NUR3632 Foundations Exam 2 Study |\ |\ |\ |\ |\
questions with answers |\ |\
A nurse is planning care for a male adolescent patient who is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
admitted to the hospital for treatment of a drug overdose. Which
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
nursing actions are related to the outcome identification and
|\ |\ |\ |\ |\ |\ |\ |\ |\
planning step of the nursing process? Select all that apply.
|\ |\ |\ |\ |\ |\ |\ |\ |\
The nurse formulates nursing diagnoses.
|\ |\ |\ |\
The nurse identifies expected patient outcomes.
|\ |\ |\ |\ |\
The nurse selects evidence-based nursing interventions.
|\ |\ |\ |\ |\
The nurse explains the nursing care plan to the patient.
|\ |\ |\ |\ |\ |\ |\ |\ |\
The nurse assesses the patient's mental status.
|\ |\ |\ |\ |\ |\
The nurse evaluates the patient's outcome achievement. -
|\ |\ |\ |\ |\ |\ |\ |\
CORRECT ANSWERS ✔✔b, c, d. During the outcome identification
|\ |\ |\ |\ |\ |\ |\ |\
and planning step of the nursing process, the nurse works in
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
partnership with the patient and family to establish priorities,
|\ |\ |\ |\ |\ |\ |\ |\ |\
identify and write expected patient outcomes, select evidence-based
|\ |\ |\ |\ |\ |\ |\ |\
nursing interventions, and communicate the plan of nursing care.
|\ |\ |\ |\ |\ |\ |\ |\ |\
Although all these steps may overlap, formulating and validating
|\ |\ |\ |\ |\ |\ |\ |\ |\
nursing diagnoses occurs most frequently during the diagnosing
|\ |\ |\ |\ |\ |\ |\ |\
step of the nursing process. Assessing mental status is part of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
assessment step, and evaluating patient outcomes occurs during the
|\ |\ |\ |\ |\ |\ |\ |\ |\
evaluation step of the nursing process.
|\ |\ |\ |\ |\
,A nurse on a busy surgical unit relies on informal planning to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
provide appropriate nursing responses to patients in a timely
|\ |\ |\ |\ |\ |\ |\ |\ |\
manner. What are examples of this type of planning? Select all that
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
apply.
A nurse sits down with a patient and prioritizes existing diagnoses.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
A nurse assesses a woman for postpartum depression during routine
|\ |\ |\ |\ |\ |\ |\ |\ |\
care.
|\
A nurse plans interventions for a patient who is diagnosed with
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
epilepsy.
A busy nurse takes time to speak to a patient who received bad
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
news.
A nurse reassesses a patient whose PRN pain medication is not
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
working.
A nurse coordinates the home care of a patient being discharged. -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
CORRECT ANSWERS ✔✔b, d, e. Informal planning is a link
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
between identifying a patient's strength or problem and providing
|\ |\ |\ |\ |\ |\ |\ |\ |\
an appropriate nursing response. This occurs, for example, when a
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
busy nurse first recognizes postpartum depression in a patient, takes
|\ |\ |\ |\ |\ |\ |\ |\ |\
time to assess a patient who received bad news about tests, or
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
reassesses a patient for pain. Formal planning involves prioritizing
|\ |\ |\ |\ |\ |\ |\ |\ |\
diagnoses, formally planning interventions, and coordinating the
|\ |\ |\ |\ |\ |\ |\
home care of a patient being discharged.
|\ |\ |\ |\ |\ |\
,3. When helping a patient turn in bed, the nurse notices that his
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
heels are reddened and plans to place him on precautions for skin
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
breakdown. This is an example of what type of planning? |\ |\ |\ |\ |\ |\ |\ |\ |\
Initial planning |\
Standardized planning |\
Ongoing planning |\
Discharge planning - CORRECT ANSWERS ✔✔c. Ongoing |\ |\ |\ |\ |\ |\ |\
planning is problem oriented and has as its purpose keeping the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
plan up to date as new actual or potential problems are identified.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Initial planning addresses each problem listed in the prioritized
|\ |\ |\ |\ |\ |\ |\ |\ |\
nursing diagnoses and identifies appropriate patient goals and the
|\ |\ |\ |\ |\ |\ |\ |\ |\
related nursing care. Standardized care plans are prepared plans of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
care that identify the nursing diagnoses, outcomes, and related
|\ |\ |\ |\ |\ |\ |\ |\ |\
nursing interventions common to a specific population or health
|\ |\ |\ |\ |\ |\ |\ |\ |\
problem. During discharge planning, the nurse uses teaching and
|\ |\ |\ |\ |\ |\ |\ |\ |\
counseling skills effectively to help the patient and family develop
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
sufficient knowledge of the health problem and the therapeutic
|\ |\ |\ |\ |\ |\ |\ |\ |\
regimen to carry out necessary self-care behaviors competently at
|\ |\ |\ |\ |\ |\ |\ |\ |\
home.
. A nurse is prioritizing the following patient diagnoses according to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Maslow's hierarchy of human needs:
|\ |\ |\ |\ |\
(1) Disturbed Body Image
|\ |\ |\
(2) Ineffective Airway Clearance
|\ |\ |\
(3) Spiritual Distress
|\ |\
, (4) Impaired Social Interaction
|\ |\ |\
Which answer choice below lists the problems in order of highest
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
priority to lowest priority based on Maslow's model?
|\ |\ |\ |\ |\ |\ |\
2, 4, 1, 3|\ |\ |\
3, 1, 4, 2|\ |\ |\
2, 4, 3, 1|\ |\ |\
3, 2, 4, 1 - CORRECT ANSWERS ✔✔a. 2, 4, 1, 3. Because basic
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
needs must be met before a person can focus on higher ones,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
patient needs may be prioritized according to Maslow's hierarchy:
|\ |\ |\ |\ |\ |\ |\ |\ |\
(1) physiologic needs, (2) safety needs, (3) love and belonging needs,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
(4) self-esteem needs, and (5) self-actualization needs. #2 is an
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
example of a physiologic need, #4 is an example of a love and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
belonging need, #1 is an example of a self-esteem need, and #3 is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
an example of a self-actualization need.
|\ |\ |\ |\ |\
. A nurse is using critical pathway methodology for choosing
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
interventions for a patient who is receiving chemotherapy for breast |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
cancer. Which nursing actions are characteristics of this system
|\ |\ |\ |\ |\ |\ |\ |\ |\
being used when planning care? Select all that apply.
|\ |\ |\ |\ |\ |\ |\ |\
The nurse uses a minimal practice standard and is able to alter care
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
to meet the patient's individual needs.
|\ |\ |\ |\ |\
The nurse uses a binary decision tree for stepwise assessment and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
intervention.
questions with answers |\ |\
A nurse is planning care for a male adolescent patient who is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
admitted to the hospital for treatment of a drug overdose. Which
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
nursing actions are related to the outcome identification and
|\ |\ |\ |\ |\ |\ |\ |\ |\
planning step of the nursing process? Select all that apply.
|\ |\ |\ |\ |\ |\ |\ |\ |\
The nurse formulates nursing diagnoses.
|\ |\ |\ |\
The nurse identifies expected patient outcomes.
|\ |\ |\ |\ |\
The nurse selects evidence-based nursing interventions.
|\ |\ |\ |\ |\
The nurse explains the nursing care plan to the patient.
|\ |\ |\ |\ |\ |\ |\ |\ |\
The nurse assesses the patient's mental status.
|\ |\ |\ |\ |\ |\
The nurse evaluates the patient's outcome achievement. -
|\ |\ |\ |\ |\ |\ |\ |\
CORRECT ANSWERS ✔✔b, c, d. During the outcome identification
|\ |\ |\ |\ |\ |\ |\ |\
and planning step of the nursing process, the nurse works in
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
partnership with the patient and family to establish priorities,
|\ |\ |\ |\ |\ |\ |\ |\ |\
identify and write expected patient outcomes, select evidence-based
|\ |\ |\ |\ |\ |\ |\ |\
nursing interventions, and communicate the plan of nursing care.
|\ |\ |\ |\ |\ |\ |\ |\ |\
Although all these steps may overlap, formulating and validating
|\ |\ |\ |\ |\ |\ |\ |\ |\
nursing diagnoses occurs most frequently during the diagnosing
|\ |\ |\ |\ |\ |\ |\ |\
step of the nursing process. Assessing mental status is part of the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
assessment step, and evaluating patient outcomes occurs during the
|\ |\ |\ |\ |\ |\ |\ |\ |\
evaluation step of the nursing process.
|\ |\ |\ |\ |\
,A nurse on a busy surgical unit relies on informal planning to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
provide appropriate nursing responses to patients in a timely
|\ |\ |\ |\ |\ |\ |\ |\ |\
manner. What are examples of this type of planning? Select all that
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
apply.
A nurse sits down with a patient and prioritizes existing diagnoses.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
A nurse assesses a woman for postpartum depression during routine
|\ |\ |\ |\ |\ |\ |\ |\ |\
care.
|\
A nurse plans interventions for a patient who is diagnosed with
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
epilepsy.
A busy nurse takes time to speak to a patient who received bad
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
news.
A nurse reassesses a patient whose PRN pain medication is not
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
working.
A nurse coordinates the home care of a patient being discharged. -
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
CORRECT ANSWERS ✔✔b, d, e. Informal planning is a link
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
between identifying a patient's strength or problem and providing
|\ |\ |\ |\ |\ |\ |\ |\ |\
an appropriate nursing response. This occurs, for example, when a
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
busy nurse first recognizes postpartum depression in a patient, takes
|\ |\ |\ |\ |\ |\ |\ |\ |\
time to assess a patient who received bad news about tests, or
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
reassesses a patient for pain. Formal planning involves prioritizing
|\ |\ |\ |\ |\ |\ |\ |\ |\
diagnoses, formally planning interventions, and coordinating the
|\ |\ |\ |\ |\ |\ |\
home care of a patient being discharged.
|\ |\ |\ |\ |\ |\
,3. When helping a patient turn in bed, the nurse notices that his
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
heels are reddened and plans to place him on precautions for skin
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
breakdown. This is an example of what type of planning? |\ |\ |\ |\ |\ |\ |\ |\ |\
Initial planning |\
Standardized planning |\
Ongoing planning |\
Discharge planning - CORRECT ANSWERS ✔✔c. Ongoing |\ |\ |\ |\ |\ |\ |\
planning is problem oriented and has as its purpose keeping the
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
plan up to date as new actual or potential problems are identified.
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Initial planning addresses each problem listed in the prioritized
|\ |\ |\ |\ |\ |\ |\ |\ |\
nursing diagnoses and identifies appropriate patient goals and the
|\ |\ |\ |\ |\ |\ |\ |\ |\
related nursing care. Standardized care plans are prepared plans of
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
care that identify the nursing diagnoses, outcomes, and related
|\ |\ |\ |\ |\ |\ |\ |\ |\
nursing interventions common to a specific population or health
|\ |\ |\ |\ |\ |\ |\ |\ |\
problem. During discharge planning, the nurse uses teaching and
|\ |\ |\ |\ |\ |\ |\ |\ |\
counseling skills effectively to help the patient and family develop
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
sufficient knowledge of the health problem and the therapeutic
|\ |\ |\ |\ |\ |\ |\ |\ |\
regimen to carry out necessary self-care behaviors competently at
|\ |\ |\ |\ |\ |\ |\ |\ |\
home.
. A nurse is prioritizing the following patient diagnoses according to
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
Maslow's hierarchy of human needs:
|\ |\ |\ |\ |\
(1) Disturbed Body Image
|\ |\ |\
(2) Ineffective Airway Clearance
|\ |\ |\
(3) Spiritual Distress
|\ |\
, (4) Impaired Social Interaction
|\ |\ |\
Which answer choice below lists the problems in order of highest
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
priority to lowest priority based on Maslow's model?
|\ |\ |\ |\ |\ |\ |\
2, 4, 1, 3|\ |\ |\
3, 1, 4, 2|\ |\ |\
2, 4, 3, 1|\ |\ |\
3, 2, 4, 1 - CORRECT ANSWERS ✔✔a. 2, 4, 1, 3. Because basic
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
needs must be met before a person can focus on higher ones,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
patient needs may be prioritized according to Maslow's hierarchy:
|\ |\ |\ |\ |\ |\ |\ |\ |\
(1) physiologic needs, (2) safety needs, (3) love and belonging needs,
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
(4) self-esteem needs, and (5) self-actualization needs. #2 is an
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
example of a physiologic need, #4 is an example of a love and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
belonging need, #1 is an example of a self-esteem need, and #3 is
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
an example of a self-actualization need.
|\ |\ |\ |\ |\
. A nurse is using critical pathway methodology for choosing
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\
interventions for a patient who is receiving chemotherapy for breast |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
cancer. Which nursing actions are characteristics of this system
|\ |\ |\ |\ |\ |\ |\ |\ |\
being used when planning care? Select all that apply.
|\ |\ |\ |\ |\ |\ |\ |\
The nurse uses a minimal practice standard and is able to alter care
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
to meet the patient's individual needs.
|\ |\ |\ |\ |\
The nurse uses a binary decision tree for stepwise assessment and
|\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\
intervention.
