HAP Exam Study Set Questions And Answers A+

HAP Exam Study Set Questions And Answers A+

Chapter 1 Practice Quiz
1. What are the 6 steps of the Nursing Process?
1 assessment
2 diagnosis (nursing)
3 outcome identification (goal)
4 planning (How will we achieve the goal)
5 implementation
6 evaluation
2. What are two components of "Assessment"
Data Collection- subjective and objective---Forms database- clinical evidence
Interpretation/analysis of data ---Diagnostic reasoning---Organizing cues---Developing
hypothesis---Gathering data to support or reject hypothesis
3. What is important for data collection
Cluster data
Validate data (relevant or irrelevant?)
Identify nursing diagnosis
Rely on NANDA (actual or potential?)
4. During Assessment, how do you prioritize problems?
Distinguish between
--1st level problems (emergent/life threatening ABCV)
--2nd level problems (requiring attention to prevent further deterioration)
--3rd level problems (usually long term, less urgent)
--Collaborative problems (contribute & compound)
5. What does ABCV mean?
Airway, Breathing, Circulation, Vital Signs
6. When prioritizing patient needs what is a second level problem?
Those requiring attention to prevent further deterioration
Ex: diabetes
7. When prioritizing patient needs what is a third level problem?
Important, but less urgent
Usually more long-term
8. When prioritizing patient needs what are collaborative problems?
Contributes to the problem
Compounds the problem
Having social services, dietary, psychiatry help with patient
Ex: lack of knowledge, sleep deprivation
9. Steps of prioritization
Gather data
Determine relationships (does one thing cause something else?)
Set priority (1st level)
ABCV
Address 2nd level concerns
Then 3rd level
10. ANA definition of Assessment
“Assessment is the collection of comprehensive data pertinent to the patient's health
or the situation"
11. What are the 2 primary components of a Health Assessment?
1) History (subjective data)
2) Examination (objective data)
12. What is a symptom?
What client feels/communicates/reports (subjective)
13. What is a sign?
MEASURABLE DATA
clinical finding/measurable (objective)
Ex: vital signs
14. What are the four types of assessment data?
Complete (total health)
Focused (problem-centered)
Follow up
Emergency
15. What are the Components of Health Assessment?
1) Systematic method of data collection to identify client's health characteristics
2) Data collected: client's health
compared with ideal—accounting for
client's traits
3) Collection/analysis of data
---Leads to identifying problems
---Guides nurse in developing care plan
---Assist client to maximize health potential
16. What is proper documentation of data?
Data documented for use by all health care team members
Complete, accurate, descriptive data improves effectiveness of health care team
Prevents repetition
Legal document and permanent record
Baseline for evaluation of changes/care
Outline/notes facilitate documentation, ↑ accuracy
Recorded concisely, accurately, legibly without bias or opinion
17. What Do You Do with the Data that has been collected during the assessment?
Outcome of this assessment data leads to portrait of client's health characteristics
and health problems
Subjective and objective data analyzed by nurse to initiate nursing care plan

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