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Sample Provided Below:
Chapter 3: The Nursing Process
1. The client asks the nurse, “I’ve heard the student nurses talk about the nursing process. Why is there so much emphasis on using the nursing process?” The response that explains the need for nurses to understand and use the nursing process is:
1. “Do you think you have a better method we might use?”
2. “The nursing process is a systematic problem-solving method encompassing all components necessary to care for clients.”
3. “Using the nursing process is a way of legitimizing our profession and placing us on an equal footing with the pure sciences.”
4. “The nursing process is a unidimensional, static, linear approach used to guide us as we make clinical judgments.”
This response best explains the importance of the nursing process. Option 1 is challenging and does not address the question posed by the client. Option 3 is not a good explanation for use of the nursing process. Option 4 does not accurately describe the nursing process.
DIF: Cognitive Level: Application REF: Page 36 OBJ: 1
TOP: Nursing Process KEY: Nursing Process: Implementation
2. A nurse is gathering assessment data for a client admitted from the ED. The wife of the client tells the nurse, “I will give you all the information you need. He does not tell the truth.” It is best for the nurse to obtain her assessment information from the:
1. ED chart
3. Wife of the client
4. Admitting physician
The nurse can obtain supplementary information from the wife (3), the chart (1), and other health care professionals (4), but the client (2) is the primary source of information.
DIF: Cognitive Level: Application REF: Page 36 OBJ: 4
TOP: Assessment KEY: Nursing Process: Assessment
3. The nurse makes a clinical judgment about a client that is descriptive of an actual alteration in the client’s life processes. Which of the following statements is an example of the nurse’s use of this step of the nursing process?
1. Administer oral medication for anxiety when anxiety is assessed to be at moderate level.
2. Impaired verbal communication r/t impoverished thoughts secondary to depression as evidenced by monosyllabic responses.
3. Client will initiate and support conversation with nurse therapist by (date 3 weeks in future).
4. Outcome partially attained. Continue implementation of present plan.
The statement that is descriptive of an actual or potential alteration in a client’s life processes is a nursing diagnosis. Options 1, 3, and 4 are statements that relate to other steps of the nursing process.
DIF: Cognitive Level: Application REF: Page 42 OBJ: 1
TOP: Nursing Diagnosis KEY: Nursing Process: Planning
4. When the nurse looks at the defining characteristics for an actual nursing diagnosis and writes statements that are considered to be the opposite, the nurse has engaged in the step of the nursing process known as:
3. Nursing diagnosis
4. Outcome identification
Outcomes are projections of expected influence that nursing interventions will have on the client. Outcome criteria for actual diagnoses are generally considered the opposite of the defining characteristics.
DIF: Cognitive Level: Application REF: Page 44 OBJ: 1
TOP: Outcome Identification KEY: Nursing Process: Planning
5. While discussing assessment of suicidal clients, one nurse mentions, “I was taught to always base my care on concrete, evidence-based scientific reasoning and never to rely on intuition.” Which response by another nurse shows greater understanding of intuitive reasoning?
1. “That’s wise, since intuition went out of favor with the scientific revolution.”
2. “Critical thinking and intuition are at opposite poles. Keep relying on your expertise.”
3. “It’s possible that intuition about suicidality is generated by transfer of feelings from the client to the nurse.”
4. “It’s been determined that intuition is nothing more that extrasensory perception, so some folks have it, and some don’t.”
Intuition has appeared in clinical journals as a valid part of clinical reasoning. Fidaleo notes that it may be related to transfer of pain from the client to the nurse. Whiteside suggests that intuition is rapid critical thinking. Option 3 best reflects the possible usefulness of intuition to nurses.
DIF: Cognitive Level: Application REF: Page 39 OBJ: 2
TOP: Intuition KEY: Nursing Process: Implementation
6. A nurse asks her mentor, “What can I do to develop better critical thinking skills?” The best response for the mentor would be:
1. “Critical thinking includes judgment, intuition, and expertise. It takes years to develop expertise, so be patient and the skill will develop.”
2. “Critical thinking uses an explicit linear process, depending primarily on keeping data organized, so focus on organization.”
3. “Critical thinking is entirely dependent on making a rapid nursing diagnosis. Concentrate on speeding up your diagnosis making.”
4. “Critical thinking requires observing, distinguishing, validating, organizing, and categorizing data. Being aware of the components can help you use the process.”
Critical thinking is a deliberate process. Knowing the components can help the nurse use each systematically. 1. This response is placating and not a helpful response. 2. The process of critical thinking is diffuse, not linear, and involves several other components. 3. Critical thinking requires looking at many possible reasons for the problem, so nursing diagnosis should be carefully, rather than hastily, made.
DIF: Cognitive Level: Application REF: Page 41 OBJ: 2
TOP: Critical Thinking KEY: Nursing Process: Implementation
7. If asked to explain the NANDA taxonomy to another health professional, the nurse should state that it is a:
1. Hierarchic framework of human response patterns
2. Framework of functional health patterns
3. Framework for categorizing psychiatric disorders
4. Series of outcomes most influenced by nursing actions
NANDA, in its taxonomy, has identified nine human response patterns under which nursing diagnoses can be organized. 2. This refers to Marjory Gordon’s framework. 3. The DSM-IV-TR is one framework for categorizing psychiatric disorders. 4. Nursing Outcomes Classification is concerned with outcomes.
DIF: Cognitive Level: Application REF: Page 42 OBJ: 6
TOP: NANDA Taxonomy KEY: Nursing Process: N/A
8. The nurse has determined that a particular client has a history of violent outbursts. The client has told her that he feels as though he’s going to explode. The type of nursing diagnosis that is most appropriate in this case is:
1. An actual diagnosis of an existing problem
2. A risk diagnosis identifying a potential problem
3. A wellness diagnosis for an individual in transition to a higher wellness level
4. All types are equally appropriate even when differently worded
A risk diagnosis refers to an individual’s vulnerable health status. In this case the individual is at risk for violence directed at others.
DIF: Cognitive Level: Application REF: Page 42 OBJ: 6
TOP: Nursing Diagnosis KEY: Nursing Process: Diagnosis
9. The nurse writes the following nursing diagnosis for a client who is not taking his prescribed lithium regularly: Noncompliance with lithium therapy r/t dislike of side effects as evidenced by subtherapeutic lithium level and client statement that lithium makes his hands shake. Is the nursing diagnosis worded correctly for an actual problem?
1. It expresses an actual client problem, the etiology, and the defining characteristics consistent with the etiology.
2. It expresses a potential client problem and gives defining characteristics.
3. The problem statement is accurate, but the defining characteristics are not consistent with the etiology given.
4. Not enough data exist to determine an accurate problem statement.
Option 1 is correct; all elements for a proper actual nursing diagnosis are present. 2. The diagnosis is actual; it is not a risk diagnosis. 3. The defining characteristics are consistent with the etiology. 4. Data are sufficient to select this problem statement.
DIF: Cognitive Level: Evaluation REF: Page 42 OBJ: 6
TOP: Nursing Diagnosis KEY: Nursing Process: Evaluation
10. A client has the nursing diagnosis noncompliance with lithium therapy r/t dislike of side effects as evidenced by subtherapeutic lithium level and client statement that lithium makes his mouth dry. A correctly written outcome statement for this nursing diagnosis is:
1. Encourage client to take lithium as prescribed despite side effects
2. Admonish and give lab requisition for retesting lithium level in 1 week
3. Client will list interventions for dry mouth and will take lithium daily, resulting in lithium level within therapeutic range within 1 week
4. If client is in denial, provide information about his disorder and its treatment
An outcome statement consists of specific, measurable indicators that are used by nurses to evaluate the results of an intervention. Only option 3 is written as an outcome statement. The other statements address interventions.
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