TEST BANK Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care 13th Edition

TEST BANK
Ackley and Ladwig’s Nursing Diagnosis Handbook: An
Evidence-Based Guide to Planning Care 13th Edition

,Section`I:`Nursing`Diagnosis,`the`Nursing`Process,`and`Evidence-
`Based`Nursing


1. What`is`the`primary`goal`of`a`nursing`diagnosis?

 a.`To`identify`a`medical`diagnosis
 b.`To`determine`the`effectiveness`of`medications
 c.`To`identify`patient`problems`that`can`be`managed`by`nursing`i
nterventions
 d.`To`prioritize`physician`orders

ANS:`C
Rationale:`The`primary`goal`of`a`nursing`diagnosis`is`to`identify`patient`problems`t
hat`can`be`managed`by`nursing`interventions,`focusing`on`patient`care`rather`than`m
edical`diagnoses.
NCLEX`Preference:`Understanding`the`distinction`between`nursing`and`medical`
diagnoses`is`crucial`for`patient-centered`care.

2. Which`component`of`the`nursing`diagnosis`indicates`the`problem?

 a.`Defining`characteristics
 b.`Related`factors
 c.`The`actual`diagnosis
 d.`The`patient’s`history

ANS:`C
Rationale:`The`actual`diagnosis`represents`the`problem`identified`in`the`nursing`ass
essment.`It`is`essential`for`formulating`a`care`plan.
NCLEX`Preference:`Clear`identification`of`nursing`diagnoses`is`necessary`for`effecti
ve`care`planning.

3. What`does`the`"related`to"`(R/T)`statement`in`a`nursing`diagnosis`signify?

 a.`It`identifies`the`patient's`response`to`the`problem
 b.`It`indicates`the`underlying`cause`of`the`problem
 c.`It`lists`the`symptoms`observed
 d.`It`describes`the`treatment`plan

ANS:`B
Rationale:`The`"related`to"`(R/T)`statement`indicates`the`underlying`cause`or`contri
buting`factors`of`the`patient’s`problem,`guiding`intervention`strategies.

,NCLEX`Preference:`Understanding`etiology`is`vital`for`targeted`nursing`interventi
ons.

4. Which`nursing`diagnosis`format`is`used`to`articulate`the`problem`clearly?

 a.`Problem-focused`diagnosis
 b.`Risk`diagnosis
 c.`Health`promotion`diagnosis
 d.`All`of`the`above

ANS:`D
Rationale:`All`formats—problem-focused,`risk,`and`health`promotion—
articulate`different`aspects`of`patient`care`and`are`important`in`various`clinical`situa
tions.
NCLEX`Preference:`Familiarity`with`different`nursing`diagnosis`formats`enhance
s`clinical`reasoning.

5. In`which`phase`of`the`nursing`process`is`the`nursing`diagnosis`formulated?

 a.`Assessment
 b.`Diagnosis
 c.`Planning
 d.`Implementation

ANS:`B
Rationale:`The`nursing`diagnosis`is`formulated`during`the`diagnosis`phase,`after`co
llecting`and`analyzing`assessment`data.
NCLEX`Preference:`Understanding`the`nursing`process`phases`is`crucial`for`effect
ive`care`delivery.

6. What`is`a`defining`characteristic`in`a`nursing`diagnosis?

 a.`The`cause`of`the`problem
 b.`The`observable`signs`and`symptoms
 c.`The`expected`outcomes
 d.`The`patient's`medical`history

ANS:`B
Rationale:`Defining`characteristics`are`the`observable`signs`and`symptoms`that`vali
date`the`nursing`diagnosis`and`provide`evidence`of`the`problem.
NCLEX`Preference:`Identifying`defining`characteristics`is`essential`for`accurate`dia
gnosis`and`planning.

, 7. How`can`a`nurse`validate`a`nursing`diagnosis?

 a.`By`relying`solely`on`personal`experience
 b.`By`collecting`data`from`various`sources,`including`the`patient
 c.`By`discussing`it`only`with`physicians
 d.`By`documenting`the`diagnosis`without`evidence

ANS:`B
Rationale:`Validating`a`nursing`diagnosis`involves`collecting`data`from`multiple`so
urces,`including`the`patient,`to`ensure`accuracy`and`relevance.
NCLEX`Preference:`Validation`of`nursing`diagnoses`is`critical`for`patient`safety`a
nd`effective`care.

8. What`role`does`evidence-based`practice`play`in`nursing`diagnoses?

 a.`It`complicates`the`diagnosis`process
 b.`It`provides`a`scientific`basis`for`nursing`decisions
 c.`It`is`optional`for`nursing`practice
 d.`It`focuses`solely`on`traditional`methods

ANS:`B
Rationale:`Evidence-
based`practice`provides`a`scientific`basis`for`nursing`decisions,`improving`patient`o
utcomes`and`ensuring`care`is`effective`and`relevant.`NCLEX`Preference:`Knowled
ge`of`evidence-based`practice`is`essential`for`modern`nursing.

9. What`is`the`purpose`of`the`planning`phase`in`the`nursing`process?

 a.`To`assess`the`patient’s`condition
 b.`To`develop`a`care`plan`with`measurable`goals
 c.`To`implement`interventions`immediately
 **d.`To`evaluate`patient`outcomes

ANS:`B
Rationale:`The`planning`phase`involves`developing`a`care`plan`with`measurable`go
als`and`outcomes`tailored`to`the`patient’s`needs.
NCLEX`Preference:`Effective`planning`is`key`to`successful`patient`outcomes.

10. How`should`nursing`diagnoses`be`prioritized?

 a.`Based`on`the`nurse’s`preference