EVISNEHERPMOC • 2 MAXE
Nursing Fundamentals
NURS School of Nursing — Exam 2 Comprehensive Review
NURSING PROCESS · CLINICAL JUDGMENT · VITAL SIGNS · CARE PLANNING
EXAM 2
Fundamentals Exam 2 — Comprehensive Review
N U R S I N G P R O C E SS , C L I N I C A L J U D G M E N T M O D E LS , A SS E SS M E N T, D I A G N O S I S , P L A N N I N G & V I TA L S I G N S
INSTITUTION School of Nursing COURSE CODE NURS-FUND-EXAM2
PROGRAM Nursing — ADN / BSN Pathway ACADEMIC YEAR
EXAM TITLE Fundamentals Exam 2 TOTAL QUESTIONS 80+ Comprehensive Questions
COURSE TITLE Nursing Fundamentals FORMAT Multiple Choice / Definition / Select All That
Apply
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise indicated.
▸ Questions cover the nursing process (ADPIE), clinical judgment models (Tanner, Lasater, NCSBN), types of assessment, nursing
diagnoses, outcome identification, implementation, evaluation, vital signs, and professional standards.
▸ Verified answers with detailed rationales are provided for comprehensive exam preparation.
▸ Pay close attention to the differences between independent, dependent, and collaborative nursing interventions, and the proper
sequence of the nursing process.
NURSING PROCESS, CLINICAL JUDGMENT & VITAL SIGNS Questions 1 – 80+
1. What are the ANA definitions of nursing practice?
A. Only administering medications and following physician orders.
B. Building caring relationships; considering the whole person; combining patient data with experience; using science/critical
thinking; improving knowledge through research; advocating for fair healthcare policies; providing safe, evidence-based
care.
C. Documenting patient encounters only.
D. Performing tasks delegated by physicians.
CORRECT ANSWER B — Caring relationships, holistic care, evidence integration, critical thinking, research, advocacy, safe/quality
care
RATIONALE The ANA defines professional nursing as a multifaceted discipline encompassing: building therapeutic, caring
relationships that promote healing; holistic consideration of how body, emotions, family, and environment affect
health; integrating patient data with clinical experience to guide individualized care; applying scientific knowledge
and critical thinking for sound clinical decisions; advancing nursing knowledge through research and continuous
learning; advocating for equitable healthcare policies and social justice; and delivering safe, high-quality, evidence-
based care. This definition establishes nursing's professional identity, autonomy, and accountability.
, 2. What are the components of thoughtful person-centered practice?
A. Only the nursing process.
B. The person, the professional nurse, reflective practice, clinical reasoning/judgment/decision-making, nurse's action in
response to need, and the person-centered nursing process.
C. Only vital signs and documentation.
D. Only physician orders.
CORRECT ANSWER B — The person, professional nurse, reflective practice, clinical reasoning/judgment, responsive action,
person-centered nursing process
RATIONALE Thoughtful person-centered practice integrates six interconnected components: (1) The Person — the unique
individual with values, preferences, and needs at the center; (2) The Professional Nurse — bringing knowledge, skills,
and ethical commitment; (3) Reflective Practice Leading to Personal Learning — deliberate self-examination of
actions and outcomes; (4) Clinical Reasoning, Judgment, and Decision-Making — the cognitive processes linking
assessment to action; (5) The Nurse's Action in Response to Individual Clinical Need — tailored interventions; (6)
Person-Centered Nursing Process — ADPIE adapted to the individual. This model emphasizes that the patient, not
the task, drives care.
3. What are the 10 guiding principles of person-centered care?
A. Only principles related to medication administration.
B. Everyone on the team provides care; ongoing healing relationships; personalized care; open information sharing; calm
healing environment; family/friends included; safety priority; transparency; team collaboration for patient goals; patient
guides their own care.
C. Only infection control principles.
D. Only documentation standards.
CORRECT ANSWER B — Team care, healing relationships, personalization, information sharing, healing environment, family
inclusion, safety, transparency, collaboration, patient autonomy
RATIONALE The 10 guiding principles operationalize patient-centered care: (1) All healthcare team members provide care — not
just the nurse; (2) Build ongoing healing relationships — continuity matters; (3) Personalize care to patient needs and
choices; (4) Share information openly with patients and the team; (5) Create a calm, supportive healing environment;
(6) Include family and friends as care partners; (7) Make patient safety a top priority; (8) Be open and honest
(transparency); (9) Work together for the patient's goals (interprofessional collaboration); (10) Let the patient guide
their own care (autonomy and shared decision-making). These principles are foundational to QSEN patient-centered
care competency.
4. What are the four phases of Tanner's Clinical Judgment Model?
A. Assess, Diagnose, Plan, Evaluate.
B. Notice, Interpret, Respond, Reflect.
C. Observe, Document, Report, Follow-up.
D. Screen, Test, Refer, Treat.
CORRECT ANSWER B — Notice (recognize), Interpret (understand meaning), Respond (take action), Reflect (evaluate outcome)
RATIONALE Tanner's model describes how nurses think in real-time clinical situations: (1) Noticing — recognizing what is
happening through focused observation, recognizing patterns, and detecting deviations from expected; (2)
Interpreting — understanding the meaning of the clinical data, prioritizing what is most important; (3) Responding —
taking appropriate, timely action based on interpretation; (4) Reflecting — evaluating the outcome of actions
(reflection-in-action during the event; reflection-on-action afterward). This model is the foundation for the Lasater
Clinical Judgment Rubric and Next Generation NCLEX clinical judgment measurement.
Nursing Fundamentals
NURS School of Nursing — Exam 2 Comprehensive Review
NURSING PROCESS · CLINICAL JUDGMENT · VITAL SIGNS · CARE PLANNING
EXAM 2
Fundamentals Exam 2 — Comprehensive Review
N U R S I N G P R O C E SS , C L I N I C A L J U D G M E N T M O D E LS , A SS E SS M E N T, D I A G N O S I S , P L A N N I N G & V I TA L S I G N S
INSTITUTION School of Nursing COURSE CODE NURS-FUND-EXAM2
PROGRAM Nursing — ADN / BSN Pathway ACADEMIC YEAR
EXAM TITLE Fundamentals Exam 2 TOTAL QUESTIONS 80+ Comprehensive Questions
COURSE TITLE Nursing Fundamentals FORMAT Multiple Choice / Definition / Select All That
Apply
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise indicated.
▸ Questions cover the nursing process (ADPIE), clinical judgment models (Tanner, Lasater, NCSBN), types of assessment, nursing
diagnoses, outcome identification, implementation, evaluation, vital signs, and professional standards.
▸ Verified answers with detailed rationales are provided for comprehensive exam preparation.
▸ Pay close attention to the differences between independent, dependent, and collaborative nursing interventions, and the proper
sequence of the nursing process.
NURSING PROCESS, CLINICAL JUDGMENT & VITAL SIGNS Questions 1 – 80+
1. What are the ANA definitions of nursing practice?
A. Only administering medications and following physician orders.
B. Building caring relationships; considering the whole person; combining patient data with experience; using science/critical
thinking; improving knowledge through research; advocating for fair healthcare policies; providing safe, evidence-based
care.
C. Documenting patient encounters only.
D. Performing tasks delegated by physicians.
CORRECT ANSWER B — Caring relationships, holistic care, evidence integration, critical thinking, research, advocacy, safe/quality
care
RATIONALE The ANA defines professional nursing as a multifaceted discipline encompassing: building therapeutic, caring
relationships that promote healing; holistic consideration of how body, emotions, family, and environment affect
health; integrating patient data with clinical experience to guide individualized care; applying scientific knowledge
and critical thinking for sound clinical decisions; advancing nursing knowledge through research and continuous
learning; advocating for equitable healthcare policies and social justice; and delivering safe, high-quality, evidence-
based care. This definition establishes nursing's professional identity, autonomy, and accountability.
, 2. What are the components of thoughtful person-centered practice?
A. Only the nursing process.
B. The person, the professional nurse, reflective practice, clinical reasoning/judgment/decision-making, nurse's action in
response to need, and the person-centered nursing process.
C. Only vital signs and documentation.
D. Only physician orders.
CORRECT ANSWER B — The person, professional nurse, reflective practice, clinical reasoning/judgment, responsive action,
person-centered nursing process
RATIONALE Thoughtful person-centered practice integrates six interconnected components: (1) The Person — the unique
individual with values, preferences, and needs at the center; (2) The Professional Nurse — bringing knowledge, skills,
and ethical commitment; (3) Reflective Practice Leading to Personal Learning — deliberate self-examination of
actions and outcomes; (4) Clinical Reasoning, Judgment, and Decision-Making — the cognitive processes linking
assessment to action; (5) The Nurse's Action in Response to Individual Clinical Need — tailored interventions; (6)
Person-Centered Nursing Process — ADPIE adapted to the individual. This model emphasizes that the patient, not
the task, drives care.
3. What are the 10 guiding principles of person-centered care?
A. Only principles related to medication administration.
B. Everyone on the team provides care; ongoing healing relationships; personalized care; open information sharing; calm
healing environment; family/friends included; safety priority; transparency; team collaboration for patient goals; patient
guides their own care.
C. Only infection control principles.
D. Only documentation standards.
CORRECT ANSWER B — Team care, healing relationships, personalization, information sharing, healing environment, family
inclusion, safety, transparency, collaboration, patient autonomy
RATIONALE The 10 guiding principles operationalize patient-centered care: (1) All healthcare team members provide care — not
just the nurse; (2) Build ongoing healing relationships — continuity matters; (3) Personalize care to patient needs and
choices; (4) Share information openly with patients and the team; (5) Create a calm, supportive healing environment;
(6) Include family and friends as care partners; (7) Make patient safety a top priority; (8) Be open and honest
(transparency); (9) Work together for the patient's goals (interprofessional collaboration); (10) Let the patient guide
their own care (autonomy and shared decision-making). These principles are foundational to QSEN patient-centered
care competency.
4. What are the four phases of Tanner's Clinical Judgment Model?
A. Assess, Diagnose, Plan, Evaluate.
B. Notice, Interpret, Respond, Reflect.
C. Observe, Document, Report, Follow-up.
D. Screen, Test, Refer, Treat.
CORRECT ANSWER B — Notice (recognize), Interpret (understand meaning), Respond (take action), Reflect (evaluate outcome)
RATIONALE Tanner's model describes how nurses think in real-time clinical situations: (1) Noticing — recognizing what is
happening through focused observation, recognizing patterns, and detecting deviations from expected; (2)
Interpreting — understanding the meaning of the clinical data, prioritizing what is most important; (3) Responding —
taking appropriate, timely action based on interpretation; (4) Reflecting — evaluating the outcome of actions
(reflection-in-action during the event; reflection-on-action afterward). This model is the foundation for the Lasater
Clinical Judgment Rubric and Next Generation NCLEX clinical judgment measurement.
