Nursing 101 Fundamentals of Nursing
Practice Exam 1 (Latest )
| 100% Correct Questions & Answers
The clinical instructor is discussing about the Nursing Process. She mentioned that
when a cluster of actual or high-risk diagnosis are present because of a certain
situation it is called:
A. Wellness nursing diagnosis
B. Actual nursing diagnosis
C. Syndrome nursing diagnosis
D. Risk nursing diagnosis - ANSWER C. Syndrome nursing diagnosis
Presence of both actual and high-risk diagnosis is called a syndrome nursing
diagnosis. Wellness nursing diagnosis focuses on the clinical judgment on an
individual from a specific to higher level of wellness. Actual diagnoses are clinical
judgment of the nurse that is validated. A risk diagnosis is based on the clinical are
based on clinical judgment that the client may develop vulnerability to the
problem.
The nurse in charge measures a patient's temperature at 101 degrees F. What is the
equivalent centigrade temperature?
A. 36.3 degrees C
B. 37.95 degrees C
C. 40.03 degrees C
D. 38.01 degrees C - ANSWER B. 37.95
To convert °F to °C use this formula, ( °F - 32 ) (0.55). While when converting °C
to °F use this formula, ( °C x 1.8) + 32. Note that 0.55 is 5/9 and 1.8 is 9/5.
,During a change-of-shift report, it would be important for the nurse relinquishing
responsibility for care of the patient to communicate. Which of the following facts
to the nurse assuming responsibility for care of the patient?
A. That the patient verbalized, "My headache is gone."
B. That the patient's barium enema performed 3 days ago was negative
C. Patient's NGT was removed 2 hours ago
D. Patient's family came for a visit this morning. - ANSWER C.
Patient's NGT was removed 2 hours ago
The change-of-shift report should indicate significant recent changes in the
patient's condition that the nurse assuming responsibility for care of the patient will
need to monitor. The other options are not critical enough to include in the report
A client is receiving 115 ml/hr of continuous IVF. The nurse notices that the
venipuncture site is red and swollen. Which of the following interventions would
the nurse perform first?
A. Stop the infusion
B. Call the attending physician
C. Slow that infusion to 20 ml/hr
D. Place a cold towel on the site - ANSWER A. Stop the infusion
The sign and symptoms indicate extravasation so the IVF should be stopped
immediately and put warm not cold towel on the affected site.
Which data would be of greatest concern to the nurse when completing the nursing
assessment of a 68-year-old woman hospitalized due to Pneumonia?
A. Oriented to date, time and place
B. Clear breath sounds
C. Capillary refill greater than 3 seconds and buccal cyanosis
, D. Hemoglobin of 13 g/dl - ANSWER C. Capillary refill greater than
3 seconds and buccal cyanosis
Capillary refill greater than 3 seconds and buccal cyanosis indicate decreased
oxygen to the tissues which requires immediate attention/intervention. Oriented to
date, time and place, hemoglobin of 13 g/dl are normal data.
What is the order of the nursing process?
A. Assessing, diagnosing, implementing, evaluating, planning
B. Diagnosing, assessing, planning, implementing, evaluating
C. Assessing, diagnosing, planning, implementing, evaluating
D. Planning, evaluating, diagnosing, assessing, implementing - ANSWER
C. Assessing, diagnosing, planning, implementing, evaluating
The correct order of the nursing process is assessing, diagnosing, planning,
implementing, evaluating.
Which of the following is the most important purpose of planning care with a
patient?
A. Development of a standardized NCP.
B. Expansion of the current taxonomy of nursing diagnosis
C. Making of individualized patient care
D. Incorporation of both nursing and medical diagnoses in patient care -
ANSWER C. Making of individualized patient care
To be effective, the nursing care plan developed in the planning phase of the
nursing process must reflect the individualized needs of the patient.
Practice Exam 1 (Latest )
| 100% Correct Questions & Answers
The clinical instructor is discussing about the Nursing Process. She mentioned that
when a cluster of actual or high-risk diagnosis are present because of a certain
situation it is called:
A. Wellness nursing diagnosis
B. Actual nursing diagnosis
C. Syndrome nursing diagnosis
D. Risk nursing diagnosis - ANSWER C. Syndrome nursing diagnosis
Presence of both actual and high-risk diagnosis is called a syndrome nursing
diagnosis. Wellness nursing diagnosis focuses on the clinical judgment on an
individual from a specific to higher level of wellness. Actual diagnoses are clinical
judgment of the nurse that is validated. A risk diagnosis is based on the clinical are
based on clinical judgment that the client may develop vulnerability to the
problem.
The nurse in charge measures a patient's temperature at 101 degrees F. What is the
equivalent centigrade temperature?
A. 36.3 degrees C
B. 37.95 degrees C
C. 40.03 degrees C
D. 38.01 degrees C - ANSWER B. 37.95
To convert °F to °C use this formula, ( °F - 32 ) (0.55). While when converting °C
to °F use this formula, ( °C x 1.8) + 32. Note that 0.55 is 5/9 and 1.8 is 9/5.
,During a change-of-shift report, it would be important for the nurse relinquishing
responsibility for care of the patient to communicate. Which of the following facts
to the nurse assuming responsibility for care of the patient?
A. That the patient verbalized, "My headache is gone."
B. That the patient's barium enema performed 3 days ago was negative
C. Patient's NGT was removed 2 hours ago
D. Patient's family came for a visit this morning. - ANSWER C.
Patient's NGT was removed 2 hours ago
The change-of-shift report should indicate significant recent changes in the
patient's condition that the nurse assuming responsibility for care of the patient will
need to monitor. The other options are not critical enough to include in the report
A client is receiving 115 ml/hr of continuous IVF. The nurse notices that the
venipuncture site is red and swollen. Which of the following interventions would
the nurse perform first?
A. Stop the infusion
B. Call the attending physician
C. Slow that infusion to 20 ml/hr
D. Place a cold towel on the site - ANSWER A. Stop the infusion
The sign and symptoms indicate extravasation so the IVF should be stopped
immediately and put warm not cold towel on the affected site.
Which data would be of greatest concern to the nurse when completing the nursing
assessment of a 68-year-old woman hospitalized due to Pneumonia?
A. Oriented to date, time and place
B. Clear breath sounds
C. Capillary refill greater than 3 seconds and buccal cyanosis
, D. Hemoglobin of 13 g/dl - ANSWER C. Capillary refill greater than
3 seconds and buccal cyanosis
Capillary refill greater than 3 seconds and buccal cyanosis indicate decreased
oxygen to the tissues which requires immediate attention/intervention. Oriented to
date, time and place, hemoglobin of 13 g/dl are normal data.
What is the order of the nursing process?
A. Assessing, diagnosing, implementing, evaluating, planning
B. Diagnosing, assessing, planning, implementing, evaluating
C. Assessing, diagnosing, planning, implementing, evaluating
D. Planning, evaluating, diagnosing, assessing, implementing - ANSWER
C. Assessing, diagnosing, planning, implementing, evaluating
The correct order of the nursing process is assessing, diagnosing, planning,
implementing, evaluating.
Which of the following is the most important purpose of planning care with a
patient?
A. Development of a standardized NCP.
B. Expansion of the current taxonomy of nursing diagnosis
C. Making of individualized patient care
D. Incorporation of both nursing and medical diagnoses in patient care -
ANSWER C. Making of individualized patient care
To be effective, the nursing care plan developed in the planning phase of the
nursing process must reflect the individualized needs of the patient.
