Fundamentals of Nursing Exam 1 TB C
g g g g g g
hapters 9, 13, 14, 15, 27, 28, 29, 31,
g g g g g g g g
32, 36, and 37
g g g
, Chapterg09:gNursinggProcessgMygNursinggTestgBanksgChapterg09:gNursinggProcessgP
otter:gEssentialsgforgNursinggPractice,g8thgEditiongMULTIPLEgCHOICE
1. Agnursegisgcollectinggdatagongagpatientgwhogisgbeinggadmittedgintoghospicegcare.gThegnurs
egcollectsgdatagfromgbothgthegpatientgandgthegfamilygsogthatgagcleargpicturegofgthegpatientgstatusgi
sgobtained.gThegnursegisgcurrentlyginvolvedgingwhichgstepgofgthegnursinggprocess?
a. Assessment
b. Implementation
c. Evaluation
d. Diagnosing
ANS:gA
g
Assessmentgisgthegdeliberategandgsystematicgcollectiongofgdatagaboutgagpatient.gThegdatagwillgrev
ealgagpatientsgcurrentgandgpastghealthgstatus,gfunctionalgstatus,gandgpresentgandgpastgcopinggpatter
ns.gAgnursinggdiagnosisgisgagclinicalgjudgmentgaboutgindividual,gfamily,gorgcommunitygresponses
gtogactualgandgpotentialghealthgproblemsgorglifegprocessesgthatgthegnursegisglicensedgandgcompeten
tgtogtreat.gImplementationgisgthegperformancegofgnursingginterventionsgnecessarygforgachievinggth
eggoalsgandgexpectedgoutcomesgofgnursinggcare.gEvaluationgisgcrucialgtogdecidinggwhether,gafterg
interventionsghavegbeengdelivered,gagpatientsgconditiongorgwell-beinggimproves.
PTS:1DIF:CognitivegLevel:gApplyingg(Application)gREF:124OBJescribegeachgstepgofgthegnursi
nggprocess.
TOP:gNursinggProcess:gAssessmentgMSC:gNCLEX:gManagementgofgCare
2. Thegnursegisgadmittinggagpatientgtogthegunitgandgasksgthegpatientgaboutgtheghealthghistor
y.gThegnursegisgengagedgingwhichgcomponentgofgthegnursinggprocess?
a. Evaluation
b. Diagnosis
c. Assessment
d. Planning
ANS:gC
g
,Thegnursegisgingthegassessmentgphase.gAngassessmentgdatabasegincludesgagpatientsgcomprehensiv
eghealthghistory,gwhichgincludesginformationgaboutgagpatientsgphysicalgandgdevelopmentalgstatus
,gemotionalghealth,gsocialgpracticesgandgresources,ggoals,gvalues,glifestyle,gandgexpectationsgabo
utgtheghealthgcaregsystem.gThegdatabasegalsogincludesgphysicalgexaminationgfindingsgandgagsum
marygofgresultsgfromglaboratorygandgdiagnosticgtesting.gAgnursinggdiagnosisgisgagclinicalgjudgme
ntgaboutgindividual,gfamily,gorgcommunitygresponsesgtogactualgandgpotentialghealthgproblemsgorg
lifegprocessesgthatgthegnursegisglicensedgandgcompetentgtogtreat.gEvaluationgisgcrucialgtogdecidin
ggwhether,gafterginterventionsghavegbeengdelivered,gagpatientsgconditiongorgwell-beinggimproves.
Planningginvolvesgsettinggpriorities,gidentifyinggpatient-
centeredggoalsgandgexpectedgoutcomes,gandgprescribinggnursingginterventions.
PTS:1DIF:CognitivegLevel:gApplyingg(Application)
REF:g124gOBJ:gDiscussgapproachesgtogdatagcollectiongingnursinggassessment.gTOP:gNursinggPr
ocess:gAssessmentgMSC:gNCLEX:gManagementgofgCare
3. Agpostoperativegpatientgisgcontinuinggtoghavegincisionalgpain.gAsgpartgofgthegnursesgasses
sment,gthegnursegnotesgthatgthegpatientgisggrimacinggwhenghegorgshegchangesgposition.gThegpatie
ntsggrimacegcangbegusefulgingthegassessmentgandgcangbegdescribedgasgwhichgofgthegfollowing?
a. Cue
b. Inference
c. Diagnosis
d. Healthgpattern
ANS:gA
g
Grimacinggisgagcue.gAgcuegisginformationgthatgagnursegobtainsgthroughgusegofgthegsenses.gAnginfe
rencegisgyourgjudgmentgorginterpretationgofgthesegcues.gGordonsgfunctionalghealthgpatternsgaregagt
ypegofgdatabasegformatgtogobtaingagcomprehensivegassessment.gAgnursinggdiagnosisgisgagclinicalgj
udgmentgaboutgindividual,gfamily,gorgcommunitygresponsesgtogactualgandgpotentialghealthgproble
msgorglifegprocessesgthatgthegnursegisglicensedgandgcompetentgtogtreat.
PTS:1DIF:CognitivegLevel:gApplyingg(Application)
REF:g125gOBJ:gExplaingthegtypegofgconclusionsgthatgresultgfromgdataganalysis.gTOP:gNursinggP
rocess:gAssessmentgMSC:gNCLEX:gManagementgofgCare
4. Agpostoperativegpatientghasgdeniedgthegneedgforgpaingmedication.gThegnurseghasgnotedgth
atgthegpatientgdescribesgthegpaingasgag1gongag0gtog10gscale.gThegnursegalsognotesgthatgthegpatient
, grimacesgwhenghegorgshegchangesgpositiongandgguardsgthegincision.gThegnursegbelievesgthatgth
egpatientgisgexperiencinggpaingbasedgongtheginformationggatheredgingthegassessment.gWhatgisgt
hisgphenomenongknowngas?
a. Cue
b. Inference
c. Diagnosis
d. Healthgpattern
ANS:gB
g
Thegnursegmadegagjudgment,gwhichgisganginference,gthatgthegpatientgisgexperiencinggpain.gAnginf
erencegisgagnursesgjudgmentgorginterpretationgofgagcue.gAgcuegisginformationgthatgyougobtaingthr
oughgusegofgthegsenses.gGordonsgfunctionalghealthgpatternsgaregagtypegofgdatabasegformatgtogobt
aingagcomprehensivegassessment.gAgnursinggdiagnosisgisgagclinicalgjudgmentgaboutgindividual,gf
amily,gorgcommunitygresponsesgtogactualgandgpotentialghealthgproblemsgorglifegprocessesgthatgthe
gnursegisglicensedgandgcompetentgtogtreatgsuchgasgimpairedgtissuegperfusion.
PTS:1DIF:CognitivegLevel:gApplyingg(Application)
REF:g125gOBJ:gExplaingthegtypegofgconclusionsgthatgresultgfromgdataganalysis.gTOP:gNursinggP
rocess:gAssessmentgMSC:gNCLEX:gManagementgofgCare
5. Agnursegisgcollectinggdatagduringgthegassessmentgofgagpatient.gDuringgthegassessment,gthe
gnursegcollectsgbothgsubjectivegandgobjectivegdata.gWhichginformationgshouldgthegnursegconsiderg
asgsubjectivegdata?
a. Heartgrategofg96
b. Incisionalgerythema
c. Emesisgofg150gmL
d. Sharp,gburninggpain
ANS:gD
g
Sharp,gburninggpaingisgsubjective.gSubjectivegdatagaregpatientsgverbalgdescriptionsgofgtheirghealt
hgproblems.gOnlygpatientsgprovidegsubjectivegdata.gHeartgrate,gincisions,gandgemesisgaregallgobj
ectivegdata.gObjectivegdatagaregobservationsgorgmeasurementsgofgagpatientsghealthgstatus.
PTS:1DIF:CognitivegLevel:gAnalyzingg(Analysis)
g g g g g g
hapters 9, 13, 14, 15, 27, 28, 29, 31,
g g g g g g g g
32, 36, and 37
g g g
, Chapterg09:gNursinggProcessgMygNursinggTestgBanksgChapterg09:gNursinggProcessgP
otter:gEssentialsgforgNursinggPractice,g8thgEditiongMULTIPLEgCHOICE
1. Agnursegisgcollectinggdatagongagpatientgwhogisgbeinggadmittedgintoghospicegcare.gThegnurs
egcollectsgdatagfromgbothgthegpatientgandgthegfamilygsogthatgagcleargpicturegofgthegpatientgstatusgi
sgobtained.gThegnursegisgcurrentlyginvolvedgingwhichgstepgofgthegnursinggprocess?
a. Assessment
b. Implementation
c. Evaluation
d. Diagnosing
ANS:gA
g
Assessmentgisgthegdeliberategandgsystematicgcollectiongofgdatagaboutgagpatient.gThegdatagwillgrev
ealgagpatientsgcurrentgandgpastghealthgstatus,gfunctionalgstatus,gandgpresentgandgpastgcopinggpatter
ns.gAgnursinggdiagnosisgisgagclinicalgjudgmentgaboutgindividual,gfamily,gorgcommunitygresponses
gtogactualgandgpotentialghealthgproblemsgorglifegprocessesgthatgthegnursegisglicensedgandgcompeten
tgtogtreat.gImplementationgisgthegperformancegofgnursingginterventionsgnecessarygforgachievinggth
eggoalsgandgexpectedgoutcomesgofgnursinggcare.gEvaluationgisgcrucialgtogdecidinggwhether,gafterg
interventionsghavegbeengdelivered,gagpatientsgconditiongorgwell-beinggimproves.
PTS:1DIF:CognitivegLevel:gApplyingg(Application)gREF:124OBJescribegeachgstepgofgthegnursi
nggprocess.
TOP:gNursinggProcess:gAssessmentgMSC:gNCLEX:gManagementgofgCare
2. Thegnursegisgadmittinggagpatientgtogthegunitgandgasksgthegpatientgaboutgtheghealthghistor
y.gThegnursegisgengagedgingwhichgcomponentgofgthegnursinggprocess?
a. Evaluation
b. Diagnosis
c. Assessment
d. Planning
ANS:gC
g
,Thegnursegisgingthegassessmentgphase.gAngassessmentgdatabasegincludesgagpatientsgcomprehensiv
eghealthghistory,gwhichgincludesginformationgaboutgagpatientsgphysicalgandgdevelopmentalgstatus
,gemotionalghealth,gsocialgpracticesgandgresources,ggoals,gvalues,glifestyle,gandgexpectationsgabo
utgtheghealthgcaregsystem.gThegdatabasegalsogincludesgphysicalgexaminationgfindingsgandgagsum
marygofgresultsgfromglaboratorygandgdiagnosticgtesting.gAgnursinggdiagnosisgisgagclinicalgjudgme
ntgaboutgindividual,gfamily,gorgcommunitygresponsesgtogactualgandgpotentialghealthgproblemsgorg
lifegprocessesgthatgthegnursegisglicensedgandgcompetentgtogtreat.gEvaluationgisgcrucialgtogdecidin
ggwhether,gafterginterventionsghavegbeengdelivered,gagpatientsgconditiongorgwell-beinggimproves.
Planningginvolvesgsettinggpriorities,gidentifyinggpatient-
centeredggoalsgandgexpectedgoutcomes,gandgprescribinggnursingginterventions.
PTS:1DIF:CognitivegLevel:gApplyingg(Application)
REF:g124gOBJ:gDiscussgapproachesgtogdatagcollectiongingnursinggassessment.gTOP:gNursinggPr
ocess:gAssessmentgMSC:gNCLEX:gManagementgofgCare
3. Agpostoperativegpatientgisgcontinuinggtoghavegincisionalgpain.gAsgpartgofgthegnursesgasses
sment,gthegnursegnotesgthatgthegpatientgisggrimacinggwhenghegorgshegchangesgposition.gThegpatie
ntsggrimacegcangbegusefulgingthegassessmentgandgcangbegdescribedgasgwhichgofgthegfollowing?
a. Cue
b. Inference
c. Diagnosis
d. Healthgpattern
ANS:gA
g
Grimacinggisgagcue.gAgcuegisginformationgthatgagnursegobtainsgthroughgusegofgthegsenses.gAnginfe
rencegisgyourgjudgmentgorginterpretationgofgthesegcues.gGordonsgfunctionalghealthgpatternsgaregagt
ypegofgdatabasegformatgtogobtaingagcomprehensivegassessment.gAgnursinggdiagnosisgisgagclinicalgj
udgmentgaboutgindividual,gfamily,gorgcommunitygresponsesgtogactualgandgpotentialghealthgproble
msgorglifegprocessesgthatgthegnursegisglicensedgandgcompetentgtogtreat.
PTS:1DIF:CognitivegLevel:gApplyingg(Application)
REF:g125gOBJ:gExplaingthegtypegofgconclusionsgthatgresultgfromgdataganalysis.gTOP:gNursinggP
rocess:gAssessmentgMSC:gNCLEX:gManagementgofgCare
4. Agpostoperativegpatientghasgdeniedgthegneedgforgpaingmedication.gThegnurseghasgnotedgth
atgthegpatientgdescribesgthegpaingasgag1gongag0gtog10gscale.gThegnursegalsognotesgthatgthegpatient
, grimacesgwhenghegorgshegchangesgpositiongandgguardsgthegincision.gThegnursegbelievesgthatgth
egpatientgisgexperiencinggpaingbasedgongtheginformationggatheredgingthegassessment.gWhatgisgt
hisgphenomenongknowngas?
a. Cue
b. Inference
c. Diagnosis
d. Healthgpattern
ANS:gB
g
Thegnursegmadegagjudgment,gwhichgisganginference,gthatgthegpatientgisgexperiencinggpain.gAnginf
erencegisgagnursesgjudgmentgorginterpretationgofgagcue.gAgcuegisginformationgthatgyougobtaingthr
oughgusegofgthegsenses.gGordonsgfunctionalghealthgpatternsgaregagtypegofgdatabasegformatgtogobt
aingagcomprehensivegassessment.gAgnursinggdiagnosisgisgagclinicalgjudgmentgaboutgindividual,gf
amily,gorgcommunitygresponsesgtogactualgandgpotentialghealthgproblemsgorglifegprocessesgthatgthe
gnursegisglicensedgandgcompetentgtogtreatgsuchgasgimpairedgtissuegperfusion.
PTS:1DIF:CognitivegLevel:gApplyingg(Application)
REF:g125gOBJ:gExplaingthegtypegofgconclusionsgthatgresultgfromgdataganalysis.gTOP:gNursinggP
rocess:gAssessmentgMSC:gNCLEX:gManagementgofgCare
5. Agnursegisgcollectinggdatagduringgthegassessmentgofgagpatient.gDuringgthegassessment,gthe
gnursegcollectsgbothgsubjectivegandgobjectivegdata.gWhichginformationgshouldgthegnursegconsiderg
asgsubjectivegdata?
a. Heartgrategofg96
b. Incisionalgerythema
c. Emesisgofg150gmL
d. Sharp,gburninggpain
ANS:gD
g
Sharp,gburninggpaingisgsubjective.gSubjectivegdatagaregpatientsgverbalgdescriptionsgofgtheirghealt
hgproblems.gOnlygpatientsgprovidegsubjectivegdata.gHeartgrate,gincisions,gandgemesisgaregallgobj
ectivegdata.gObjectivegdatagaregobservationsgorgmeasurementsgofgagpatientsghealthgstatus.
PTS:1DIF:CognitivegLevel:gAnalyzingg(Analysis)
