A 19-year-old woman comes to the clinic at the insistence of her brother. She is wearing black combat boots and a black lace nightgown over her other clothes. Her hair is dyed pink with black streaks. She has several piercings in her nares and ears and is wearing an earring on her eyebrow and heavy black makeup. The nurse concludes that:

Questions 37

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health assessment exam 1 test bank Questions

Question 1 of 9

A 19-year-old woman comes to the clinic at the insistence of her brother. She is wearing black combat boots and a black lace nightgown over her other clothes. Her hair is dyed pink with black streaks. She has several piercings in her nares and ears and is wearing an earring on her eyebrow and heavy black makeup. The nurse concludes that:

Correct Answer: D

Rationale: The correct answer is D because more information should be gathered to assess the situation appropriately. The woman's appearance may suggest alternative lifestyles or personal expression rather than mental health issues. It is essential to avoid assumptions based solely on appearance and gather a comprehensive history to understand her choices. Options A and B are dismissive and judgmental, failing to consider the complexity of human behavior. Option C is incorrect as the presented information does not provide enough evidence to diagnose manic syndrome. In summary, option D is the most logical and ethical approach to understanding the woman's situation without making unfounded assumptions.

Question 2 of 9

A 19-year-old woman comes to the clinic at the insistence of her brother. She is wearing black combat boots and a black lace nightgown over her other clothes. Her hair is dyed pink with black streaks. She has several piercings in her nares and ears and is wearing an earring on her eyebrow and heavy black makeup. The nurse concludes that:

Correct Answer: D

Rationale: The correct answer is D because more information should be gathered to assess the situation appropriately. The woman's appearance may suggest alternative lifestyles or personal expression rather than mental health issues. It is essential to avoid assumptions based solely on appearance and gather a comprehensive history to understand her choices. Options A and B are dismissive and judgmental, failing to consider the complexity of human behavior. Option C is incorrect as the presented information does not provide enough evidence to diagnose manic syndrome. In summary, option D is the most logical and ethical approach to understanding the woman's situation without making unfounded assumptions.

Question 3 of 9

A nurse is caring for a patient who has a history of myocardial infarction. The nurse should prioritize which of the following assessments?

Correct Answer: A

Rationale: The correct answer is A: Blood pressure and heart rate. This is crucial in assessing the cardiac function of a patient with a history of myocardial infarction. Monitoring blood pressure and heart rate helps in evaluating cardiovascular status and detecting any potential complications. Abnormal values in these parameters can indicate inadequate perfusion to the heart or other organs, which can be life-threatening. Other choices are incorrect because: B: Temperature and respiratory rate are important assessments but not the priority for a patient with a history of myocardial infarction. C: Bowel sounds and abdominal girth are more relevant for gastrointestinal issues and not a priority in this scenario. D: Urine output and skin integrity are important assessments for overall health but do not directly relate to the cardiovascular status in a patient with a history of myocardial infarction.

Question 4 of 9

A nurse is assessing a patient with chronic kidney disease. The nurse should prioritize which of the following lab values?

Correct Answer: A

Rationale: The correct answer is A: Serum creatinine levels. In patients with chronic kidney disease, monitoring serum creatinine levels is crucial because it reflects kidney function. An increase in creatinine levels indicates worsening kidney function. Hemoglobin levels (B) are important in assessing anemia, common in CKD, but not the priority. White blood cell count (C) and platelet count (D) may indicate infection or bleeding, respectively, but are not specific to kidney function in this context.

Question 5 of 9

Which of the following statements about mental health assessment is true?

Correct Answer: C

Rationale: The correct answer is C because mental status is indeed inferred through assessment of an individual's behaviors. Mental health assessment involves observing and evaluating a person's thoughts, emotions, behaviors, and overall mental functioning to determine their mental status. This includes assessing speech, mood, cognition, and perception. Choices A, B, and D are incorrect because: A: Mental health assessment does not solely focus on diagnosing specific psychiatric disorders; it is a broader evaluation of an individual's mental well-being. B: Mental disorders can result from a variety of factors beyond everyday life stressors, such as genetic predisposition or traumatic experiences. D: Mental health assessment is more complex than assessing physical characteristics and involves subjective interpretation of behaviors rather than direct observation like physical assessments.

Question 6 of 9

Which of the following statements accurately reflects the concept of ethnicity?

Correct Answer: B

Rationale: The correct answer is B because ethnicity is defined by shared heritage, culture, language, or religion. This definition encompasses the key components that make up an individual's ethnic identity. Choice A is incorrect because while political forces may influence ethnicity, it does not define the concept itself. Choice C is incorrect as ethnicity is not necessarily related to belief in a higher power. Choice D is incorrect as ethnicity is not solely a learned behavior but also includes innate aspects like heritage.

Question 7 of 9

In the socioenvironmental model, the focus of the health care provider includes:

Correct Answer: D

Rationale: The correct answer is D because in the socioenvironmental model, the health care provider aims to help the patient view health as a resource. This approach emphasizes empowering patients to take control of their health by recognizing it as an asset that enables them to lead fulfilling lives. By focusing on health as a resource, the provider encourages positive health behaviors and preventive measures. A, changing the patient's perceptions of disease, is incorrect because the socioenvironmental model does not solely target disease perceptions but rather prioritizes health promotion. B, identification of biomedical model interventions, is incorrect as the socioenvironmental model places more emphasis on holistic and social determinants of health rather than solely biomedical interventions. C, identifying the negative health behaviors of the patient, is also incorrect as the model aims to address health behaviors in a positive and empowering way rather than focusing solely on negatives.

Question 8 of 9

A patient is admitted to the hospital with suspected pneumoniWhat is the first step the nurse should take in the nursing process?

Correct Answer: B

Rationale: The correct answer is B: Assessment. The first step in the nursing process is to assess the patient's condition to gather data and information. In this case, assessing the patient's symptoms, vital signs, and history will help the nurse identify signs of pneumonia and determine the appropriate interventions. Diagnosis (A) comes after assessment, as it involves analyzing the data collected. Implementation (C) and Evaluation (D) are subsequent steps in the nursing process after assessment and diagnosis have been completed. Assessment is crucial for developing an effective care plan and ensuring the best possible outcomes for the patient.

Question 9 of 9

A nurse is caring for a patient who is post-operative following a hip replacement. The nurse should monitor for which of the following complications?

Correct Answer: B

Rationale: The correct answer is B: Deep vein thrombosis (DVT). Post-operative hip replacement patients are at high risk for DVT due to immobility and surgical trauma. The nurse should monitor for signs such as swelling, redness, and pain in the affected leg. DVT can lead to serious complications like pulmonary embolism if not detected early. Choices A, C, and D are incorrect because while pneumonia, wound infection, and hypoglycemia are also potential post-operative complications, they are not as directly associated with hip replacement surgery as DVT.

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