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NURS 1020 Exam 2 Questions With Complete Solutions
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NURS 1020 Exam 2 Questions With Complete Solutions
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NURS 1020 Exam 2 Questions With Complete SolutionsA nurse has just admitted a patient with a medical diagnosis of
congestive heart failure. When completing the admission paper
work, the nurse needs to record
A. An interpretation of patient behavior.
B. Objective data that are observed.
C. Lengthy entry using lay terminology.
D. Abbreviations familiar to the nurse. Correct Answer B.
Objective data that are observed.
A patient is experiencing Ineffective Breathing Pattern. The
correct goal statement would be written as
A. The patient will be comfortable by the morning.
B. The patient will breath unlabored at 12 to 20 breaths per
minute by the end of the shift.
C. The patient will not complain of breathing problems within
the next 8 hours.
D. The patient will have a respiratory rate of 12 to 20 breaths per
minute. Correct Answer B. The patient will breath unlabored at
12 to 20 breaths per minute by the end of the shift.
are we allowed to use abbreviations when we record in legal
documents? Correct Answer don't use abbreviations
do occurrence reports go in the patient record? Correct Answer
DO NOT DOCUMENT OCCURRENCE REPORT
Completed/Filed IN THE PATIENT RECORD: Document goes
to Nurse Manager, Provider, Facility Risk Manager
,during which phase of the nursing process is the criterion-based
evaluation? Correct Answer planing
example of "related to" on slide 26 Correct Answer
For a student to avoid a data collection error, the student
should : Select the Best Answer
A. Assess the patient and, if unsure of the finding, ask a faculty
member to assess the patient.
B. Review his or her own comfort level and competency with
assessment skills.
C. Ask another student to perform the assessment.
D. Consider whether the diagnosis should be actual, potential, or
risk. Correct Answer A. Assess the patient and, if unsure of the
finding, ask a faculty member to assess the patient
how are student nurses expected to perform? Correct Answer
Nursing students are expected to perform as professional
nurses , RN'S, would in providing safe patient care. Different
levels of standards do not apply. Nursing students, just as
nurses, provide safe, complete patient care, or they don't. No
standard is used for nursing students other than that they must
meet the standards of a professional nurse.
Standards SN = Standards RN
how can we modify an existing written care plan? Correct
Answer -Revise data assessment.
-Revise the nursing diagnoses.
-Revise specific interventions.
,-Determine how to evaluate whether you have achieved
outcomes.
*The NURSE modifies the care of the patient based on current
assessment data*
how do the nursing interventions use implementation? Correct
Answer -Nurses initiate the nursing interventions most likely to
achieve the goals and that support or improve the patient's health
status.
-Nursing interventions can be direct or indirect.
-Nursing interventions should be evidence based and should use
the most up-to-date approaches to solving patient problems.
how do we clarify an order? Correct Answer -When preparing
for physician-initiated or collaborative interventions, do not
automatically implement the therapy, but determine whether it is
appropriate for the patient.
-The ability to recognize incorrect therapies is particularly
important when administering medications or implementing
procedures.
how do we classify priorities and what are examples? Correct
Answer *High*—Emergent (if left untreated will result in harm
to patient)
*Intermediate* - non emergent, non-life threatening
*Low*—Affect patients' future well-being and chronic
healthcare needs
, how do we collaborate and evaluate for the most effective
interventions? Correct Answer -Collaborate with the patient
and family.
-If your patient meets a goal successfully, discuss your
evaluation with the patient. If you and the patient agree,
discontinue that portion of the patient's care plan.
how do we communicate clearly? Correct Answer -task,
outcome, time
-closed loop communication
how do we document every call? Correct Answer in narrative
how do we establish nursing priorities? Correct Answer
Ordering of nursing diagnoses or patient problems uses
determinations of urgency and/or importance to establish a
preferential order for nursing actions and helps nurses anticipate
and sequence nursing interventions
-The order of priorities changes as a patient's condition changes.
-Priority setting begins at a holistic level when you identify and
prioritize a patient's main diagnoses or problems.
-Patient-centered care requires you to know a patient's
preferences, values, and expressed needs.
how do we modify the care plan? Correct Answer -
Reassessment = Start Again
-Re-diagnose = Start Again
-Goals and expected outcomes = Review/Revise
-Time Frame = Patient requires more time to reach the goal, set
a future date for the patient to achieve the goal and evaluate at
that time.
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