Deck 4: The Nursing Process and Pharmacology

Question 1

Which task is included in the assessment step of the nursing process?

A) Establishing patient goals/outcomes
B) Implementing the nursing care plan (NCP)
C) Measuring goal/outcome achievement
D) Collecting and communicating data

Answer 1

Collecting and communicating data

Question 2

Which statement regarding nursing diagnoses is accurate?

A) Nursing diagnoses remain the same for as long as the disease is present.
B) Nursing diagnoses are written to identify disease states.
C) Nursing diagnoses describe patient problems that nurses treat.
D) Nursing diagnoses identify causes related to illness.

Answer 2

Nursing diagnoses describe patient problems that nurses treat.

Question 3

The nurse has determined that the pain medication given to a patient an hour ago has been effective.The nurse is using which step of the nursing process?

A) Evaluation
B) Intervention
C) Nursing diagnosis
D) Planning

Answer 3

Evaluation

Question 4

An obese patient did not meet the goal of "by the end of the second week,is able to follow a 1500 calorie diet." What will the nurse and the patient reassess?

A) Patient's weight
B) Patient's understanding of the 1500 calorie diet
C) Nurse's feelings about obese patients
D) Health care agency's ability to provide the prescribed diet

Question 5

The nurse is prioritizing care of a pediatric patient diagnosed with cystic fibrosis.Which nursing diagnosis would the nurse consider the highest priority?

A) Risk for altered nutrition: less than body related to decreased appetite
B) Altered breathing pattern related to thickened mucus secretions
C) Knowledge deficit related to disease process
D) Impaired skin integrity related to decreased mobility

Question 6

What do the classification systems NIC and NOC provide?

A) Individualized data banks of treatments related to disease processes
B) Standardized language for reporting and analyzing nursing care delivery
C) A measure for cost containment within medical institutions
D) Specialized interventions for rare diseases

Question 7

A patient is experiencing adverse effects of a medication.Which information obtained by the nurse is subjective?

A) Cough
B) Edema
C) Nausea
D) Tachycardia

Question 8

What is a critical care pathway?

A) A nursing care plan for a patient in a critical care unit
B) A standardized care plan derived from best practice patterns
C) A care plan that has been critiqued by a quality improvement officer
D) A care plan based on measurable goals and outcomes

Question 9

What is the priority nursing diagnosis for an older adult with diabetes who is hospitalized for pneumonia?

A) Deficient knowledge related to lack of information about diabetic medication
B) Risk for falls related to weakness
C) Impaired gas exchange related to decreased pulmonary ventilation
D) Imbalanced nutrition: more than body requirements related to obesity

Question 10

What is the nurse's primary source of information when obtaining a patient history?

A) The physician
B) The patient record
C) The family
D) The patient

Question 11

Which type of nursing diagnosis will be written when the patient exhibits factors that make him or her susceptible to the development of a problem?

A) Actual diagnosis
B) Risk diagnosis
C) Possible diagnosis
D) Wellness diagnosis

Question 12

Which outcome statement identified by the nurse is written correctly?

A) After surgery, patient will express acceptance of loss of breast.
B) Patient will die with dignity.
C) At the end of the shift, the nurse will determine whether the patient is more comfortable.
D) Within the next 8 hours, urine output will be greater than 30 mL/hr.

Question 13

What is the primary purpose of the nursing assessment?

A) Identifying underlying pathologic conditions
B) Assisting the physician in identifying medical conditions
C) Determining the patient's mental status
D) Exploring patient responses to health problems

Question 14

Which statement(s)regarding critical pathways is/are true?

A) Efficient for specific diseases or case types
B) The same as medical plans
C) Standardized and enhanced quality care
D) Evaluated less frequently than care plans
E) Enhanced communication for a variety of health care providers

Question 15

When a nursing diagnosis statement is written,who or what directs the nurse to identify appropriate nursing interventions?

A) Other nurses on staff who have experience with the diagnoses
B) The patient and family who have an interest in the outcome
C) The etiologies of the problems identified in the nursing diagnoses
D) The medical staff who have more expertise than the nurses

Question 16

Which statement best describes the planning phase of the nursing process?

A) Administer insulin subcutaneously (subcut) in the abdominal area.
B) Patient is at high risk for falls related to hypotension.
C) The patient will state the expected adverse effects of medication by the end of the teaching session.
D) Itching has resolved; medication given is effective.

Question 17

What is the basis of the NANDA-I taxonomy?

A) Functional health patterns
B) Human response patterns
C) Basic human needs
D) Pathophysiologic needs

Question 18

Which is an example of an interdependent nursing action?

A) Assess lung sounds every 4 hours.
B) Educate the patient about the prescribed medication.
C) Administer Demerol 50 mg intramuscularly (IM) every 4 hours PRN.
D) Encourage the patient to express feelings.

Question 19

In which way(s)is nursing diagnosis different from a medical diagnosis?

A) Statement of the patient's alterations in structure and functions
B) Description of the patient's ability to function in relation to impairment
C) Tend to remain the same throughout the course of illness or recovery from injury
D) Varies depending on patient's state of recovery
E) Based on research done by nurses
F) Conditions can be accurately identified by nursing assessment methods

Question 20

Prior to the administration of a nephrotoxic drug,the nurse determines that the kidney lab data are within normal range.Which step of the nursing process is being used?

A) Assessment
B) Nursing diagnosis
C) Planning
D) Evaluation

Question 21

The nurse is participating in the planning phase of the nursing process for a new admission to a long-term care facility.When formulating a plan to meet the patient's needs,the nurse will take which action(s)?

A) Formulate nursing interventions.
B) Collect data.
C) Make a clinical judgment about the patient.
D) Set priorities.
E) Develop measurable goals.

Question 22

Rank the patient needs according to Maslow's hierarchy,beginning with the lowest level need to the highest level need.(Enter your answer with a comma and space between each lettered option as follows: A,B,C,D,E.)

A) A patient would like to write a book.
B) A patient becomes frightened when no one answers the call light during the night.
C) A pediatric patient is worrying that school friends will forget him.
D) A patient needs to be repositioned in bed.
E) A chronically ill patient states that he feels worthless because he is unable to support his family.

Question 23

The nurse is preparing a patient's prescribed medications.In order to ensure patient safety,the nurse will perform which intervention(s)?

A) Select the correct supplies.
B) Administer the medication by the correct route.
C) Use room number to identify correct patient.
D) Educate patient regarding medications prescribed.
E) Document in chart all aspects of medication administration.