One of the main methods to obtain a good health assessment is to obtain vital signs. Of which of the listed descriptions below is not a use of obtaining vital signs?

Choice A reason: Assessment in the nursing process involves collecting subjective and objective data via interviews, physical exams, and observations to inform clinical judgments. This foundational step identifies patient needs, guiding subsequent planning. Accurate data collection ensures comprehensive care, preventing oversight of critical health issues and supporting effective diagnosis and intervention in clinical practice.

Choice B reason: Using problem-solving to prioritize outcomes and develop interventions describes the planning step, not assessment. Assessment focuses on data collection, not goal-setting. Assuming this misaligns with the nursing process, risking premature intervention without thorough data, which could lead to ineffective care plans or missed health issues in patient management.

Choice C reason: Assessing goal effectiveness and adjusting interventions pertains to the evaluation step, not assessment. Assessment gathers data to identify needs, not evaluate outcomes. Misidentifying this risks skipping data collection, leading to incomplete assessments and inappropriate interventions, compromising patient safety and care quality in the nursing process.

Choice D reason: Using clinical judgment to formulate problems is part of diagnosis, not assessment. Assessment collects raw data, while diagnosis analyzes it to identify issues. Assuming this conflates steps, risking incomplete data collection, which could result in inaccurate diagnoses and ineffective care plans, undermining the systematic approach of the nursing process.

Choice A reason: Inspection, palpation, and auscultation is incorrect, as palpation before auscultation can alter bowel sounds by stimulating peristalsis. Abdominal assessment requires auscultation first to capture natural bowel activity, followed by palpation to avoid disrupting the acoustic findings critical for diagnosing conditions like obstruction.

Choice B reason: Inspection, auscultation, and palpation is the correct sequence for abdominal assessment. Inspection identifies visible abnormalities, auscultation captures unaltered bowel sounds, and palpation assesses tenderness or masses. This order prevents palpation from affecting auscultatory findings, ensuring accurate evaluation of gastrointestinal function and potential pathologies.

Choice C reason: Auscultation, inspection, and palpation disrupts the logical flow of abdominal assessment. Inspection should precede auscultation to note visible abnormalities that may guide listening. Starting with auscultation risks missing contextual visual cues, reducing the effectiveness of the assessment and potentially overlooking critical signs.

Choice D reason: Palpation, auscultation, and inspection is incorrect, as palpation first can stimulate or suppress bowel sounds, skewing auscultation results. Inspection must initiate the process to identify visible issues, followed by auscultation and palpation, to maintain accuracy in assessing abdominal conditions like peritonitis or organ enlargement.