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1. Whatqisqtheqrationaleqforqusingqtheqnursingqprocessqinqplanningqcareq
for clients? q
A. As a scientific process to identify nursing diagnoses of a client
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s' healthcare problems. B. To establish nursing theory thatincorpor
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ates the biopsychosocial nature of humans. C. As a toolto organize
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thinking and clinical decision making about clients' healthcare nee
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ds.
D. To promote the management of client care in collaboration with o
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ther healthcare professionals. - Answer -
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q C (The nursing process is a problem-
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solving approach that provides an organized, systematic, decision
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making process to effectively address the client's needs and problem
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s. The nursing process includes an organized framework using knowl
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edge, judgments, and actions by the nurse as the client's plan of car
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e is determined, and encompasses assessment, analysis, planning, i
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mplementation, and evaluation of client care (C). (A, B, and D) donot q q q q q q q q q q q q
q support the basis for using the nursing process.
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Correct Answer: C) q q
2. What activity should the nurse use in the evaluation phaseof
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q the nursing process? A. Ask a client to evaluate the nursing care
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provided.
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B. Documentqtheqnursingqcareqplanqinqtheqprogressqnotes.
C. Determineq whetherq aq client'sq healthq problemsq haveq beenqal
leviated.
D. Examineq theq effectivenessq ofq nursingq interventionsq towardqmee
ting client outcomes. - Answer -
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q In the nursing process, theevaluation component examines the e
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ffectiveness of nursing interventions in achieving client outcomes
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q (D). (A) is an evaluation of client satisfaction, not outcomes. (B) i
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s a written record of the plan of care. Although (C) may occur whe
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n client outcomes are achieved, evaluation is best determined by
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attainment of measurable client outcomes. q q q q
Correct Answer: D q q
3. Which statement is an example of a correctly writtenn
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ursing diagnosis statement? A. Altered tissue perfusion rel
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ated to congestive heart failure.
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B. Alteredqurinaryqeliminationqrelatedqtoqurinaryqtractqinfection.
C. Riskqforqimpairedqtissueqintegrityqrelatedq toqclient'sqrefusalqtoqtu
rn.
D. Ineffectiveq copingq relatedq toq responseq toq positiveq biopsyq testqre
sults. - Answer - q q q
q The first part of the nursing diagnosis statement is the diagnostic
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q label and is followed by related to the cause, which should direc
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t the nurse to the appropriate
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interventions. (D) best fits this criteria. (A and B) contain a medical
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diagnosis. (C) includes an observable cause, but (D) focuses on the
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client's response, which the nurse can providesupport, reflection, a
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nd dialogue.
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Correct Answer: D q q
4. What action by the nurse demonstratesc
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ulturally sensitive care? A. Asks permissionb
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efore touching a client.
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B. Avoidsq questionsq aboutq male-femaleq relationships.
C. ExplainsqtheqdifferencesqbetweenqWesternqmedicalqcareqandqc
ultural folk remedies.
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