QUESTIONS AND ANSWERS 100% PASS
2026 EDITION
Assessment, diagnosis, outcome identification, implementation, and evaluation - ANS What
are the 5 steps of the nursing process
health assessment - ANS involves the collection, clinical judgment, and evaluation of data to
plan and deliver client-centered care while accounting for the client's preferences, goals, and
needs. identifies the needs of the client that will be addressed by the health care team to assist
the client in achieving their highest level of health possible.
comprehensive or focused exam - ANS a health assessment can be ____ or ____
comprehensive exam - ANS a full examination of all body systems that is conducted in a
systematic way from head to toe. it is important to review any previous health conditions, or
concerns, and social determinants of health that can help direct the approach of the current
assessment and the plan of care
focused exam - ANS the assessment of either a body system or a body part that is
guided by the client's presenting concern.
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,where the client lives, economic stability, access to education, access to health care, physical
environment, and social context. - ANS What is included in the social determinants of health?
asking appropriate health history questions regarding present symptoms, allergies, or
unresolved health concerns - ANS how can you assess a clients current health condition?
inspection, palpation, auscultation, critical thinking, and therapeutic communication;
documentation of findings; collaboration with all the members of the health care team; and
collaboration with the client - ANS nursing actions that play a role in health assessment
include the use of skills such as ______, _____, ____, _______, and ______; _____;________;
and ________
nursing process - ANS a structured course of action called the nursing process to develop,
implement, and evaluate the care of clients. This process is a problem-solving approach and
provides a
blueprint for delivering care that is holistic and enhances client outcomes. a framework that
guides nurses in delivering client-focused care that considers the entire person. 5 step
sequential process
the nurse gathers information from the client through interview, physical exam, and
observation. it requires the use of critical thinking including the important data from the
information the client shared, obtaining additional data if a problem is identified, and organizing
the data according to an established framework; the application of nursing knowledge to the
collection, organization, validation, and documentation of data about a client's health status.
nurse performs a comprehensive assessment of subjective and objective information -
ANS what occurs in the assessment phase of the nursing process?
subjective and objective - ANS the assessment phase involves obtaining ____ and ____ data
subjective data - ANS derived from the client's self-report or a family member. the client's
reason, usually physical symptoms, for visiting the
provider. The nurse guides the initial interview to obtain the timeframe and extent of current
manifestations as well as any significant past medical history; data that is based upon the
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, client's feelings, perceptions, and assumptions. documented on the medical record by using
quotation marks to indicate client's verbatim remarks
objective data - ANS measurable. based on facts and on what the nurse can observe or notice
by using the senses- seeing, hearing, smelling, and touch. the nurse's observations or
measurements of a client's health condition. It is typically obtained through physical
examination or laboratory and diagnostic studies; data that can be observed by the nurse
through the senses
health database - ANS together with the individual's laboratory and diagnostic studies, these
elements form the ____
RNs analyze the subjective and objective data collected during assessment using clinical
judgment. Then the RN collaborates with the client to develop the client's plan of care,
identifying both actual and potential problems. They consider the need for education as well as
the client's readiness to learn and any barriers to learning. This step is important in determining
nursing interventions, which will be necessary for health promotion - ANS what occurs during
the diagnosis/analysis stage of the nursing process?
the nurse uses problem-solving and decision-making skills to prioritize care. The nurse
prioritizes outcomes and goals and develops interventions to meet those goals. This is a
collaboration between the RN, client, and possibly the family, in which the goals are set and
agreed upon by all parties involved. - ANS what occurs during the planning stage of the
nursing process
evidence based practice (EBP) - ANS the planning process involves using _______ and current
nursing standards
first level priority problems, second level priority problems, and third level priority problems -
ANS there are different levels of priority problems: _____, _____, and ____
First-level priority problems - ANS Emergent, life threatening, and immediate. Examples
include establishing an airway, supporting breathing, defibrillation
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