Chapter 1

Question 1

Subjective data

Answer 1

What the person says themselves during the interview

Question 2

Objective data

Answer 2

What you observe by inspection, percussing, palpating, and auscultating

Question 3

Purpose of assessment

Answer 3

To make judgment or diagnosis

Question 4

Data base

Answer 4

Subjective, objective, patients record, and lab studies

Question 5

Diagnostic reasoning

Answer 5

The process of analyzing health data and drawing conclusions to identify diagnoses

Question 6

Four components to diagnostic reasoning

Answer 6

1) Attending to initially available cues
2) Formulating diagnostic hypothesis
3) Gathering data relative to tentative hypotheses
4) Evaluating each hypothesis with new data collected (driving at final diagnosis)

Question 7

Cues

Answer 7

A piece of information, sign, symptom, or piece of lab data

Question 8

Hypothesis

Answer 8

tentative explanation for a cue or set of cues that can be used as a basis for further investigation

Question 9

Parts of the nursing process

Answer 9

Assessment
Diagnosis
Outcome identification
Planning
Implementation
Evaluate

Question 10

Critical thinking enables you to

Answer 10

• Analyze complex data
• Make decisions about patient problems and alternatives
• Evaluate each problem to decide which applies
• Decide on most appropriate interventions based on situation

Question 11

Identify assumptions

Answer 11

Dont assume anything before you gather the facts

Question 12

Validate

Answer 12

always validate information

Question 13

Distinguish normal from abnormal

Answer 13

Ensure you know your patient’s normal

Question 14

Identify and…

Answer 14

organize comprehensive approach to assessment

Question 15

Make inferences

Answer 15

Drawing valid conclusions

Question 16

Clustering related cues

Answer 16

Cluster alike information to sort the information

Question 17

Distinguish

Answer 17

relevant from irrelevant

Question 18

Recognize inconsistencies

Answer 18

Is the person’s story changing?

Question 19

Identify…

Answer 19

Patterns and missing information

Question 20

Promoting health by identifying risk factors

Answer 20

Make sure you identify the patient

Question 21

Ensure to diagnose both

Answer 21

actual and potential problems

Question 22

First level

Answer 22

Emergent, life threatening problems that cannot wait

Question 23

First level examples

Answer 23

Airway
Breathing
Circulation
Vital signs

Question 24

Second level

Answer 24

Require prompt intervention to stop further deterioration

Question 25

Second level examples

Answer 25

``` Mental status change Acute pain Acute urinary elimination Untreated medical problems abnormal lab values risk of infection risk of safety and security ```

Question 26

Third level

Answer 26

Important to patients health but can be addressed at a later time

Question 27

Third level examples

Answer 27

weight loss Stoping smoking Dietary management Increasing activity

Question 28

Outcomes should be patient centered

Answer 28

You cannot make changes the patient is not ready for | ex: smoking/weight loss

Question 29

You should determine specific

Answer 29

interventions

Question 30

When evaluating you should

Answer 30

look at what you have done and correct thinking

Question 31

Determining a comprehensive plan/evaluation

Answer 31

come up with a plan and all faculty must collaborate to help

Question 32

Four factors of decision making

Answer 32

- Best evidence from a critical review of literature - Clinical expertise and experience - Patient preference - Physical examination and assessment

Question 33

Complete health history

Answer 33

Health history Physical exam Information about diagnosis Primary care, community health nurse, visiting nurse, administration to hospital

Question 34

Focused database

Answer 34

- For limited or short term problem - Only for a certain area or body part - Used in times such as urgent care

Question 35

Follow up

Answer 35

Has the problem changed? is it getting better or worse? Post surgery, checking blood pressure, medication check

Question 36

Emergency data base

Answer 36

Urgent and rapid collection of information while completing lifesaving measures Taking vital signs while acting

Question 37

Holistic health

Answer 37

looking at the whole person

Question 38

Mind body and spirit

Answer 38

are independent and function as a whole

Question 39

Disease originates

Answer 39

from both internally and externally

Question 40

Individual and environment are...

Answer 40

open systems

Question 41

Each person is responsible for self-health and is active in their health care

Answer 41

You can't make someone do something they dont want to do

Question 42

Health promotion and disease prevention are the core of nursing practice

Answer 42

Can we get you healthy and keep you that way?

Question 43

Lifestyle behaviors

Answer 43

Diet, exercise

Question 44

Culture and values

Answer 44

Some religion restricts type of care you can give

Question 45

Family and social roles

Answer 45

Who takes care of who?

Question 46

Self-care behaviors

Answer 46

keeping up with hygiene, ADL's

Question 47

Job related stress

Answer 47

Can cause high blood pressure

Question 48

Developmental tasks

Answer 48

Developmental stages (where are you mentally, socially?)

Question 49

Failures and frustrations of life

Answer 49

what in life that makes you frustrated and feel like a failure. How do you deal with it?

Question 50

Disease prevention

Answer 50

Counseling from primary care providers designed to change people's unhealthy behaviors related to smoking, alcohol, and other drug use, lack of exercise, poor nutrition, injuries, and STI's

Question 51

Health promotion

Answer 51

A set of positive acts that we can take Teaching and helping consumer choose a healthier lifestyle Education, leading by example