user/BRAINSCAPE1
Nurs104 Final Exam Questions and
Answers A+ Graded (2025)
A nurse will arrive at a nursing diagnosis through the nursing process step of: -
CORRECT ANSWER-assessment.
A student nurse can begin to develop critical thinking skills by means of: -
CORRECT ANSWER-listening attentively and focusing on the speaker's words
and meaning.
An emergency room nurse will give first priority to the patient with the most
critical need, which is the patient who: - CORRECT ANSWER-complains of severe
chest pain.
Constant nursing assessments and evaluations of the patient will most likely
result in: - CORRECT ANSWER-the nursing care plan changing to reflect
appropriate priorities.
Descriptions of the activities involved in the nursing diagnosis step of the
nursing process are: (Select all that apply.) - CORRECT ANSWER-determination
of potential health problems., clustering of related assessments.
In the collaborative process of delivering care based on the nursing process, the
responsibility of the LPN/LVN is to: - CORRECT ANSWER-collect data of health
status.
Once the nursing plan has been initiated, the nursing care plan will: - CORRECT
ANSWER-change as the patient's condition changes.
The activity that is implementation in nursing care is: - CORRECT ANSWER-
changing the patient's surgical dressing.
The effect of using a scientific problem-solving approach in nursing care will
cause decision making to be: - CORRECT ANSWER-improved nursing care
outcomes.
The nurse who uses the nursing process will: - CORRECT ANSWER-approach the
patient's disorder in a step-by-step method.
,user/BRAINSCAPE1
The order in which the nursing process is approached is: - CORRECT ANSWER-
assessment, nursing diagnosis, planning, implementation, evaluation.
The participants of the planning stage of the nursing process during which the
health goals are defined include the: - CORRECT ANSWER-health team, the
patient, and the patient's family.
When a nurse prioritizes the patient care, consideration is given to: - CORRECT
ANSWER-considering situations that may result in an alteration of health.
When a patient states, "I can't walk very well," the first problem-solving step
would be to: - CORRECT ANSWER-find out what the problem is, such as
weakness or poor balance.
When a resident in the nursing home complains of constipation, the nurse
performs a digital rectal examination and finds a hard fecal mass. This is an
example of: - CORRECT ANSWER-assessment.
When the nurse checks to see whether a patient has had relief 45 minutes after
administering pain medication, the nurse is performing a(n): - CORRECT
ANSWER-evaluation.
A nursing care plan consists of: - CORRECT ANSWER-nursing orders for
individualized interventions to assist the patient to meet expected outcomes.
A nursing diagnosis consists of: - CORRECT ANSWER-diagnostic labels
formulated by the North American Nursing Diagnosis Association-International
(NANDA-I).
A patient with visual impairment is identified as at risk for falls related to
blindness. An appropriate intervention would be to: - CORRECT ANSWER-
arrange furnishings in room to provide clear pathways and orient the patient to
these.
An elderly patient with a medical diagnosis of chronic lung disease has
developed pneumonia. She is coughing frequently and expectorating thick, sticky
secretions. She is very short of breath, even with oxygen running, and she is
exhausted and says she "can't breathe." Based on this information, an
appropriately worded nursing diagnosis for this patient is - CORRECT ANSWER-
Airway clearance, ineffective, related to lung secretions as evidenced by cough
and shortness of breath.
During the assessment phase of the nursing process, the nurse - CORRECT
ANSWER-gathers, organizes, and documents data in a logical database.
The statements that are correctly stated as expected outcomes are: (Select all
that apply.) - CORRECT ANSWER-Patient will be able to ambulate using a walker
independently within 3 days., Patient will perform active range of motion (ROM) of
her upper extremities independently every 4 hours.
, user/BRAINSCAPE1
A nurse is caring for a patient with a medical diagnosis of right lower lobe
pneumonia. The patient is expectorating thick green mucus, has an oxygen
saturation level of 90%, and has audible crackles in the base of the right lung. An
appropriate nursing diagnosis for this patient is: - CORRECT ANSWER-Airway
clearance, ineffective, related to retained secretions as evidenced by
expectoration of thick green mucus, oxygen saturation level of 90%, and audible
crackles in the base of the right lung.
A nursing care plan consists of: - CORRECT ANSWER-nursing orders for
individualized interventions to assist the patient to meet expected outcomes.
A nursing diagnosis consists of: - CORRECT ANSWER-diagnostic labels
formulated by the North American Nursing Diagnosis Association-International
(NANDA-I).
A patient has a nursing diagnosis of Imbalanced nutrition: less than body
requirements, related to mental impairment and decreased intake, as evidenced
by increasing confusion and weight loss of more than 30-pounds over the last 6
months. An appropriate short-term goal for this patient is to: - CORRECT
ANSWER-eat 50% of six small meals each day by the end of 1 week.
A patient with visual impairment is identified as at risk for falls related to
blindness. An appropriate intervention would be to: - CORRECT ANSWER-
arrange furnishings in room to provide clear pathways and orient the patient to
these.
After the admission assessment is completed, on subsequent shifts or days, the
nurse: - CORRECT ANSWER-assesses the patient briefly in the first hour of the
shift.
Aside from the information obtained from the patient (primary source) in the
admission interview, the nurse will also access: (Select all that apply - CORRECT
ANSWER-the patient's family., the admission note., the physician's history and
physical., an observation of the patient for non-verbal clues.
If a patient has several nursing diagnoses, the nurse will first: - CORRECT
ANSWER-prioritize the nursing problems according to Maslow's hierarchy of
needs.
In an acute care facility, a nursing care plan is usually reviewed and updated -
CORRECT ANSWER-every 24 hours.
The major goal of the admission interview (usually performed by the RN) is to: -
CORRECT ANSWER-identify the patient's major complaints.
The nurse clarifies that nursing orders are also called: - CORRECT ANSWER-
interventions.
Nurs104 Final Exam Questions and
Answers A+ Graded (2025)
A nurse will arrive at a nursing diagnosis through the nursing process step of: -
CORRECT ANSWER-assessment.
A student nurse can begin to develop critical thinking skills by means of: -
CORRECT ANSWER-listening attentively and focusing on the speaker's words
and meaning.
An emergency room nurse will give first priority to the patient with the most
critical need, which is the patient who: - CORRECT ANSWER-complains of severe
chest pain.
Constant nursing assessments and evaluations of the patient will most likely
result in: - CORRECT ANSWER-the nursing care plan changing to reflect
appropriate priorities.
Descriptions of the activities involved in the nursing diagnosis step of the
nursing process are: (Select all that apply.) - CORRECT ANSWER-determination
of potential health problems., clustering of related assessments.
In the collaborative process of delivering care based on the nursing process, the
responsibility of the LPN/LVN is to: - CORRECT ANSWER-collect data of health
status.
Once the nursing plan has been initiated, the nursing care plan will: - CORRECT
ANSWER-change as the patient's condition changes.
The activity that is implementation in nursing care is: - CORRECT ANSWER-
changing the patient's surgical dressing.
The effect of using a scientific problem-solving approach in nursing care will
cause decision making to be: - CORRECT ANSWER-improved nursing care
outcomes.
The nurse who uses the nursing process will: - CORRECT ANSWER-approach the
patient's disorder in a step-by-step method.
,user/BRAINSCAPE1
The order in which the nursing process is approached is: - CORRECT ANSWER-
assessment, nursing diagnosis, planning, implementation, evaluation.
The participants of the planning stage of the nursing process during which the
health goals are defined include the: - CORRECT ANSWER-health team, the
patient, and the patient's family.
When a nurse prioritizes the patient care, consideration is given to: - CORRECT
ANSWER-considering situations that may result in an alteration of health.
When a patient states, "I can't walk very well," the first problem-solving step
would be to: - CORRECT ANSWER-find out what the problem is, such as
weakness or poor balance.
When a resident in the nursing home complains of constipation, the nurse
performs a digital rectal examination and finds a hard fecal mass. This is an
example of: - CORRECT ANSWER-assessment.
When the nurse checks to see whether a patient has had relief 45 minutes after
administering pain medication, the nurse is performing a(n): - CORRECT
ANSWER-evaluation.
A nursing care plan consists of: - CORRECT ANSWER-nursing orders for
individualized interventions to assist the patient to meet expected outcomes.
A nursing diagnosis consists of: - CORRECT ANSWER-diagnostic labels
formulated by the North American Nursing Diagnosis Association-International
(NANDA-I).
A patient with visual impairment is identified as at risk for falls related to
blindness. An appropriate intervention would be to: - CORRECT ANSWER-
arrange furnishings in room to provide clear pathways and orient the patient to
these.
An elderly patient with a medical diagnosis of chronic lung disease has
developed pneumonia. She is coughing frequently and expectorating thick, sticky
secretions. She is very short of breath, even with oxygen running, and she is
exhausted and says she "can't breathe." Based on this information, an
appropriately worded nursing diagnosis for this patient is - CORRECT ANSWER-
Airway clearance, ineffective, related to lung secretions as evidenced by cough
and shortness of breath.
During the assessment phase of the nursing process, the nurse - CORRECT
ANSWER-gathers, organizes, and documents data in a logical database.
The statements that are correctly stated as expected outcomes are: (Select all
that apply.) - CORRECT ANSWER-Patient will be able to ambulate using a walker
independently within 3 days., Patient will perform active range of motion (ROM) of
her upper extremities independently every 4 hours.
, user/BRAINSCAPE1
A nurse is caring for a patient with a medical diagnosis of right lower lobe
pneumonia. The patient is expectorating thick green mucus, has an oxygen
saturation level of 90%, and has audible crackles in the base of the right lung. An
appropriate nursing diagnosis for this patient is: - CORRECT ANSWER-Airway
clearance, ineffective, related to retained secretions as evidenced by
expectoration of thick green mucus, oxygen saturation level of 90%, and audible
crackles in the base of the right lung.
A nursing care plan consists of: - CORRECT ANSWER-nursing orders for
individualized interventions to assist the patient to meet expected outcomes.
A nursing diagnosis consists of: - CORRECT ANSWER-diagnostic labels
formulated by the North American Nursing Diagnosis Association-International
(NANDA-I).
A patient has a nursing diagnosis of Imbalanced nutrition: less than body
requirements, related to mental impairment and decreased intake, as evidenced
by increasing confusion and weight loss of more than 30-pounds over the last 6
months. An appropriate short-term goal for this patient is to: - CORRECT
ANSWER-eat 50% of six small meals each day by the end of 1 week.
A patient with visual impairment is identified as at risk for falls related to
blindness. An appropriate intervention would be to: - CORRECT ANSWER-
arrange furnishings in room to provide clear pathways and orient the patient to
these.
After the admission assessment is completed, on subsequent shifts or days, the
nurse: - CORRECT ANSWER-assesses the patient briefly in the first hour of the
shift.
Aside from the information obtained from the patient (primary source) in the
admission interview, the nurse will also access: (Select all that apply - CORRECT
ANSWER-the patient's family., the admission note., the physician's history and
physical., an observation of the patient for non-verbal clues.
If a patient has several nursing diagnoses, the nurse will first: - CORRECT
ANSWER-prioritize the nursing problems according to Maslow's hierarchy of
needs.
In an acute care facility, a nursing care plan is usually reviewed and updated -
CORRECT ANSWER-every 24 hours.
The major goal of the admission interview (usually performed by the RN) is to: -
CORRECT ANSWER-identify the patient's major complaints.
The nurse clarifies that nursing orders are also called: - CORRECT ANSWER-
interventions.
