Which of the following behaviors is most representative of the "nursing diagnosis" phase of the nursing
process?
A: Identifying major problems or needs
B: Organizing data in the client's family history
C: Establishing short-term and long-term goals
D: Administering an antibiotic - correct answer ✔✔A: Identifying major problems or needs
Which of the following behaviors would indicate that the nurse was utilizing the assessment phase of the
nursing proess to provide nursing care?
A: Proposes hypotheses
B: Generates desired outcomes
C: Reviews results of laboratory tests
D: Documents care - correct answer ✔✔C: Reviews results of laboratory tests
Which of the following elements is best characterized as secondary subjective data?
A: The nurse measures a weight loss of 10 lbs since the last clinic visit
B: Spouse states the client has lost all appetite
C: The nurse palpates edema in lower extremities
D: Client states severe pain when walking up stairs - correct answer ✔✔B: Spouse states the client has
lost all appetite
The nurse wishes to determine the client's feelings about a recent diagnosis. Which interview question is
most likely to elicit this information?
, A: "What did the doctor tell you about your diagnosis?"
B: "Are you worried about how the diagnosis will affect you in the future?"
C: "Tell me about your reactions to the diagnosis"
D: "How is your family responding to the diagnosis?" - correct answer ✔✔C: "Tell me about your
reactions to the diagnosis"
The most important component to the effective use of the nursing process is:
A: Collaboration
B: Critical thinking
C: Client compliance with the plan
D: Nursing theory - correct answer ✔✔B: Critical thinking
Characteristics of the nursing process include: (select all that apply)
A: It is nursing centered
B: It is universally applicable in all settings
C: It is individual and autonomous
D: Decision making is involved in each phase of the nursing process
E: Data from each phase is used in the next phase - correct answer ✔✔B: It is universally applicable in all
settings
D: Decision making is involved in each phase of the nursing process
E: Data from each phase is used in the next phase
The client has had a stroke and has difficulty speaking. An example of the most appropriate form of
communication the nurse can use is:
A: "Are you having pain?"
B: "Tell me about your family."
C: "Tell me about your health history."
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