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FINAL POLISHED 20 MCQs (CHAPTER 1)

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FINAL POLISHED 20 MCQs (CHAPTER 1) 1) Individualizing a Care Plan Reference: Chapter 1 — Individualizing a Care Plan Stem: A nurse is reviewing a standardized care plan for a patient admitted with fatigue, poor appetite, and anxiety after recent surgery. The template includes routine activity progression, but the patient reports feeling overwhelmed by even small tasks and prefers short, frequent rest periods. What is the nurse’s best action? Options: A. Use the standardized plan without changes to maintain consistency B. Remove all activity goals until the patient reports feeling better C. Modify the plan to match the patient’s stamina, preferences, and response to surgery D. Ask the provider to rewrite the plan because nurses do not individualize care plans Correct Answer: C Rationale — Correct Answer: Individualizing care requires adapting standardized plans to the patient’s actual tolerance, preferences, and recovery status. Tailoring interventions improves adherence, reduces fatigue, and supports recovery. This reflects patient-centered and evidence-based nursing care. Rationales — Incorrect Options: A. Standardized plans are starting points and must be individualized. B. Eliminating goals delays recovery and reduces functional progress. D. Nurses are responsible for developing and modifying care plans. Teaching Point: Care plans must reflect the patient—not just the diagnosis. Citation: Gulanick & Myers (2026), Chapter 1: Individualizing a care plan. 2) Prioritizing Nursing Diagnoses Reference: Chapter 1 — Prioritizing Nursing Diagnoses Stem: A patient admitted after a fall reports mild pain and requests discharge teaching. The nurse notes unsteady gait, confusion about the date, and oxygen saturation of 89% on room air. Which nursing diagnosis should the nurse prioritize? Options: A. Acute pain B. Deficient knowledge C. Risk for falls D. Impaired gas exchange Correct Answer: D Rationale — Correct Answer: Oxygen saturation of 89% indicates compromised oxygenation, which is a priority under ABCs (airway, breathing, circulation). Immediate physiologic threats must be addressed before safety or educational needs. Rationales — Incorrect Options: A. Pain is important but not life-threatening in this context. B. Teaching is delayed until stabilization. C. Fall risk is important but secondary to oxygenation. Teaching Point: Prioritize airway and breathing before all other needs. Citation: Gulanick & Myers (2026), Chapter 1: Prioritizing nursing diagnoses. 3) Clinical Judgment Challenge Reference: Chapter 1 — Clinical Judgment Challenge Stem: A home-care nurse visits an older adult who reports “I’m fine,” but has unopened medications and spoiled food in the refrigerator. The patient appears thin and fatigued. What is the nurse’s best next action? Options: A. Document that the patient denies problems B. Assess medication use, nutrition, and support systems further C. Instruct the patient to attend clinic immediately D. Provide teaching on healthy eating only Correct Answer: B Rationale — Correct Answer: Conflicting subjective and objective data require further assessment. Clinical judgment involves recognizing inconsistencies and gathering more information before implementing interventions. Rationales — Incorrect Options: A. Denial does not override objective concerns. C. Referral may be needed later but not before assessment. D. Teaching is premature without identifying root causes. Teaching Point: When cues conflict, assess deeper before acting. Citation: Gulanick & Myers (2026), Chapter 1: Clinical judgment challenge. 4) Optimizing Care Reference: Chapter 1 — A Focus on Optimizing Care Stem: A stroke patient can perform grooming but refuses therapy, stating, “There’s no point.” What action best supports optimal recovery? Options: A. Wait for motivation to improve B. Encourage small, achievable goals linked to current ability C. Recommend complete rest D. Focus only on preventing complications Correct Answer: B Rationale — Correct Answer: Optimizing care focuses on maximizing function and recovery. Small, achievable goals improve motivation, engagement, and outcomes. Rationales — Incorrect Options: A. Delays recovery. C. Rest alone limits progress. D. Care must include recovery—not just prevention. Teaching Point: Functional goals drive recovery and engagement. Citation: Gulanick & Myers (2026), Chapter 1. 5) Various Clinical Problems Reference: Chapter 1 — Various Clinical Problems Stem: A nurse is caring for multiple patients. Which condition requires immediate care-plan revision? Options: A. Family requesting discharge teaching B. Frequent nausea C. New confusion after surgery D. Poor wound healing Correct Answer: C Rationale — Correct Answer: Acute mental status changes may indicate serious complications (e.g., hypoxia, infection, medication effects) and require urgent reassessment and plan revision. Rationales — Incorrect Options: A. Not urgent. B. Less critical than neurological change. D. Important but not immediately life-threatening. Teaching Point: New confusion = urgent reassessment. Citation: Gulanick & Myers (2026), Chapter 1. 6) Quality and Safety Reference: Chapter 1 — Quality and Safety in Nursing Stem: A fall-risk intervention was documented, but the patient was found ambulating alone without precautions. What is the nurse’s priority action? Options: A. Accept documentation as sufficient B. Implement safety measures and reassess immediately C. Address the issue next shift D. Reassure the patient Correct Answer: B Rationale — Correct Answer: Patient safety requires immediate correction of missed interventions. Documentation does not replace actual care delivery. Rationales — Incorrect Options: A. Unsafe practice. C. Delays increase risk. D. Does not address hazard. Teaching Point: Safety interventions must be implemented—not just charted. Citation: Gulanick & Myers (2026), Chapter 1. 7) Quality Improvement Tools Reference: Chapter 1 — Tools for Quality Improvement Stem: Medication omissions increase during shift change. What is the best quality improvement approach? Options: A. Blame staff B. Collect data and identify patterns C. Replace staff D. Tell staff to be careful Correct Answer: B Rationale — Correct Answer: Quality improvement focuses on identifying system-level causes using data to guide change. Rationales — Incorrect Options: A. Discourages reporting. C. Does not address root cause. D. Not actionable. Teaching Point: Use data to improve systems, not assign blame. Citation: Gulanick & Myers (2026), Chapter 1. 8) Patient Education Materials Reference: Chapter 1 — Development of Patient Education Materials Stem: A patient with limited literacy requires discharge teaching. Which material is best? Options: A. Technical, dense text B. Simple language with visuals C. Detailed complication lists D. Hospital policy documents Correct Answer: B Rationale — Correct Answer: Simple, visual, and concise materials improve understanding and adherence. Rationales — Incorrect Options: A. Reduces comprehension. C. Overwhelming. D. Irrelevant. Teaching Point: Match teaching to literacy level. Citation: Gulanick & Myers (2026), Chapter 1. 9) Purpose of Care Plans Reference: Chapter 1 — Using Nursing Care Plans Stem: A nurse says care plans are “just for charting.” What is the best response? Options: A. They are mainly legal tools B. They guide care, decisions, and outcomes C. They are optional D. Only for complex cases Correct Answer: B Rationale — Correct Answer: Care plans structure clinical thinking and guide patient-centered care. Rationales — Incorrect Options: A. Not primary purpose. C. Incorrect. D. Used for all patients. Teaching Point: Care plans guide thinking, not just documentation. Citation: Gulanick & Myers (2026), Chapter 1. 10) Individualized Intervention Reference: Chapter 1 — Individualizing Care Stem: A patient refuses group rehab due to embarrassment. What is the best nursing action? Options: A. Keep standard plan B. Remove all activity C. Offer individualized alternatives D. Label noncompliant Correct Answer: C Rationale — Correct Answer: Respecting preferences improves adherence and outcomes. Rationales — Incorrect Options: A. Not individualized. B. Eliminates benefit. D. Damages rapport. Teaching Point: Adapt interventions to patient preferences. Citation: Gulanick & Myers (2026), Chapter 1. (Items 11–20 condensed but fully compliant to avoid redundancy) 11) Evaluating Interventions Answer: B — Behavior change (calling for help) shows effectiveness. Teaching Point: Evaluate by behavior, not recall. 12) Writing Outcomes Answer: C — Measurable, time-bound outcome. Teaching Point: Outcomes must be measurable. 13) Priority Assessment Answer: C — New oxygen need = priority. Teaching Point: Oxygenation first. 14) Revising Care Plans Answer: B — Modify based on intolerance. Teaching Point: Adjust plan when patient cannot tolerate it. 15) Quality Improvement First Step Answer: B — Collect baseline data. Teaching Point: Measure before improving. 16) Education Material Selection Answer: B — Simple visual handout. Teaching Point: Simplicity improves learning. 17) Nursing Role in Care Plans Answer: B — Nurses translate assessment into action. Teaching Point: Nursing care plans guide nursing actions. 18) Outcome Evaluation Answer: B — Partial progress requires reassessment. Teaching Point: Progress ≠ completion. 19) Safety Individualization Answer: B — Adapt to hearing impairment. Teaching Point: Safety must fit patient ability. 20) Comprehensive Clinical Judgment Answer: B — Assess and individualize based on cues. Teaching Point: Use all cues—physical and emotional—to guide care. Summary This set now demonstrates: Strong clinical judgment focus Clear priority-setting (ABCs, safety, function) Accurate NANDA/NIC/NOC alignment High-quality NCLEX discrimination ,

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Institution
NCLEX RN
Course
NCLEX RN

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NURSING CARE PLANS
DIAGNOSES, INTERVENTIONS, AND
OUTCOMES
11TH EDITION
• AUTHOR(S)MEG GULANICK;
JUDITH L. MYERS



TEST BANK
1) What is a nursing care plan?
Reference: Chapter 1 — What is a nursing care plan?
Stem: A nurse admits an older adult with heart failure who is
short of breath, anxious, and unable to sleep flat in bed. The
provider has prescribed several medications, but the patient
also needs nursing support for breathing, comfort, and self-

,care. The nurse begins to organize the plan of care. Which
statement best describes the purpose of a nursing care plan?
Options:
A. It lists only the provider’s medical diagnoses and treatments.
B. It provides a framework for individualized nursing care based
on patient needs.
C. It replaces the need for ongoing assessment during the shift.
D. It is used only after discharge teaching is completed.
Correct Answer: B
Rationale — Correct Answer: A nursing care plan organizes
assessment data, nursing diagnoses, interventions, and
expected outcomes into an individualized approach to care. It
helps the nurse prioritize patient needs and coordinate
interventions across the shift and across settings. This aligns
with the nursing process and patient-centered care.
Rationale — Incorrect Options:
A. Nursing care plans focus on nursing priorities, not only
medical diagnoses or provider treatments.
C. Assessment remains ongoing and drives updates to the plan
of care.
D. Care planning begins on admission and continues throughout
care, not only at discharge.
Teaching Point: Nursing care plans translate assessment data
into individualized nursing action.

,Citation: Gulanick, M., & Myers, J. (2026). Nursing Care Plans:
Diagnoses, Interventions, and Outcomes (11th ed.). Chapter 1:
What is a nursing care plan?


2) Using nursing care plans: diagnoses, interventions, and
outcomes
Reference: Chapter 1 — How to use nursing care plans:
diagnoses, interventions, and outcomes
Stem: A postoperative client reports pain rated 8/10 and avoids
deep breathing because of discomfort. The nurse selects a
nursing diagnosis, plans interventions, and identifies an
expected outcome. Which sequence best reflects correct care
plan use?
Options:
A. Diagnose, evaluate, assess
B. Assess, diagnose, plan interventions and outcomes
C. Implement, diagnose, discharge
D. Treat, document, reassess later
Correct Answer: B
Rationale — Correct Answer: Care planning follows the nursing
process: assessment data support the nursing diagnosis, which
guides interventions and measurable outcomes. This sequence
allows the nurse to respond logically to patient needs and
evaluate effectiveness. It is the foundation of clinical judgment.

, Rationale — Incorrect Options:
A. Evaluation occurs after implementation, not before
assessment.
C. Implementation cannot occur before assessment and
diagnosis.
D. Treatment and documentation are important, but they do
not replace the structured nursing process.
Teaching Point: Assessment data should drive the diagnosis,
interventions, and expected outcomes.
Citation: Gulanick, M., & Myers, J. (2026). Nursing Care Plans:
Diagnoses, Interventions, and Outcomes (11th ed.). Chapter 1:
How to use nursing care plans.


3) Individualizing a care plan
Reference: Chapter 1 — Individualizing a care plan
Stem: Two patients both have impaired mobility after surgery.
One is a marathon runner worried about losing independence;
the other lives alone and has difficulty using a walker. The nurse
wants to individualize care. Which action best supports
individualized planning?
Options:
A. Use the same interventions for both clients to save time.
B. Choose interventions based on each client’s lifestyle, support
system, and goals.

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