portability and Accountability Act (HIPAA) does not dictate who is allowed to communicate with the client. Rationale 4: The medical records are open to any hospital employee, including administration. Global Rationale: Confidentiality means that information sharing is limited to those directly involved in the client care. Not all members of the health care team have access to the chart, only those who are directly caring for the client. The Health Insurance Portability and Accountability Act (HIPAA) does not dictate who is allowed to communicate with the client. Hospital records are open only to those directly related to the care of the client. Cognitive Level: Applying Client Need: Safe and Effective Care Environment Client Need Sub: Management of Care QSEN Competencies: II.B.4. Function competently within own scope of practice as a member of the health care team. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement.
Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.5: Explain the role of the professional nurse in health assessment. MNL Learning Outcome: 2.1.1. Apply appropriate communication skills required to conduct the health history interview of a client; 2.1.3. Apply the components of conducting the health history interview of a client. Page Number: p. 5 Question 18 Type: MCSA The nurse educator is presenting information about the nursing process to a group of students. Which statement by a student reflects the appropriate sequence when implementing the nursing process? 1. “The correct order of the nursing process is diagnosis, assessment, planning, implementation, evaluation.” 2. “The correct order of the nursing process is assessment, diagnosis, planning, implementation, evaluation.” 3. “The correct order of the nursing process is planning, assessment, diagnosis, implementation, evaluation.” 4. “The correct order of the nursing process is assessment, planning, diagnosis, implementation, evaluation.” Correct Answer: 2 Rationale 1: The nursing process is a systematic, rational, dynamic, and cyclic process used by the nurse for planning and providing care for the client. The assessment phase, step 1, involves the collection of data. Step 2 of the nursing process is diagnosis. Step 3 of the process is planning. Implementation is step 4. The final stage in the process, step 5, is evaluation. Rationale 2: The nursing process is a systematic, rational, dynamic, and cyclic process used by the nurse for planning and providing care for the client. The assessment phase, step 1, involves the collection of data. Step 2 of the nursing process is diagnosis. Step 3 of the process is planning. Implementation is step 4. The final stage in the process, step 5, is evaluation. Rationale 3: The nursing process is a systematic, rational, dynamic, and cyclic process used by the nurse for planning and providing care for the client. The assessment phase, step 1, involves the collection of data. Step 2 of the nursing process is diagnosis. Step 3 of the process is planning. Implementation is step 4. The final stage in the process, step 5, is evaluation. Rationale 4: The nursing process is a systematic, rational, dynamic, and cyclic process used by the nurse for planning and providing care for the client. The assessment phase, step 1, involves the collection of data. Step 2 of the nursing process is diagnosis. Step 3 of the process is planning. Implementation is step 4. The final stage in the process, step 5, is evaluation. Global Rationale: The nursing process is a systematic, rational, dynamic, and cyclic process used by the nurse for planning and providing care for the client. The assessment phase, step 1, involves the collection of data. Step 2 of the nursing process is diagnosis. The nurse uses critical thinking and applies knowledge from the sciences and other disciplines to analyze and synthesize the data. Similar data is clustered together and become the basis for the nursing diagnosis. Step 3 of the process is planning. During the planning phase the nurse sets the course for the care to be delivered. Implementation is the fourth step. During the implementation phase, step 4, the care is delivered. The final stage in the process, step 5, is evaluation. The professional nurse compares
the present client status to achievement of the stated goals or outcomes. At this time the nurse will need to modify the nursing care plan. Cognitive Level: Remembering Client Need: Safe and Effective Care Environment Client Need Sub: Management of Care QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1.3: Explain the steps of the nursing process. MNL Learning Outcome: Page Number: pp. 11–14 Question 19 Type: Sequencing Standard Text: Click on the down arrow for each response in the right column and select the correct choice from the list. When conducting a health history for a client hospitalized with end-stage renal failure after many year of cocaine abuse, what is the correct sequence for collecting data for this client? Response 1: Organizing how to proceed with the client and generating alternatives to the approach. Response 2: Identifying assumptions that can misguide or misdirect the assessment and intervention process. Response 3: Collecting information and determining its relevance as far as impacting the client care. Response 4: Identifying any inconsistencies in the communication from the client and or significant others. Response 5: Determining the reliability of the data collected by the client. Correct Answer: 2, 1, 5, 3, 4 Rationale 1: Organizing how to proceed with the client is the second step of the critical thinking process. Rationale 2: The process of data collection involves a systematic approach through the use of critical thinking. The first step in the process involves the identification of assumptions. Assumptions may misguide or misdirect the process of assessment and intervention. Rationale 3: Collecting information and determining its relevance is the fourth step of the critical thinking process. Rationale 4: Identifying any inconsistencies in communication is the fifth and final step of the critical thinking process. Rationale 5: Determining the reliability of the data collected by the client is third step of the critical thinking process. Global Rationale: The process of data collection involves a systematic approach using critical thinking. The first step in the process involves the identification of assumptions. Assumptions
may misguide or misdirect the process of assessment and intervention. Additional steps in the process, in order, include organizing the approach, determining the reliability and accuracy of the information, distinguishing between relevant and irrelevant information, and looking for any inconsistencies in the information. Cognitive Level: Applying Client Need: Safe and Effective Care Environment Client Need Sub: Management of Care QSEN Competencies: III.C.5. Value the need for continuous improvement in clinical practice based on new knowledge. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.6: Apply the critical thinking process to health assessment in nursing. MNL Learning Outcome: 2.1.3. Apply the components of conducting the health history interview of a client. Page Number: p. 15 Question 20 Type: MCSA The nurse is preparing a teaching plan for a client diagnosed with hypertension. Which objective is appropriate when addressing the psychomotor domain for the client? 1. The client will discuss measures to take when experiencing dizziness. 2. The client will describe signs and symptoms of an elevated blood pressure. 3. The client will demonstrate how to monitor own blood pressure. 4. The client will define the dimensions of hypertension. Correct Answer: 3 Rationale 1: Cognitive objectives include those concerning the acquisition of knowledge. The client’s understanding of actions to take when experiencing the dizziness that occurs with hypertension is an example of a cognitive domain. Rationale 2: The identification of the signs and symptoms of an elevated blood pressure are reflective of the cognitive domain. Rationale 3: The demonstration of skills such as monitoring blood pressure is reflective of the psychomotor domain. Rationale 4: Defining the dimensions of hypertension is consistent with the cognitive domain. Global Rationale: In the teaching plan the objectives identify specific, measurable behaviors or activities expected of the client. Action verbs may be from the cognitive, affective, or psychomotor domain. The demonstration of skills such as monitoring blood pressure is reflective of the psychomotor domain. Psychomotor objectives include the acquisition of skills. The affective domain refers to attitudes, feelings, values, and opinions. The identification of the signs and symptoms of an elevated blood pressure are reflective of the cognitive domain. Cognitive objectives include those concerning the acquisition of knowledge. Cognitive Level: Applying Client Need: Health Promotion and Maintenance
Client Need Sub: QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1.4: Identify the key components of health assessment in nursing. MNL Learning Outcome: 2.1.2. Distinguish the phases of conducting the health history interview of a client. Page Number: pp. 4–11 Question 21 Type: MCSA Which statement best describes the active role of the professional nurse as an educator? 1. Nurses must consider learning needs, goals, objectives, content, teaching methods, and evaluation when carrying out client education. 2. Teaching plans are developed for informal teaching when distinct needs are identified or when common needs are recognized. 3. In the role of educator, the nurse should refer the client to other health care providers who specialize in the area of need. 4. Teaching is to be delegated to the advanced practice nurse specialist or the nurse educator. Correct Answer: 1 Rationale 1: Roles of the professional nurse include teacher, both formal and informal, caregiver, and client advocate. Rationale 2: Informal teaching does not involve teaching plans. Rationale 3: Roles of the professional nurse include teacher, both formal and informal, caregiver, and client advocate. Rationale 4: Teaching is often done in collaboration with the advanced practice nurse specialist or the nurse educator. Nurses at the bedside also must share the role of client educator. Global Rationale: Roles of the professional nurse include teacher, both formal and informal, caregiver, and client advocate. The professional nurse may also have advanced practice roles. Informal teaching does not involve teaching plans. Teaching is often done in collaboration with the advanced practice nurse specialist or the nurse educator. Nurses at the bedside also must share the role of client educator. Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: II.B.4. Function competently within own scope of practice as a member of the health care team. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches.
NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1.5: Explain the role of the professional nurse in health assessment. MNL Learning Outcome: 2.1.1. Apply appropriate communication skills required to conduct the health history interview of a client; 2.1.3. Apply the components of conducting the health history interview of a client. Page Number: pp. 17–19 Question 22 Type: MCSA A novice nurse is conducting a focused interview on an older adult client who is being admitted for a urinary tract infection (UTI). Which action by the novice nurse is appropriate? 1. Obtaining a urine sample to send for a urinalysis. 2. Monitoring the client’s vital signs. 3. Questioning the client about dietary preferences. 4. Assessing the characteristics of the client’s pain. Correct Answer: 4 Rationale 1: The client may need to have a urine specimen, but that does not directly relate to determining more information about the chief complaints of the client. Rationale 2: The client vital signs will be taken but they do not directly relate to determining more information about the chief complaints of the client. Rationale 3: Dietary preferences of clients are recorded but are not a part of the focused assessment. Rationale 4: The focused interview is used to allow for clarification of information from the initial interview. The goal of the focused interview is to expand the information available. Global Rationale: The focused interview is used to allow for clarification of information from the initial interview. The goal of the focused interview is to expand the information available. The client may need to have a urine specimen and will need vital signs taken but they do not directly relate to determining more information about the chief complaints of the client. Dietary preferences of clients are recorded but are not a part of the focused assessment. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.4: Identify the key components of health assessment in nursing. MNL Learning Outcome: 2.1.2. Distinguish the phases of conducting the health history interview of a client. Page Number: pp. 4–11
Question 23 Type: MCSA The nurse is assessing a client who presents in the emergency department (ED) with abdominal pain, nausea, and vomiting. Vital signs are within normal limits. The client’s health history indicates pelvic inflammatory disease, mitral valve prolapse, and childbirth. When analyzing the available data, what items should be clustered together? 1. Vital signs, complaints of pain, history of childbirth. 2. Abdominal pain, nausea, vomiting, and history of pelvic inflammatory disease. 3. Gender, history of mitral valve prolapse, and vital signs. 4. History of pelvic inflammatory disease, mitral valve prolapse, and pain scale reports. Correct Answer: 2 Rationale 1: The analysis of assessment data includes clustering or grouping related pieces of information. There is no obvious relationship between these pieces of information. Rationale 2: The analysis of assessment data includes clustering or grouping related pieces of information. The client’s complaints of abdominal pain, nausea, vomiting, and history of pelvic inflammatory disease are interrelated items. Rationale 3: The analysis of assessment data includes clustering or grouping related pieces of information. There is no obvious relationship among these pieces of information. Rationale 4: The analysis of assessment data includes clustering or grouping related pieces of information. There is no obvious relationship among these pieces of information. Global Rationale: The analysis of assessment data includes clustering or grouping related pieces of information. The client’s complaints of abdominal pain, nausea, vomiting, and history of pelvic inflammatory disease are interrelated items. There is no obvious relationship between the remaining pieces of information. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: III.C.5. Value the need for continuous improvement in clinical practice based on new knowledge. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.6: Apply the critical thinking process to health assessment in nursing. MNL Learning Outcome: 2.1.3. Apply the components of conducting the health history interview of a client. Page Number: pp. 14–17 Question 24 Type: MCMA The nurse is preparing the care plan for a client who admitted to the unit after an abdominal hysterectomy to manage endometriosis. Which goal statements reflect the need for further development by the nurse?
Standard Text: Select all that apply. 1. The nurse will assess the vital signs every 2 hours. 2. The client will walk Q2h on the first postoperative day. 3. The client will report feeling better. 4. The client will begin a clear liquid diet on the first postoperative day. 5. The healthcare provider will prescribe oral analgesics on the first postoperative day. Correct Answer: 1, 3, 5 Rationale 1: Goal statements are used to provide planned outcomes for the client. Goal statements must be measurable and are reflective of client activities. This statement reflects actions of the nurse, not the client. Rationale 2: The goal statement is used to provide planned outcomes for the client. Goal statements must be measurable and reflective of client activities. All elements needed for an appropriate goal statement are represented. Rationale 3: Goal statements must be measurable and reflective of client activities. This statement is vague and does not provide a definitive means for measurement. Rationale 4: Goal statements are used to provide planned client outcomes. This statement contains the needed elements for a successful goal statement. Rationale 5: This statement is not a client-centered goal statement. This statement reflects an intervention performed by the healthcare provider. Global Rationale: Goal statements are used to provide planned outcomes for the client. Goal statements must be measurable and are reflective of client activities. The only statement reflecting these criteria is that the client will walk Q2h on the first postoperative day. Statements reflecting actions of the nurse or healthcare provider are not goal statements. Vague statements such as “feeling better” are not measurable. The statement that the client will begin a clear liquid diet on the first postoperative day contains the needed elements for a successful goal statement. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1.3: Explain the steps of the nursing process. MNL Learning Outcome: Page Number: pp. 11–14 Question 25 Type: MCSA When using Leavall and Clark’s model as a framework for preparing a community health program, which program objective best reflect the concepts presented by this model? 1. The participants will recognize health as the absence of disease. 2. The participants will verbalize the role of self-actualization achievement in relation to health.
3. The participants will define health as the interrelationships between the agent, host, and the environment. 4. Internal harmony is the foundational basis for health achievement. Correct Answer: 3 Rationale 1: The absence of disease and internal harmony are not specific independent models for health. Rationale 2: Self-actualization and health are explored in the eudaemonistic model for health. Rationale 3: Leavall and Clark developed the ecologic model for health. This model considers the relationship between the agent, host, and environment as the key determinants for health status. Rationale 4: The absence of disease and internal harmony are not specific independent models for health. Global Rationale: Leavall and Clark developed the ecologic model for health. This model considers the relationship between the agent, host, and environment as the key determinants for health status. Self-actualization and health are explored in the eudaemonistic model for health. The absence of disease and internal harmony are not specific independent models for health. Cognitive Level: Understanding Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: I.1. Integrate theories and concepts from liberal education into nursing practice. NLN Competencies: Knowledge and Practice: Health promotion/disease prevention. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1.1: Distinguish various definitions of health. MNL Learning Outcome: Page Number: pp. 3-4 Question 26 Type: MCMA Standard Text: Select all that apply. The nurse educator is presenting information about the APIE method of charting as it will be implemented by the facility in a few weeks. Which statements by the participants indicate an appropriate understanding of this method of charting? 1. “I will only need to chart by exception with this method.” 2. “Only subjective data are included in the assessment portion.” 3. “The ‘P’ refers to the chief problem of the client.” 4. “The activities implemented to manage the client’s needs will be documented in the ‘I’ section.” 5. “The ‘E’ refers to the evaluation that occurs after an intervention is implemented.” Correct Answer: 2, 3, 4, 5 Rationale 1: APIE is not the same as charting by exception. Rationale 2: The APIE method of charting uses the letters to refer to the assessment, problem, intervention, and evaluation. The assessment includes both the objective and subjective data.
Rationale 3: The APIE method of charting uses the letters to refer to the assessment, problem, intervention, and evaluation. The “P” refers to the chief problem. Rationale 4: The APIE method of charting uses the letters to refer to the assessment, problem, intervention, and evaluation. “I” includes the interventions implemented to manage the client. Rationale 5: The APIE method of charting uses the letters to refer to the assessment, problem, intervention, and evaluation. “E” includes evaluation of the interventions that have been implemented. Global Rationale: The APIE method of charting involves charting that is problem based. Information documented is only those items that are not within normal limits. The APIE method of charting uses the letters to refer to the assessment, problem, intervention, and evaluation. The assessment includes both the objective and subjective data. The “P” refers to the chief problem. “I” includes the interventions implemented to manage the client. “E” stands for evaluation of the response to the plan of care. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: II.B.4. Function competently within own scope of practice as a member of the health care team. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 1.5: Explain the role of the professional nurse in health assessment. MNL Learning Outcome: 2.1.1. Apply appropriate communication skills required to conduct the health history interview of a client; 2.1.3. Apply the components of conducting the health history interview of a client. Page Number: pp. 5–8 Question 27 Type: MCSA The health care organization is planning to change the type of documentation done on the client care units. The nurses have requested a system that will reduce time spent writing out routine tasks and will still allow for documentation of exceptions. Which type of documentation will best meet the needs of the nursing staff? 1. Focus documentation. 2. Flow sheets. 3. SOAP charting. 4. APIE charting. Correct Answer: 2 Rationale 1: Focused documentation records client problems and strengths. Rationale 2: Flow sheets use columns or categories to log in assessment findings and to note interventions performed. Flow sheets reduce repetition and are time efficient. Rationale 3: SOAP charting is detailed and includes subjective and objective data, assessment findings, and planning information.
Rationale 4: APIE charting includes assessment, planning, intervention, and evaluation. Global Rationale: Flow sheets use columns or categories to log in assessment findings and to note interventions performed. Focused documentation records client problems and strengths. Flow sheets reduce repetition and are time efficient. Focused documentation records client problems and strengths. SOAP charting is detailed and includes subjective and objective data, assessment findings, and planning information. APIE charting includes assessment, planning, intervention, and evaluation. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care QSEN Competencies: II.B.4. Function competently within own scope of practice as a member of the health care team. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 1.5: Explain the role of the professional nurse in health assessment. MNL Learning Outcome: 2.1.1. Apply appropriate communication skills required to conduct the health history interview of a client; 2.1.3. Apply the components of conducting the health history interview of a client. Page Number: pp. 5–8 Question 28 Type: MCMA The student nurse is preparing a care plan for an assigned client. When writing the nursing diagnose for this client, which elements are required? Standard Text: Select all that apply. 1. Medical diagnosis. 2. Risk or related factors. 3. Defining characteristics. 4. A diagnostic label. 5. A definition. Correct Answer: 2, 3, 4, 5 Rationale 1: The nursing diagnosis is composed of four components. These components are a diagnostic label, definition, defining characteristics, and risks or related factors. A medical diagnosis is not included in the nursing diagnosis. Rationale 2: The nursing diagnosis is composed of four components. These components are a diagnostic label, definition, defining characteristics, and risks or related factors. Rationale 3: The nursing diagnosis is composed of four components. These components are a diagnostic label, definition, defining characteristics, and risks or related factors. Rationale 4: The nursing diagnosis is composed of four components. These components are a diagnostic label, definition, defining characteristics, and risks or related factors. Rationale 5: The nursing diagnosis is composed of four components. These components are a diagnostic label, definition, defining characteristics, and risks or related factors.
Global Rationale: The nursing diagnosis is composed of four components. These components are a diagnostic label, definition, defining characteristics, and risks or related factors. A medical diagnosis is not included in the nursing diagnosis. Cognitive Level: Remembering Client Need: Safe and Effective Care Environment Client Need Sub: Management of Care QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 1.3: Explain the steps of the nursing process. MNL Learning Outcome: Page Number: pp. 12–13 Question 29 Type: MCSA The nurse is developing a plan of care for a recently admitted client to the medical-surgical unit. Which is the basis for the plan and implementation of the client’s care? 1. The nursing diagnosis. 2. The objective data. 3. The subjective data. 4. Client goals. Correct Answer: 1 Rationale 1: The nursing diagnosis is the basis for the plan and implementation of care delivered to the client. Rationale 2: Objective and subjective data are collected and used to formulate the nursing diagnosis. Rationale 3: Objective and subjective data are collected and used to formulate the nursing diagnosis. Rationale 4: Client goals are developed to determine the success of the care delivered. Global Rationale: The nursing diagnosis is the basis for the plan and implementation of care delivered to the client. Objective and subjective data are collected and used to formulate the nursing diagnosis. Client goals are developed to determine the success of the care delivered. Cognitive Level: Remembering Client Need: Safe and Effective Care Environment Client Need Sub: Management of Care QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care.
NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: 1.3: Explain the steps of the nursing process. MNL Learning Outcome: Page Number: pp. 12–13 Question 30 Type: MCSA During step 3 of the nursing process, which activity is performed? 1. Statement of client goals. 2. Collection of subjective data. 3. Performance of care activities. 4. Review of client goal achievement. Correct Answer: 1 Rationale 1: The third step in the nursing process is the planning phase. During the planning phase, care interventions are determined, priorities are set, and client goals are stated. Rationale 2: Collection of subjective data takes place during the first step in the nursing process. Rationale 3: Care activities are implemented during the fourth phase of the nursing process. Rationale 4: During the final stage of the nursing process the client’s progress toward goal achievement is evaluated. Global Rationale: The third step in the nursing process is the planning phase. During the planning phase, care interventions are determined, priorities are set, and client goals are stated. Collection of subjective data takes place during the first step in the nursing process. Care activities are implemented during the fourth phase of the nursing process. During the final stage of the nursing process the client’s progress toward goal achievement is evaluated. Cognitive Level: Remembering Client Need: Safe and Effective Care Environment Client Need Sub: Management of Care QSEN Competencies: I.B.3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. AACN Essentials Competencies: III.6. Integrate evidence, clinical judgment, interprofessional perspectives, and patient preferences in planning, implementing, and evaluating outcomes of care. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 1.3: Explain the steps of the nursing process. MNL Learning Outcome: Page Number: p. 13 Question 31 Type: MCMA Standard Text: Select all that apply. The nurse is reviewing flow chart entries for a client experiencing pain. Which chart entries represent subjective data?
1. The client’s leg is red and swollen. 2. The client complains of leg tenderness. 3. The client’s white blood cell count is 5.6. 4. The client demonstrates guarding behaviors during the assessment of the affected extremity. 5. The client complains leg cramps. Correct Answer: 2, 5 Rationale 1: Objective information is observable by the examiner. The examiner is able to visualize the appearance of the extremity. Rationale 2: Subjective information refers to data reported by the client. The client’s complaints are an example of subjective information. Rationale 3: The laboratory values are objective data that can be determined by a technician. Rationale 4: Objective information is observable by the examiner. The presence of guarding behaviors may be noted by the examiner. Rationale 5: Subjective information refers to data reported by the client. The client’s complaints are an example of subjective information. Global Rationale: Subjective information refers to data reported by the client. The client’s complaints are an example of subjective information. Objective information is observable by the examiner. The examiner is able to visualize the appearance of the extremity. The laboratory values are objective data that can be determined by a technician. The presence of guarding behaviors may be noted by the examiner. Cognitive Level: Analyzing Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Personal and Professional Development: Identify problems; Contribute to assessment of outcome achievement. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.4: Identify the key components of health assessment in nursing. MNL Learning Outcome: 2.1.2. Distinguish the phases of conducting the health history interview of a client. Page Number: pp. 4–11 Question 32 Type: MCSA The nurse manager is reviewing SOAP entries in the medical record for a novice nurse. Which entry indicates that the nurse needs further instruction concerning documentation? 1. S: The client states, “I am so nauseated.” 2. O: The client reports feeling fatigued. 3. A: Bowel sounds are high-pitched in all abdominal quadrants. 4. P: The client will remain NPO. Correct Answer: 2 Rationale 1: S refers to subjective data. Client reports are examples of subjective information.
(that is, drugs, animals, insects, environmental agents) and how the reaction is treated, the nurse should always ask about the type of reaction that occurs with exposure to the allergen. What occurs with exposure is especially important in order to be able to help identify the severity of any potential exposure as well as to obtain a better understanding of an individual’s perspective of what constitutes an “allergy.” For example, the implications of a client telling the nurse that he or she has an anaphylactic reaction to bee stings or to penicillin differs from the implications of a client who reports an “allergy” to mosquito bites, which become reddened and itch. The location where the reaction occurred might be helpful in discerning the potential cause of current signs and symptoms of allergies and how long the symptoms lasted (e.g., recently visiting a relative who has several cats with symptoms improving upon leaving the home), but what reaction occurs with exposure has greater importance than this information when asking about past history. Similarly, knowing that family members have the same allergy is not as critical as discerning what occurs with exposure to various allergens. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential QSEN Competencies: I.B.1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Context and Environment: Conduct population-based transcultural health assessments and interventions. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 8.4: Collect a nursing health history that incorporates patient-specific findings related to health, illness, and wellness. MNL Learning Outcome: 2.1.2. Distinguish the phases of conducting the health history interview of a client. Page Number: pp. 137–142 Question 30 Type: MCSA The nurse is constructing a pedigree for a client. Which symbol designates the client’s biological parents? 1.
2.
3. 4. Correct Answer: 1
Rationale 1: This symbol indicates the client’s biological parents when constructing a pedigree. Rationale 2: This symbol indicates an unaffected female when constructing a pedigree. Rationale 3: This symbol indicates an unaffected family member, sex unknown. Rationale 4: This symbol indicates identical twins. Global Rationale: The square symbol connected to the circle with a straight line is the symbol that indicates the client’s biological parents. The other symbols indicate an unaffected female, unaffected family member (sex unknown), and identical twins. Cognitive Level: Remembering Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: III.A.1. Demonstrate knowledge of basic scientific methods and processes. AACN Essentials Competencies: IX.2. Recognize the relationship of genetics and genomics to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness, using a constructed pedigree from collected family history information as well as standardized symbols and terminology. NLN Competencies: Context and Environment: Conduct population-based transcultural health assessments and interventions. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 8.5: Develop a pedigree. MNL Learning Outcome: 2.1.2. Distinguish the phases of conducting the health history interview of a client. Page Number: p. 135
D’Amico/Barbarito Health & Physical Assessment in Nursing, 3/e Chapter 9 Question 1 Type: HOTSPOT The nurse educator is demonstrating the proper technique for assessing a client for fremitus. Which part of the hand will the instructor use to demonstrate proper technique? A
B C
D
1. A. 2. B. 3. C. 4. D. Correct Answer: 3 Rationale 1: Fremitus, or vibration, is best assessed using the metacarpophalangeal joints, at the base of the fingers on the ulnar surface of the hand. Rationale 2: Fremitus, or vibration, is best assessed using the metacarpophalangeal joints, at the base of the fingers on the ulnar surface of the hand. Rationale 3: Fremitus, or vibration, is best assessed using the metacarpophalangeal joints, at the base of the fingers on the ulnar surface of the hand. Rationale 4: Fremitus, or vibration, is best assessed using the metacarpophalangeal joints, at the base of the fingers on the ulnar surface of the hand. Global Rationale: Fremitus, or vibration, is best assessed using the metacarpophalangeal joints, at the base of the fingers on the ulnar surface of the hand. Cognitive Level: Remembering Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: III.A.5. Explain the role of evidence in determining best clinical practice. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches.
NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 9.1: Differentiate between the four basic techniques used by the professional nurse when performing physical assessment. MNL Learning Outcome: 2.2. Techniques of Physical Assessment Page Number: p. 146 Question 2 Type: MCSA The nurse is preparing to assess the sinuses of an adult client using direct percussion. Which technique is the most appropriate for this assessment? 1. Using the hyperextended middle finger of the nondominant hand. 2. Using the closed fist of dominant hand. 3. Using the palm of the nondominant hand. 4. Using the fingertips of the dominant hand. Correct Answer: 4 Rationale 1: Indirect percussion is the technique most commonly used and performed by placing the hyperextended middle finger of the nondominant hand firmly over the area to be examined and striking it with a plexor. Rationale 2: Blunt percussion is used for assessing pain and tenderness in the gallbladder, liver, and kidneys and involves placing the palm of the nondominant hand flat against the body surface and striking the nondominant hand with the closed fist of the dominant hand. Rationale 3: The palm of the nondominant hand is used to assess pain and tenderness of the gallbladder, liver, and kidneys in blunt percussion. Rationale 4: Direct percussion is the technique of tapping the body with the fingertips of the dominant hand. It is used to assess thorax of an infant and also to assess the sinuses of an adult client. Global Rationale: Direct percussion is the technique of tapping the body with the fingertips of the dominant hand. It is used to assess the thorax of an infant and also to assess the sinuses of an adult client. Indirect percussion is the technique most commonly used and performed by placing the hyperextended middle finger of the nondominant hand firmly over the area to be examined and striking it with a plexor. Blunt percussion is used for assessing pain and tenderness in the gallbladder, liver, and kidneys and involves placing the palm of the nondominant hand flat against the body surface and striking the nondominant hand with the closed fist of the dominant hand. The palm of the nondominant hand is used to assess pain and tenderness of the gallbladder, liver, and kidneys in blunt percussion. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: III.A.5. Explain the role of evidence in determining best clinical practice. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care.
Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 9.1: Differentiate between the four basic techniques used by the professional nurse when performing physical assessment. MNL Learning Outcome: 2.2. Techniques of Physical Assessment Page Number: p. 147 Question 3 Type: MCSA During auscultation of the breath sounds of an adult male client, the nurse hears crackling sounds over most of the chest. Which action by the nurse is the most appropriate? 1. Document this as abnormal. 2. Wet the chest hair before auscultating the chest. 3. Place the diaphragm on top of the client’s shirt. 4. Switch from the diaphragm to the bell. Correct Answer: 2 Rationale 1: The crackling sounds may or may not be an abnormal finding; the cause of the sounds should be fully investigated before the nurse documents the finding as abnormal. Rationale 2: Friction on either the bell or the diaphragm from coarse body hair may cause a crackling sound easily confused with abnormal breath sounds. To avoid artifact caused from friction, the nurse should wet the hair on the client’s chest before auscultation. Rationale 3: Auscultating lung sounds over the client’s clothing will increase rather than decrease friction sounds. Rationale 4: Lung sounds are high-pitched sounds, best heard with the diaphragm of the stethoscope. Friction from hair will cause abnormal crackling sounds using either the diaphragm or the bell, so switching them won’t make a difference. Global Rationale: Friction on either the bell or the diaphragm from coarse body hair may cause a crackling sound easily confused with abnormal breath sounds. To avoid artifact caused from friction, the nurse should wet the hair on the client’s chest before auscultation. The crackling sounds may or may not be an abnormal finding; the cause of the sounds should be fully investigated before the nurse documents the finding as abnormal. Auscultation of lung sounds over the client’s clothing will increase rather than decrease friction sounds. Lung sounds are high-pitched sounds, best heard with the diaphragm of the stethoscope. Friction from hair will cause abnormal crackling sounds using either the diaphragm or the bell, so switching them won’t make a difference. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: III.A.5. Explain the role of evidence in determining best clinical practice. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9.1: Differentiate between the four basic techniques used by the professional nurse when performing physical assessment.
MNL Learning Outcome: 2.2. Techniques of Physical Assessment Page Number: pp. 148–149 Question 4 Type: MCSA The nurse educator is observing a student nurse who is performing cervical palpation on an adult client. Which technique is appropriate for this assessment? 1. Downward pressure of 1–2 cm using the finger pads. 2. Side to side pressure of ½–1 cm using the finger pads. 3. Downward pressure of 2–4 cm using the palmar surface of the fingers 4. Light pressure using the base of the fingers (metacarpophalangeal joints). Correct Answer: 2 Rationale 1: Downward depression of 1–2 cm using the finger pads is not sufficient depth to assess structures that lie deep within the abdominal cavity. This describes moderate palpation, used for most of the structures of the body, but not the kidney or spleen. Rationale 2: Side-to-side palpation of ½–1 cm in depth will not be sufficient to examine structures that lie deep within a body cavity or those that are covered with thick muscle. This may be sufficient to determine the size and consistency of a finding in the soft tissue (such as a cervical lymph node). Rationale 3: Deep palpation of 2–4 cm (3/4–1½ in.) is used to palpate an organ lying deep within a body cavity such as the spleen or the kidneys. This is done by placing the palmar surface of the fingers of the dominant hand on the skin surface with the extended fingers of the nondominant hand covering and guiding the fingers downward. Rationale 4: Light pressure using the base of the fingers or metacarpophalangeal joints is the technique used in the assessment for vibratory tremors, or fremitus. Global Rationale: Side-to-side palpation of ½–1 cm in depth will not be sufficient to examine structures that lie deep within a body cavity or those that are covered with thick muscle. This may be sufficient to determine the size and consistency of a finding in the soft tissue (such as a cervical lymph node). Downward depression of 1–2 cm using the finger pads is not sufficient depth to assess structures that lie deep within the abdominal cavity. This describes moderate palpation, used for most of the structures of the body, but not the kidney or spleen. Deep palpation of 2–4 cm (3/4–1½ in.) is used to palpate an organ lying deep within a body cavity such as the spleen or the kidneys. This is done by placing the palmar surface of the fingers of the dominant hand on the skin surface with the extended fingers of the nondominant hand covering and guiding the fingers downward. Light pressure using the base of the fingers or metacarpophalangeal joints is the technique used in the assessment for vibratory tremors, or fremitus. Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: QSEN Competencies: III.A.5. Explain the role of evidence in determining best clinical practice. AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care.