Nurs 3000 exam 2 UPDATED ACTUAL Questions and CORRECT
Answers
Physiologic needs (air, food, water) What is the correct order of Maslow's Hierarchy of Needs (from most to least
Safety and security priority)?
Love and belonging
Self-esteem
Self-actualization
Physiologic needs (e.g., breathing, circulation, nutrition) According to Maslow's hierarchy, which patient need takes top priority?
Specific, Measurable, Attainable, Relevant, Time-bound What does the SMART acronym stand for when writing nursing goals?
No. It is not specific, not measurable, and not time- Is this a SMART goal? "Patient will feel better soon." Why or why not?
bound.
Yes. It is specific, measurable, realistic, and time-bound. Is this a SMART goal? "Patient will verbalize pain level of 3 or less within 1 hour of
receiving pain meds."
Immediate outcomes (e.g., by tomorrow or within a few What is a short term goal?
days)
Achieved over weeks or months; often used for discharge What is a long term goal?
or rehabilitation planning
"Patient will raise right arm to shoulder height by Friday" Which is a short-term goal?A. "Patient will regain full use of right arm in 6
is a short-term goal. weeks."B. "Patient will raise right arm to shoulder height by Friday."
Nurse-initiated actions based on knowledge and skill, no Define independent nursing interventions
provider order needed
Require a provider’s order or supervision Define dependent nursing interventions
the action phase where the nurse performs interventions What is the main purpose of the implementation phase in the nursing process?
to address the patient's needs
Implementing safe, evidence-based interventions using What does the "taking action" phase in clinical reasoning involve?
critical thinking and decision-making
Reassess the patient What are the 5 steps in the taking action phase?
Determine need for help
Implement interventions
Supervise delegated care
Document actions
Right task, circumstance, person, What are the 5 Rights of Delegation?
directions/communication, supervision/evaluation
, Delegating vital signs on stable patients, bedmaking, or What is an example of appropriate delegation?
basic hygiene tasks.
remains responsible for the overall care, must ensure it What is the RN's ultimate responsibility when delegating care?
aligns with the care plan, and must evaluate and respond
to any patient outcomes.
To determine the patient's progress toward goals, and What is the purpose of evaluating outcomes in nursing care?
decide whether to continue, modify, or stop the care plan
Collect data What are the 5 steps in the evaluation process?
Compare data to outcomes
Relate actions to outcomes
Draw conclusions
Continue, modify, or terminate care
conclusion and supporting data What 2 parts are in the evaluation statement?
statement that goal/desired outcome was met, partially What is the conclusion?
met, or not met
list of client responses that support the conclusion What is the supporting data?
Reassess the patient What actions should a nurse take if the client's goals are not met?
Review nursing diagnosis
Ask why the goal wasn't met
Revise the care plan
Communicate with the team
body response to stress involving physiologic events What is General Adaptation Syndrome (GAS)?
dominated by the sympathetic nervous system
Initial reaction; activates defenses (fight or flight) What is the alarm stage of GAS?
Body adapts to stress What is the resistance stage of GAS?
Adaptation can't be maintained; resources depleted What is the exhaustion stage of GAS?
short-term stress reaction (1 min-24 hrs) during the alarm What is the fight-or-flight response, and when does it occur?
stage that prepares the body to respond to threats
A localized body response where only one organ or What is Local Adaptation Syndrome?
body part reacts to stress (e.g., inflammation)
Altered elimination, changes in appetite, and disrupted What are some effects of prolonged stress on physiological needs?
sleep patterns
nervousness, feeling threatened, focusing only on How does prolonged stress affect safety and security needs?
stressors, or neglecting safety
Answers
Physiologic needs (air, food, water) What is the correct order of Maslow's Hierarchy of Needs (from most to least
Safety and security priority)?
Love and belonging
Self-esteem
Self-actualization
Physiologic needs (e.g., breathing, circulation, nutrition) According to Maslow's hierarchy, which patient need takes top priority?
Specific, Measurable, Attainable, Relevant, Time-bound What does the SMART acronym stand for when writing nursing goals?
No. It is not specific, not measurable, and not time- Is this a SMART goal? "Patient will feel better soon." Why or why not?
bound.
Yes. It is specific, measurable, realistic, and time-bound. Is this a SMART goal? "Patient will verbalize pain level of 3 or less within 1 hour of
receiving pain meds."
Immediate outcomes (e.g., by tomorrow or within a few What is a short term goal?
days)
Achieved over weeks or months; often used for discharge What is a long term goal?
or rehabilitation planning
"Patient will raise right arm to shoulder height by Friday" Which is a short-term goal?A. "Patient will regain full use of right arm in 6
is a short-term goal. weeks."B. "Patient will raise right arm to shoulder height by Friday."
Nurse-initiated actions based on knowledge and skill, no Define independent nursing interventions
provider order needed
Require a provider’s order or supervision Define dependent nursing interventions
the action phase where the nurse performs interventions What is the main purpose of the implementation phase in the nursing process?
to address the patient's needs
Implementing safe, evidence-based interventions using What does the "taking action" phase in clinical reasoning involve?
critical thinking and decision-making
Reassess the patient What are the 5 steps in the taking action phase?
Determine need for help
Implement interventions
Supervise delegated care
Document actions
Right task, circumstance, person, What are the 5 Rights of Delegation?
directions/communication, supervision/evaluation
, Delegating vital signs on stable patients, bedmaking, or What is an example of appropriate delegation?
basic hygiene tasks.
remains responsible for the overall care, must ensure it What is the RN's ultimate responsibility when delegating care?
aligns with the care plan, and must evaluate and respond
to any patient outcomes.
To determine the patient's progress toward goals, and What is the purpose of evaluating outcomes in nursing care?
decide whether to continue, modify, or stop the care plan
Collect data What are the 5 steps in the evaluation process?
Compare data to outcomes
Relate actions to outcomes
Draw conclusions
Continue, modify, or terminate care
conclusion and supporting data What 2 parts are in the evaluation statement?
statement that goal/desired outcome was met, partially What is the conclusion?
met, or not met
list of client responses that support the conclusion What is the supporting data?
Reassess the patient What actions should a nurse take if the client's goals are not met?
Review nursing diagnosis
Ask why the goal wasn't met
Revise the care plan
Communicate with the team
body response to stress involving physiologic events What is General Adaptation Syndrome (GAS)?
dominated by the sympathetic nervous system
Initial reaction; activates defenses (fight or flight) What is the alarm stage of GAS?
Body adapts to stress What is the resistance stage of GAS?
Adaptation can't be maintained; resources depleted What is the exhaustion stage of GAS?
short-term stress reaction (1 min-24 hrs) during the alarm What is the fight-or-flight response, and when does it occur?
stage that prepares the body to respond to threats
A localized body response where only one organ or What is Local Adaptation Syndrome?
body part reacts to stress (e.g., inflammation)
Altered elimination, changes in appetite, and disrupted What are some effects of prolonged stress on physiological needs?
sleep patterns
nervousness, feeling threatened, focusing only on How does prolonged stress affect safety and security needs?
stressors, or neglecting safety
