Potter & Perry Fundamentals of Nursing:
Chapter 20| Questions with 100%
Solutions | Verified
A nurse in a community health clinic has been caring for a young teenager with asthma for
several months. The nurse's goal of care for this patient is to achieve self-management of
asthma medications. Identify appropriate evaluative indicators for self-management for this
patient.
Select all that apply.
A. Quality of life
B. Patient satisfaction
C. Use of clinic services
D. Adherence to use of inhaler
E. Description of side effects of medications - ANSWER A, C, D
,A nurse checks an intravenous (IV) solution container for clarity of the solution, noting that it
is infusing into the patient's left arm. The IV solution of 9% NS is infusing freely at 100 mL/hr as
ordered. The nurse reviews the nurses' notes from the previous shift to determine if the
dressing over the site was changed as scheduled per standard of care. While in the room the
nurse inspects the condition of the dressing and notes the date on the dressing label. In which
ways did the nurse evaluate the condition of the IV site?
Select all that apply.
A. Checked the IV infusion rate
B. Checked the type of IV solution
C. Confirmed from nurses' notes the time of dressing change
D. Inspected the condition of the IV dressing at the site
E. Checked clarity of IV solution - ANSWER A, D
A nurse enters a patient's room and begins a conversation. During this time the nurse evaluates
how a patient is tolerating a new diet plan. The nurse decides to also evaluate the patient's
expectations of care. Which statement is appropriate for evaluating a patient's expectations of
care?
A. On a scale of 0 to 10 rate your level of nausea.
B. The nurse weighs the patient.
C. The nurse asks, "Did you believe that you received the information you needed to
follow your diet?"
, D. The nurse states, "Tell me four different foods included in your diet." - ANSWER C
A patient has been febrile and coughing thick secretions; adventitious lung sounds indicate
rales in the left lower lobe of the lungs. The nurse decides to perform nasotracheal suction
because the patient is not coughing. The nurse inspects the mucus that is suctioned, which is
minimal. The nurse again auscultates for lung sounds. Auscultation and mucus inspection
are examples of:
A. Evaluative measures.
B. Expected outcomes.
C. Reassessments.
D. Reflection. - ANSWER A
A nurse has been caring for a patient over the last 10 hours. The patient's plan of care
includes the nursing diagnosis of Nausea related to effects of postoperative anesthesia. The
nurse has been asking the patient to rate his nausea over the last several hours after
administering antiemetics and using comfort measures such as oral hygiene. The nurse
reviews the patient's responses over the past 10 hours and notes how the patient's self-report
of nausea has changed. This review an example of:
A. Comparing outcome criteria with actual response.
B. Gathering outcome criteria.
C. Evaluating the patient's actual response.
D. Reprioritizing interventions. - ANSWER A
Chapter 20| Questions with 100%
Solutions | Verified
A nurse in a community health clinic has been caring for a young teenager with asthma for
several months. The nurse's goal of care for this patient is to achieve self-management of
asthma medications. Identify appropriate evaluative indicators for self-management for this
patient.
Select all that apply.
A. Quality of life
B. Patient satisfaction
C. Use of clinic services
D. Adherence to use of inhaler
E. Description of side effects of medications - ANSWER A, C, D
,A nurse checks an intravenous (IV) solution container for clarity of the solution, noting that it
is infusing into the patient's left arm. The IV solution of 9% NS is infusing freely at 100 mL/hr as
ordered. The nurse reviews the nurses' notes from the previous shift to determine if the
dressing over the site was changed as scheduled per standard of care. While in the room the
nurse inspects the condition of the dressing and notes the date on the dressing label. In which
ways did the nurse evaluate the condition of the IV site?
Select all that apply.
A. Checked the IV infusion rate
B. Checked the type of IV solution
C. Confirmed from nurses' notes the time of dressing change
D. Inspected the condition of the IV dressing at the site
E. Checked clarity of IV solution - ANSWER A, D
A nurse enters a patient's room and begins a conversation. During this time the nurse evaluates
how a patient is tolerating a new diet plan. The nurse decides to also evaluate the patient's
expectations of care. Which statement is appropriate for evaluating a patient's expectations of
care?
A. On a scale of 0 to 10 rate your level of nausea.
B. The nurse weighs the patient.
C. The nurse asks, "Did you believe that you received the information you needed to
follow your diet?"
, D. The nurse states, "Tell me four different foods included in your diet." - ANSWER C
A patient has been febrile and coughing thick secretions; adventitious lung sounds indicate
rales in the left lower lobe of the lungs. The nurse decides to perform nasotracheal suction
because the patient is not coughing. The nurse inspects the mucus that is suctioned, which is
minimal. The nurse again auscultates for lung sounds. Auscultation and mucus inspection
are examples of:
A. Evaluative measures.
B. Expected outcomes.
C. Reassessments.
D. Reflection. - ANSWER A
A nurse has been caring for a patient over the last 10 hours. The patient's plan of care
includes the nursing diagnosis of Nausea related to effects of postoperative anesthesia. The
nurse has been asking the patient to rate his nausea over the last several hours after
administering antiemetics and using comfort measures such as oral hygiene. The nurse
reviews the patient's responses over the past 10 hours and notes how the patient's self-report
of nausea has changed. This review an example of:
A. Comparing outcome criteria with actual response.
B. Gathering outcome criteria.
C. Evaluating the patient's actual response.
D. Reprioritizing interventions. - ANSWER A
