NSG 100 EXAM 2 MULTIPLE CHOICE
QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS 100%
CORRECT (GRADED A+)
Question: Which of the following best describes the primary purpose of
the nursing process?
a. To provide a framework for patient-centered care. b. To identify the specific
members of the healthcare team. c. To organize the cognitive framework nurses
use to approach patient care. d. To facilitate better communication between
various healthcare departments.
Answer: c. Organizing the way nurses think about patient care.
Rationale: While the nursing process does support communication and patient-
centered care, its fundamental purpose is to provide a systematic, logical, and
organized method of critical thinking. It ensures that nursing care is deliberate
and scientific rather than random or intuitive. ✔✔
Question: A patient presents to the emergency department reporting
nausea and vomiting. Which of the following should the nurse prioritize
during the initial assessment?
a. Inquiring about a family history of metabolic disorders like diabetes. b.
Reviewing the list of medications the patient is currently prescribed. c. Asking
the patient about their previous surgical history. d. Investigating the intensity,
frequency, and duration of the symptoms.
Answer: d. Severity and duration of the nausea and vomiting.
Rationale: According to the nursing process, the first step is to assess the
"chief complaint." Understanding the severity and duration of the current
symptoms allows the nurse to determine the urgency of care and the risk of
immediate complications like dehydration. ✔✔
Question: An oriented and alert patient is admitted with reports of chest
pain. Who is the most appropriate source for primary data collection?
a. The patient's immediate family members. b. The admitting physician. c. The
nurse who managed the patient during the previous shift. d. The patient.
Answer: d. Patient.
,Rationale: A "primary source" is the patient themselves. If a patient is
conscious, alert, and oriented, they are the most accurate and direct source for
subjective data regarding their symptoms and history. ✔✔
Question: What is the main objective of formulating a nursing diagnosis?
a. To clear up any confusion the patient has regarding their treatment. b. To
effectively communicate the specific needs of the patient. c. To satisfy the
documentation requirements of accreditation bodies. d. To clearly define the
nurse's legal scope of practice.
Answer: b. Communicating patient needs.
Rationale: The nursing diagnosis acts as a standardized label that identifies a
patient's response to a health condition. It communicates these specific needs to
the entire nursing team to ensure consistent and targeted care. ✔✔
Question: Upon what basis does a nurse identify and select a specific
nursing diagnosis for a patient?
a. Initial impressions formed during the first encounter. b. Professional nursing
intuition and "gut feelings." c. The analysis of clustered data and identified
patterns. d. The existing medical diagnosis provided by the doctor.
Answer: c. Clustered data.
Rationale: A nursing diagnosis is not based on a single sign or symptom.
Instead, the nurse "clusters" related pieces of assessment data to identify a
pattern that points to a specific health problem or nursing diagnosis. ✔✔
Which statement is an appropriately written short-term goal?
a. Patient will walk to the bathroom independently without falling within 2
days after surgery.
b. Nurse will watch patient demonstrate proper insulin injection technique each
morning.
c. Patient's spouse will express satisfaction with patient's progress before
discharge.
d. Patient's incision will be well approximated each time it is assessed by the
nurse. -ANSWER ✔✔Patient will walk to the bathroom independently without
falling within 2 days after surgery.
What should be the primary focus for nursing interventions?
a. Patient needs
b. Nurse concerns
c. Physician priorities
, d. Patient's family requests -ANSWER ✔✔a. Patient needs
Which nursing action is critical before delegating interventions to another
member of the health care team?
a. Locate all members of the health care team.
b. Notify the physician of potential complications.
c. Know the scope of practice and competency of the other team member.
d. Call a meeting of the health care team to determine the needs of the patient. -
ANSWER ✔✔c. Know the scope of practice and competency of the other team
member.
A patient reports feeling tired and complains of not sleeping at night. What
action should the nurse perform first?
a. Identify reasons the patient is unable to sleep.
b. Request medication to help the patient sleep.
c. Tell the patient that sleep will come with relaxation.
d. Notify the physician that the patient is restless and anxious. -ANSWER
✔✔a. Identify reasons the patient is unable to sleep.
What action should the nurse take regarding a patient's plan of care if the
patient appears to have met the short-term goal of urinating within 1 hour after
surgery?
a. Consult the surgeon to see if the clinical pathway is being followed.
b. Discontinue the plan of care, because the patient has met the established
goal.
c. Monitor patient urine output to evaluate the need for the current plan of care.
d. Notify the patient that the goal has been attained and no further intervention
is needed. -ANSWER ✔✔c. Monitor patient urine output to evaluate the need
for the current plan of care.
Which action by a patient marks the beginning of the physical assessment
process?
a. Redressing after a physical examination
b. Breathing normally during auscultation
c. Greeting the nurse in the examination room
d. Sharing work environment information -ANSWER ✔✔c. Greeting the nurse
in the examination room
QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS 100%
CORRECT (GRADED A+)
Question: Which of the following best describes the primary purpose of
the nursing process?
a. To provide a framework for patient-centered care. b. To identify the specific
members of the healthcare team. c. To organize the cognitive framework nurses
use to approach patient care. d. To facilitate better communication between
various healthcare departments.
Answer: c. Organizing the way nurses think about patient care.
Rationale: While the nursing process does support communication and patient-
centered care, its fundamental purpose is to provide a systematic, logical, and
organized method of critical thinking. It ensures that nursing care is deliberate
and scientific rather than random or intuitive. ✔✔
Question: A patient presents to the emergency department reporting
nausea and vomiting. Which of the following should the nurse prioritize
during the initial assessment?
a. Inquiring about a family history of metabolic disorders like diabetes. b.
Reviewing the list of medications the patient is currently prescribed. c. Asking
the patient about their previous surgical history. d. Investigating the intensity,
frequency, and duration of the symptoms.
Answer: d. Severity and duration of the nausea and vomiting.
Rationale: According to the nursing process, the first step is to assess the
"chief complaint." Understanding the severity and duration of the current
symptoms allows the nurse to determine the urgency of care and the risk of
immediate complications like dehydration. ✔✔
Question: An oriented and alert patient is admitted with reports of chest
pain. Who is the most appropriate source for primary data collection?
a. The patient's immediate family members. b. The admitting physician. c. The
nurse who managed the patient during the previous shift. d. The patient.
Answer: d. Patient.
,Rationale: A "primary source" is the patient themselves. If a patient is
conscious, alert, and oriented, they are the most accurate and direct source for
subjective data regarding their symptoms and history. ✔✔
Question: What is the main objective of formulating a nursing diagnosis?
a. To clear up any confusion the patient has regarding their treatment. b. To
effectively communicate the specific needs of the patient. c. To satisfy the
documentation requirements of accreditation bodies. d. To clearly define the
nurse's legal scope of practice.
Answer: b. Communicating patient needs.
Rationale: The nursing diagnosis acts as a standardized label that identifies a
patient's response to a health condition. It communicates these specific needs to
the entire nursing team to ensure consistent and targeted care. ✔✔
Question: Upon what basis does a nurse identify and select a specific
nursing diagnosis for a patient?
a. Initial impressions formed during the first encounter. b. Professional nursing
intuition and "gut feelings." c. The analysis of clustered data and identified
patterns. d. The existing medical diagnosis provided by the doctor.
Answer: c. Clustered data.
Rationale: A nursing diagnosis is not based on a single sign or symptom.
Instead, the nurse "clusters" related pieces of assessment data to identify a
pattern that points to a specific health problem or nursing diagnosis. ✔✔
Which statement is an appropriately written short-term goal?
a. Patient will walk to the bathroom independently without falling within 2
days after surgery.
b. Nurse will watch patient demonstrate proper insulin injection technique each
morning.
c. Patient's spouse will express satisfaction with patient's progress before
discharge.
d. Patient's incision will be well approximated each time it is assessed by the
nurse. -ANSWER ✔✔Patient will walk to the bathroom independently without
falling within 2 days after surgery.
What should be the primary focus for nursing interventions?
a. Patient needs
b. Nurse concerns
c. Physician priorities
, d. Patient's family requests -ANSWER ✔✔a. Patient needs
Which nursing action is critical before delegating interventions to another
member of the health care team?
a. Locate all members of the health care team.
b. Notify the physician of potential complications.
c. Know the scope of practice and competency of the other team member.
d. Call a meeting of the health care team to determine the needs of the patient. -
ANSWER ✔✔c. Know the scope of practice and competency of the other team
member.
A patient reports feeling tired and complains of not sleeping at night. What
action should the nurse perform first?
a. Identify reasons the patient is unable to sleep.
b. Request medication to help the patient sleep.
c. Tell the patient that sleep will come with relaxation.
d. Notify the physician that the patient is restless and anxious. -ANSWER
✔✔a. Identify reasons the patient is unable to sleep.
What action should the nurse take regarding a patient's plan of care if the
patient appears to have met the short-term goal of urinating within 1 hour after
surgery?
a. Consult the surgeon to see if the clinical pathway is being followed.
b. Discontinue the plan of care, because the patient has met the established
goal.
c. Monitor patient urine output to evaluate the need for the current plan of care.
d. Notify the patient that the goal has been attained and no further intervention
is needed. -ANSWER ✔✔c. Monitor patient urine output to evaluate the need
for the current plan of care.
Which action by a patient marks the beginning of the physical assessment
process?
a. Redressing after a physical examination
b. Breathing normally during auscultation
c. Greeting the nurse in the examination room
d. Sharing work environment information -ANSWER ✔✔c. Greeting the nurse
in the examination room
