Nurs 224 FINAL EXAM QUESTIONS WITH
CORRECT ANSWERS
CHAPTER 10
Family of a client demonstrating confusion states that this is not the client's usual
behavior. How should the nurse document this data?
a. Inference
b. Subjective data
c. Objective data
d. Secondary subjective data - CORRECT ANSWER✔✔-c. Objective data
A newly admitted client is angry because nursing staff continue to ask the same
questions. What should the nurse respond to this client?
a. "In order to make sure all of your information is complete, I need to ask these
questions."
b. "You're right. Let me know if there's anything you need right now."
c. "I'll be done shortly, just give me a few more minutes."
d. "You shouldn't be upset. We're only doing our jobs." - CORRECT ANSWER✔✔-b.
"You're right. Let me know if there's anything you need right now."
During an initial interview, the client says, "I don't understand why I have to have
surgery; I'm really not that sick or in pain right now." How should the nurse
respond to the client?
,a. "It's OK to be worried. Surgery is a big step."
b. "What kind of questions do you have about your surgery?"
c. "I think these are things you should be asking your doctor."
d. "Have you had surgery before?" - CORRECT ANSWER✔✔-b. "What kind of
questions do you have about your surgery?"
During an assessment interview, the client states that an elective surgical
procedure will not be done because it does not fit into the client's life goals. Into
which of Gordon's functional health patterns should the nurse identify this client's
comment?
a. Cognitive/perceptual pattern
b. Coping/stress-tolerance pattern
c. Health-perception/health-management pattern
d. Value/belief pattern - CORRECT ANSWER✔✔-d. Value/belief pattern
The nurse suspects that a client with a history of injuries is a victim of abuse.
What did the nurse use to come to this conclusion?
a. Observation of cues
b. Validation
c. Inference
d.Judgment - CORRECT ANSWER✔✔-c. Inference
The nurse is reviewing the nursing process with a first-year nursing student. What
should the nurse explain as being the purpose of the diagnosis phase? (Select all
that apply.)
,a. Develop a list of problems.
b. Identify client strengths.
c. Develop a plan.
d. Specify goals and outcomes.
e.Identify problems that can be prevented. - CORRECT ANSWER✔✔-a. Develop a
list of problems.
b. Identify client strengths.
e. Identify problems that can be prevented.
The nurse decides to seek wound care alternatives for a client's stasis ulcer that is
not healing after treatment for 2 weeks. In which phase of the nursing process is
the nurse functioning?
a. Diagnosis
b. Implementation
c. Evaluation
d. Assessment - CORRECT ANSWER✔✔-d. Assessment
While preparing a client for a procedure, the nurse notes that the client has
become unresponsive and respirations have become shallow. What type of
assessment should the nurse complete at this time?
a. Initial assessment
b. Problem-focused assessment
c. Emergency assessment
d.Time-lapsed assessment - CORRECT ANSWER✔✔-c. Emergency assessment
, A nurse is performing an initial assessment on a new admission. What information
should the nurse consider as being a part of the database? (Select all that apply.)
a. Reports from physical therapy the client received as an outpatient
b. Documentation of the nurse's physical assessment
c. Physician's orders
d. A list of current medications
e. Information about the client's cultural preferences
f. Discharge instructions - CORRECT ANSWER✔✔-a. Reports from physical therapy
the client received as an outpatient
b. Documentation of the nurse's physical assessment
d. A list of current medications
e. Information about the client's cultural preferences
The nurse manager observes a staff nurse perform actions within the nursing
process. Which activities did the manager observe the nurse perform? (Select all
that apply.)
a. Notifying the surgeon that a postoperative client is experiencing an increase in
temperature
b. Advocating for a client who is mentally incapable of expressing her needs
c. Deciding to increase a client's nasal oxygen based on his current pulse
oxygenation levels
d. Documenting all clients' pain level responses after administering pain
medication
e. Attending in-services on a new hydraulic lift to be used to support safe client
care - CORRECT ANSWER✔✔-a. Notifying the surgeon that a postoperative client
is experiencing an increase in temperature
CORRECT ANSWERS
CHAPTER 10
Family of a client demonstrating confusion states that this is not the client's usual
behavior. How should the nurse document this data?
a. Inference
b. Subjective data
c. Objective data
d. Secondary subjective data - CORRECT ANSWER✔✔-c. Objective data
A newly admitted client is angry because nursing staff continue to ask the same
questions. What should the nurse respond to this client?
a. "In order to make sure all of your information is complete, I need to ask these
questions."
b. "You're right. Let me know if there's anything you need right now."
c. "I'll be done shortly, just give me a few more minutes."
d. "You shouldn't be upset. We're only doing our jobs." - CORRECT ANSWER✔✔-b.
"You're right. Let me know if there's anything you need right now."
During an initial interview, the client says, "I don't understand why I have to have
surgery; I'm really not that sick or in pain right now." How should the nurse
respond to the client?
,a. "It's OK to be worried. Surgery is a big step."
b. "What kind of questions do you have about your surgery?"
c. "I think these are things you should be asking your doctor."
d. "Have you had surgery before?" - CORRECT ANSWER✔✔-b. "What kind of
questions do you have about your surgery?"
During an assessment interview, the client states that an elective surgical
procedure will not be done because it does not fit into the client's life goals. Into
which of Gordon's functional health patterns should the nurse identify this client's
comment?
a. Cognitive/perceptual pattern
b. Coping/stress-tolerance pattern
c. Health-perception/health-management pattern
d. Value/belief pattern - CORRECT ANSWER✔✔-d. Value/belief pattern
The nurse suspects that a client with a history of injuries is a victim of abuse.
What did the nurse use to come to this conclusion?
a. Observation of cues
b. Validation
c. Inference
d.Judgment - CORRECT ANSWER✔✔-c. Inference
The nurse is reviewing the nursing process with a first-year nursing student. What
should the nurse explain as being the purpose of the diagnosis phase? (Select all
that apply.)
,a. Develop a list of problems.
b. Identify client strengths.
c. Develop a plan.
d. Specify goals and outcomes.
e.Identify problems that can be prevented. - CORRECT ANSWER✔✔-a. Develop a
list of problems.
b. Identify client strengths.
e. Identify problems that can be prevented.
The nurse decides to seek wound care alternatives for a client's stasis ulcer that is
not healing after treatment for 2 weeks. In which phase of the nursing process is
the nurse functioning?
a. Diagnosis
b. Implementation
c. Evaluation
d. Assessment - CORRECT ANSWER✔✔-d. Assessment
While preparing a client for a procedure, the nurse notes that the client has
become unresponsive and respirations have become shallow. What type of
assessment should the nurse complete at this time?
a. Initial assessment
b. Problem-focused assessment
c. Emergency assessment
d.Time-lapsed assessment - CORRECT ANSWER✔✔-c. Emergency assessment
, A nurse is performing an initial assessment on a new admission. What information
should the nurse consider as being a part of the database? (Select all that apply.)
a. Reports from physical therapy the client received as an outpatient
b. Documentation of the nurse's physical assessment
c. Physician's orders
d. A list of current medications
e. Information about the client's cultural preferences
f. Discharge instructions - CORRECT ANSWER✔✔-a. Reports from physical therapy
the client received as an outpatient
b. Documentation of the nurse's physical assessment
d. A list of current medications
e. Information about the client's cultural preferences
The nurse manager observes a staff nurse perform actions within the nursing
process. Which activities did the manager observe the nurse perform? (Select all
that apply.)
a. Notifying the surgeon that a postoperative client is experiencing an increase in
temperature
b. Advocating for a client who is mentally incapable of expressing her needs
c. Deciding to increase a client's nasal oxygen based on his current pulse
oxygenation levels
d. Documenting all clients' pain level responses after administering pain
medication
e. Attending in-services on a new hydraulic lift to be used to support safe client
care - CORRECT ANSWER✔✔-a. Notifying the surgeon that a postoperative client
is experiencing an increase in temperature
