1. Nursing process (assessment, diagnosis, planning, implementation, evaluation)
2. Vital signs and physiological monitoring
3. Infection prevention and control practices
4. Medication administration and safety
5. Patient safety and risk reduction
6. Documentation and communication
7. Mobility, positioning, and falls prevention
8. Nutrition, hydration, and elimination
9. Oxygenation and respiratory care
10. Wound care and skin integrity
11. Pain assessment and management
12. Patient education and health promotion
13. Ethical and legal aspects of nursing
14. Interprofessional collaboration and teamwork
15. Emergency response and deterioration recognition
,NFDN 2007 Nursing Midterm Exam
1. When a nurse notices a patient's condition deteriorating shortly after surgery,
which action should be taken first according to the nursing process?
A. Document the findings and continue monitoring every four hours
B. Complete a focused assessment and notify the appropriate provider
promptly
C. Wait for the next scheduled vital signs round before acting
D. Ask the family whether the patient has seemed different recently
Answer: B
Rationale: A focused assessment and timely provider notification are essential
when deterioration is suspected, because early recognition improves
outcomes and supports the assessment phase of the nursing process.
2. Which statement best explains why the nursing process is described as
cyclical rather than linear in everyday clinical practice?
A. Each step must be completed once before any other step can begin
B. Evaluation can lead to reassessment and revision of the plan of care
C. Documentation replaces the need for ongoing patient assessment
, D. The process applies only to patients with chronic illnesses
Answer: B
Rationale: The nursing process is dynamic and cyclical, and evaluation
frequently prompts reassessment and modification of the care plan.
3. During the assessment phase, which activity demonstrates the nurse is
collecting subjective data from a newly admitted patient?
A. Measuring the patient's blood pressure with an automated cuff
B. Asking the patient to describe the location and nature of the pain
C. Observing redness along the patient's surgical incision
D. Reviewing the laboratory report for elevated white blood cell count
Answer: B
Rationale: Subjective data are what the patient reports, such as descriptions
of pain, whereas measurements and observations are objective data.
4. A nurse is prioritizing care for four patients at the start of a shift. Which patient
should be assessed first based on clinical urgency?
A. A patient requesting assistance with a scheduled shower
B. A patient with new shortness of breath and an oxygen saturation of 88%
, C. A patient asking questions about discharge instructions
D. A patient waiting for a routine blood glucose check
Answer: B
Rationale: New hypoxia and respiratory distress indicate an immediate threat
to airway and breathing, which takes priority over routine and nonurgent
needs.
5. Which nursing diagnosis statement is written in the correct format for a
problem-focused diagnosis?
A. Risk for falls related to unsteady gait
B. Impaired gas exchange related to alveolar hypoventilation as evidenced by
oxygen saturation of 86%
C. The patient seems anxious about the upcoming procedure
D. Encourage the patient to use the incentive spirometer every hour
Answer: B
Rationale: A problem-focused diagnosis includes the diagnostic label, related
factors, and defining characteristics as evidence, which this option correctly
demonstrates.
2. Vital signs and physiological monitoring
3. Infection prevention and control practices
4. Medication administration and safety
5. Patient safety and risk reduction
6. Documentation and communication
7. Mobility, positioning, and falls prevention
8. Nutrition, hydration, and elimination
9. Oxygenation and respiratory care
10. Wound care and skin integrity
11. Pain assessment and management
12. Patient education and health promotion
13. Ethical and legal aspects of nursing
14. Interprofessional collaboration and teamwork
15. Emergency response and deterioration recognition
,NFDN 2007 Nursing Midterm Exam
1. When a nurse notices a patient's condition deteriorating shortly after surgery,
which action should be taken first according to the nursing process?
A. Document the findings and continue monitoring every four hours
B. Complete a focused assessment and notify the appropriate provider
promptly
C. Wait for the next scheduled vital signs round before acting
D. Ask the family whether the patient has seemed different recently
Answer: B
Rationale: A focused assessment and timely provider notification are essential
when deterioration is suspected, because early recognition improves
outcomes and supports the assessment phase of the nursing process.
2. Which statement best explains why the nursing process is described as
cyclical rather than linear in everyday clinical practice?
A. Each step must be completed once before any other step can begin
B. Evaluation can lead to reassessment and revision of the plan of care
C. Documentation replaces the need for ongoing patient assessment
, D. The process applies only to patients with chronic illnesses
Answer: B
Rationale: The nursing process is dynamic and cyclical, and evaluation
frequently prompts reassessment and modification of the care plan.
3. During the assessment phase, which activity demonstrates the nurse is
collecting subjective data from a newly admitted patient?
A. Measuring the patient's blood pressure with an automated cuff
B. Asking the patient to describe the location and nature of the pain
C. Observing redness along the patient's surgical incision
D. Reviewing the laboratory report for elevated white blood cell count
Answer: B
Rationale: Subjective data are what the patient reports, such as descriptions
of pain, whereas measurements and observations are objective data.
4. A nurse is prioritizing care for four patients at the start of a shift. Which patient
should be assessed first based on clinical urgency?
A. A patient requesting assistance with a scheduled shower
B. A patient with new shortness of breath and an oxygen saturation of 88%
, C. A patient asking questions about discharge instructions
D. A patient waiting for a routine blood glucose check
Answer: B
Rationale: New hypoxia and respiratory distress indicate an immediate threat
to airway and breathing, which takes priority over routine and nonurgent
needs.
5. Which nursing diagnosis statement is written in the correct format for a
problem-focused diagnosis?
A. Risk for falls related to unsteady gait
B. Impaired gas exchange related to alveolar hypoventilation as evidenced by
oxygen saturation of 86%
C. The patient seems anxious about the upcoming procedure
D. Encourage the patient to use the incentive spirometer every hour
Answer: B
Rationale: A problem-focused diagnosis includes the diagnostic label, related
factors, and defining characteristics as evidence, which this option correctly
demonstrates.
