Reading Assessment 1 – The Nursing Process
1. The nurse is attempting to develop nursing diagnoses for her patient. The nurse understands that nursing
diagnoses:
A. identify actual or potential problems as well as responses to a problem
B. require naming patient problems using nursing diagnostic labels
C. utilize objective data since subjective data are often inaccurate
D. includes unvalidated data to determine an accurate and thorough diagnosis
E. are similar to medical diagnoses since they both are labels for diseases
Answer Key: A, B
2. Which of the following examples given indicate objective data?
A. Respirations – 24 breaths per minute
B. Wound size – 3 cm x 2 cm
C. Platelet count – 350,000 mm
D. Complaints of severe abdominal pain
E. Temperature – 98.4° F (36.8° C)
Answer Key: A, B, C, E
3. Which assessment made by the nurse should be addressed first?
A. Reddened area to coccyx
B. Decreased urinary
C. Shortness of breath
D. Drainage from surgical incision
Answer Key: C
4. The nurse has a thorough understanding of the planning phase of the nursing process when stating:
A. “Patients should be included in the planning process”
B. “Patient families should not interfere in the planning process”
C. “The planning process should focus on short-term goals only”
D. “Planning is the first phase of the nursing process”
Answer Key: A
5. The nursing process is an attempt to meet patient needs. As such, it:
A. is linear in nature
B. is dynamic and cyclic
C. requires care plans to be re-evaluated occasionally
D. does not allow care plans to be modified
Answer Key:B