Deck 13: Planning and Implementing Nursing Care

Question 1

During which aspect of the nursing process will the nurse most likely consult with other health professionals?

A) Assessment
B) Diagnosis
C) Implementation
D) Evaluation

Answer 1

C

Question 2

Which of the following processes is an example of indirect care?

A) Documentation
B) Medication administration
C) Catheterization
D) Grief counselling

Answer 2

A

Question 3

What is the first step in the implementation process?

A) Providing care
B) Reassessing the client
C) Reviewing and revising the existing nursing care plan
D) Organizing resources and care delivery before delivering an intervention

Answer 3

B

Question 4

Which of the following is often missing when writing nursing interventions and is acknowledged as a frequent error?

A) Etiology
B) Frequency
C) Action verbs
D) Purpose of the intervention

Question 5

The nurse is working with a client who is being prepared for a diagnostic test this afternoon.The client tells the nurse that she wants to have her hair shampooed.Which of the following is the most appropriate label with regard to assigning a priority for the client's request?

A) Low priority
B) An unmet need
C) Intermediate priority
D) A safety and security need

Question 6

Nursing interventions may be categorized based on the degree of nursing autonomy.Which one of the following is an example of a nurse-initiated intervention?

A) Providing client teaching
B) Administering medication
C) Ordering a computed tomography scan
D) Referring a client to physiotherapy

Question 7

Which of the following is measurable along a continuum in response to a nursing intervention?

A) Client goal
B) Nursing diagnosis
C) Time-limited nursing intervention
D) Nursing-sensitive client outcome

Question 8

A number of different types of nursing interventions may be incorporated into the plan of care.Which of the following interventions is an example of a specific life-saving measure that the nurse may implement?

A) Restraining a violent client
B) Administering analgesics
C) Initiating stress-reduction therapy
D) Teaching the client how to take his or her pulse

Question 9

In documentation of nursing care plans,how do critical pathways differ from traditional nursing care plans?

A) Multidisciplinary approach
B) Nursing interventions
C) Client outcomes
D) Client assessment

Question 10

When an etiological factor cannot change,at which of the following should interventions be directed?

A) Eliminating risk factors
B) Treating signs and symptoms
C) Creating a safe environment for the client
D) Understanding the scientific rationale for the interventions

Question 11

Which one of the following interventions selected by the nurse is classified as Level 2,Domain 2 (Physiological: Complex Care)?

A) Maintaining regular bowel elimination
B) Promoting the health of the family
C) Managing restricted body movement
D) Restoring tissue integrity

Question 12

The nurse may use a concept map when implementing a plan of care.What is the purpose and distinction of a concept map?

A) Quality assurance in the health care facility
B) Multidisciplinary communication
C) Provision of a standardized format for client problems
D) Identification of the relation of client problems and interventions

Question 13

The nurse is working with postoperative clients on a surgical unit.One aspect of care is manipulation of the client's environment.What does this involve on the part of the nurse?

A) Delegating ambulation of clients to the unregulated care provider
B) Providing pain medication to the client before a dressing change
C) Maintaining client privacy during procedures
D) Repositioning the client every two hours

Question 14

Which of the following is a specific and measurable behavioural response that reflects independence in function?

A) Client goal
B) Priority setting
C) Nursing diagnosis
D) Concept mapping

Question 15

What is the primary reason for establishing standing orders?

A) To provide appropriate nursing autonomy in settings where client needs can change rapidly
B) To facilitate adequate care when direct contact with a primary health care provider is not immediately possible
C) To allow the nurse to provide certain routine therapies without first notifying the primary health care provider
D) To afford the client interventions that reflect the appropriate standard of care in the absence of a primary health care provider