Relias Assessment and Evaluation 2

Question 1

A nurse is conducting a fall risk assessment using the Morse Fall Scale. Which factor carries the HIGHEST point value on this tool?

Accepted Answer

History of falling within the past 3 months

Answer

Secondary diagnosis present

Answer

Use of intravenous therapy or heparin lock

Answer

Impaired gait or transfer ability

Question 2

When using the Glasgow Coma Scale (GCS), which component assesses verbal response?

Accepted Answer

Oriented, confused, inappropriate, incomprehensible, or none

Answer

Eye opening to verbal stimuli

Answer

Ability to state name, date, and location

Answer

Motor response to commands

Question 3

A clinician documents a patient's pain as 7/10 using a numeric rating scale. This represents which level of measurement?

Accepted Answer

Ordinal

Answer

Nominal

Answer

Interval

Answer

Ratio

Question 4

Which assessment tool is BEST suited for detecting delirium in hospitalized older adults?

Accepted Answer

Confusion Assessment Method (CAM)

Answer

Montreal Cognitive Assessment (MoCA)

Answer

Mini-Mental State Examination (MMSE)

Answer

Beck Depression Inventory (BDI)

Question 5

An evaluator notes that two raters score the same client differently on a behavioral checklist. This represents a problem with:

Accepted Answer

Inter-rater reliability

Answer

Content validity

Answer

Test-retest reliability

Answer

Construct validity

Question 6

During a comprehensive skin assessment, a stage 2 pressure injury is BEST described as:

Accepted Answer

Partial-thickness loss involving the dermis

Answer

Non-blanchable erythema of intact skin

Answer

Full-thickness tissue loss with exposed bone

Answer

Full-thickness loss with slough or eschar

Question 7

Which principle of assessment states that a test should measure what it is intended to measure?

Accepted Answer

Validity

Answer

Reliability

Answer

Sensitivity

Answer

Specificity