The assessment phase of the nursing process refers to the phase when data collection occurs. Which methods does the nurse use to collect data? (Select all that apply.)

Observing client behavior

Reviewing diagnostic testing results

Interviewing the client and significant others

Performing physical assessment

Interpreting client behaviors

Answer and Explanation

Correct Answer : A,B,C,D

Choice A rationale: Observation is a method of data collection involving the use of one’s senses to notice the aspects of a client such as their appearance, expressions, and actions.
Choice B rationale: Reviewing diagnostic testing results is a method of collecting data that involves the examination of the findings of laboratory tests, imaging studies, and other procedures. These findings provide objective information about the client's physiological functioning.
Choice C rationale: client interview is a method of data collection involving asking them questions and listening to their responses. This method helps the nurse to obtain subjective data about the client's health history, current problems, expectations, values, and beliefs.
Choice D rationale: Performing physical assessment is a method of collecting data that involves using inspection, palpation, percussion, and auscultation to examine the different body systems of the client. This provides objective information about the patient’s condition.
Choice E rationale: this is incorrect since Interpreting client behaviors is not a method of collecting data but is instead a data analysis method.

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Correct Answer is C

Explanation

Choice A rationale: this response is dismissive and invalidating since it suggests that anger is a normal and expected feeling hence the client should not feel bad about it.
Choice B rationale: this statement is presumptuous and doesn’t offer help to the patient. Furthermore, the care provider should understand that everyone’s experience and reaction after a divorce is different.
Choice C rationale: this statement empathizes with the client’s feelings and emotions without making them feel judged and guilty for expressing their emotions. It also allows the client to share more about their experience if she wishes.
Choice D rationale: this response is very unrealistic and disrespectful since it does not address the patient’s feelings and emotions about the divorce but instead it tries to impose a positive outlook on her.

A. Calm B. Depressed C. Agitated D. Confused

Correct Answer is C

Explanation

Choice A rationale: High temperatures do not usually cause people to become calm unless they are suffering from heat exhaustion or heat stroke, which are medical emergencies.
Choice B rationale: depression is usually associated with low temperatures and reduced sunlight exposure rather than high temperatures.
Choice C rationale: high temperatures is associated with arousal and agitation in some individuals which may be due to the effects of heat on the individual’s nervous system, cardiovascular, and endocrine systems.
Choice D rationale: confusion is not usually associated with confusion. However, it may result in confusion in older adults and individuals with other underlying conditions.

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The assessment phase of the nursing process refers to the phase when data collection occurs. Which methods does the nurse use to collect data? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

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Explanation

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