NFDN 2003 exam with correct |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
answers
Nursing Process - correct answer✔✔-Assess: Encounter problem
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-Diagnoses: Collect Data |||\\\ |||\\\
-Identify Outcome: Analyze Data |||\\\ |||\\\ |||\\\
-Plan: Determine plan of action
|||\\\ |||\\\ |||\\\ |||\\\
-Implement: Execute action plan |||\\\ |||\\\ |||\\\
-Evaluate: effectiveness of problem resolution |||\\\ |||\\\ |||\\\ |||\\\
Problem Solving - correct answer✔✔Assessment and analysis of a problem
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Decision Making - correct answer✔✔Choosing between options
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Qualities of a decision maker - correct answer✔✔-Self confident
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-Proactive
-Flexible
-Focused
Accountable for actions |||\\\ |||\\\
-Current knowledge |||\\\
-Works with resources |||\\\ |||\\\
Priority Setting - correct answer✔✔First order: immediate threat
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Second order: actual problem which a client has asked for immediate help
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Third order: relatively actual or potential problem that client has not recognized
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
,Fourth order: actual or potential problems client may need in the future
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Time Management - correct answer✔✔-Identify must do, should do and nice to do
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-Identify tasks, obligations, activities |||\\\ |||\\\ |||\\\
-Write them out |||\\\ |||\\\
-Prioritize |||\\\
-Follow-up and mark off ones that have been completed |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-Delegate
-Don't accept tasks you are not able to complete
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-
Mentorship - correct answer✔✔informal or formal relationship that is entered into by a senior
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
nurse and junior nurse for the purpose of helping to guide and enhance the practice of the
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
junior nurse. |||\\\
Mentorship benefits - correct answer✔✔-Support of new nurses |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-foster growth of future generations
|||\\\ |||\\\ |||\\\ |||\\\
-creates long term connections |||\\\ |||\\\ |||\\\
-role models
|||\\\
-feeling of empowerment |||\\\ |||\\\
Mentorship pitfalls - correct answer✔✔-personality conflict |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-imposing styles on you |||\\\ |||\\\ |||\\\
-social issues |||\\\
Clinical pathways - correct answer✔✔Tool used in case management of client care, an
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
effective/efficient manner. Care mapped out day by day. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
,Purpose: Meet expected outcomes, standardize care, reduce delays in care, reduce costs
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Clinical Pathway concept map - correct answer✔✔Issue 1 > solution list > Issue 2 identified >
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Solution priority > Intervention |||\\\ |||\\\ |||\\\
SBAR - correct answer✔✔S-Situation: report clearly the situation and give facts
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
B- Background: give background info about client
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
A- Assessment: Give details of your assessment
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
R- Recommendations: Suggest what you would like to see done
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Metaparadigm - correct answer✔✔Conceptual framework to define nursing by creating a |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
theoretical definition for the substance and structure of the key body of knowledge that would
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
be needed to understand clinical situations. (Person/client, Environment, Health, Nursing)
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Role of nurse: altered skin integrity - correct answer✔✔1.Gather history
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
2.Physical examination |||\\\
3.Determine PRIORITY nursing diagnosis, goals, interventions |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
4.Reporting and documentation |||\\\ |||\\\
Skin - correct answer✔✔-Primary line of defence
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-Protection of the body |||\\\ |||\\\ |||\\\
-A disruption results in loss of body fluids and risk for infection
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Wounds - correct answer✔✔-A type of lesion |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-A disruption of normal anatomical structure and function
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-Classified by cause and descriptions |||\\\ |||\\\ |||\\\ |||\\\
, Wound classification - correct answer✔✔Cause: intentional, unintentional
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Integrity: open, closed, acute, chronic |||\\\ |||\\\ |||\\\ |||\\\
Depth: partial thickness, full thickness |||\\\ |||\\\ |||\\\ |||\\\
Cleanliness: clean, clean-contaminated, contaminated, infected |||\\\ |||\\\ |||\\\ |||\\\
Duration: acute, chronic |||\\\ |||\\\ |||\\\
Type: penetrating, abrasion, laceration, contusion
|||\\\ |||\\\ |||\\\ |||\\\
Penetrating Wound - correct answer✔✔-Wound with break through epidermis, dermis, |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
underlying tissues, may enter organs |||\\\ |||\\\ |||\\\ |||\\\
-Wound that is deep and goes through all layers into internal organs. Usually an accident or
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
knife wound. Something penetrates deep into tissues.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Abrasion - correct answer✔✔Superficial injury caused by rubbing, scraping of skin against
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
another surface ie/ Bed linens, Road rash from accident.|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Laceration - correct answer✔✔Open wound with jagged edges. Penetration by sharp object. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Accident.
Contusion - correct answer✔✔Closed wound. Painful, swollen, discoloured, bruised. Blunt
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
trauma, punch to face. |||\\\ |||\\\ |||\\\
Wound Colors - correct answer✔✔Red: Healing with healthy red granulation tissue.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Means wound bed is ready for healing |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Yellow: Not ready to heal due to fibrous slough, old tissue, or exudate which has to be cleansed
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
and removed. This may take time.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Black: |||\\\
(Eschar)Indicates thick, leathery, dead, necrotic tissue. Usually needs to be debrided but in |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
some cases where people are terminal and healing is poor sometimes the eschar is just left
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
alone to cover the wound. |||\\\ |||\\\ |||\\\ |||\\\
answers
Nursing Process - correct answer✔✔-Assess: Encounter problem
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-Diagnoses: Collect Data |||\\\ |||\\\
-Identify Outcome: Analyze Data |||\\\ |||\\\ |||\\\
-Plan: Determine plan of action
|||\\\ |||\\\ |||\\\ |||\\\
-Implement: Execute action plan |||\\\ |||\\\ |||\\\
-Evaluate: effectiveness of problem resolution |||\\\ |||\\\ |||\\\ |||\\\
Problem Solving - correct answer✔✔Assessment and analysis of a problem
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Decision Making - correct answer✔✔Choosing between options
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Qualities of a decision maker - correct answer✔✔-Self confident
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-Proactive
-Flexible
-Focused
Accountable for actions |||\\\ |||\\\
-Current knowledge |||\\\
-Works with resources |||\\\ |||\\\
Priority Setting - correct answer✔✔First order: immediate threat
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Second order: actual problem which a client has asked for immediate help
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Third order: relatively actual or potential problem that client has not recognized
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
,Fourth order: actual or potential problems client may need in the future
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Time Management - correct answer✔✔-Identify must do, should do and nice to do
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-Identify tasks, obligations, activities |||\\\ |||\\\ |||\\\
-Write them out |||\\\ |||\\\
-Prioritize |||\\\
-Follow-up and mark off ones that have been completed |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-Delegate
-Don't accept tasks you are not able to complete
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-
Mentorship - correct answer✔✔informal or formal relationship that is entered into by a senior
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
nurse and junior nurse for the purpose of helping to guide and enhance the practice of the
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
junior nurse. |||\\\
Mentorship benefits - correct answer✔✔-Support of new nurses |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-foster growth of future generations
|||\\\ |||\\\ |||\\\ |||\\\
-creates long term connections |||\\\ |||\\\ |||\\\
-role models
|||\\\
-feeling of empowerment |||\\\ |||\\\
Mentorship pitfalls - correct answer✔✔-personality conflict |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-imposing styles on you |||\\\ |||\\\ |||\\\
-social issues |||\\\
Clinical pathways - correct answer✔✔Tool used in case management of client care, an
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
effective/efficient manner. Care mapped out day by day. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
,Purpose: Meet expected outcomes, standardize care, reduce delays in care, reduce costs
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Clinical Pathway concept map - correct answer✔✔Issue 1 > solution list > Issue 2 identified >
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Solution priority > Intervention |||\\\ |||\\\ |||\\\
SBAR - correct answer✔✔S-Situation: report clearly the situation and give facts
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
B- Background: give background info about client
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
A- Assessment: Give details of your assessment
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
R- Recommendations: Suggest what you would like to see done
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Metaparadigm - correct answer✔✔Conceptual framework to define nursing by creating a |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
theoretical definition for the substance and structure of the key body of knowledge that would
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
be needed to understand clinical situations. (Person/client, Environment, Health, Nursing)
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Role of nurse: altered skin integrity - correct answer✔✔1.Gather history
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
2.Physical examination |||\\\
3.Determine PRIORITY nursing diagnosis, goals, interventions |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
4.Reporting and documentation |||\\\ |||\\\
Skin - correct answer✔✔-Primary line of defence
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-Protection of the body |||\\\ |||\\\ |||\\\
-A disruption results in loss of body fluids and risk for infection
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Wounds - correct answer✔✔-A type of lesion |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-A disruption of normal anatomical structure and function
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
-Classified by cause and descriptions |||\\\ |||\\\ |||\\\ |||\\\
, Wound classification - correct answer✔✔Cause: intentional, unintentional
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Integrity: open, closed, acute, chronic |||\\\ |||\\\ |||\\\ |||\\\
Depth: partial thickness, full thickness |||\\\ |||\\\ |||\\\ |||\\\
Cleanliness: clean, clean-contaminated, contaminated, infected |||\\\ |||\\\ |||\\\ |||\\\
Duration: acute, chronic |||\\\ |||\\\ |||\\\
Type: penetrating, abrasion, laceration, contusion
|||\\\ |||\\\ |||\\\ |||\\\
Penetrating Wound - correct answer✔✔-Wound with break through epidermis, dermis, |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
underlying tissues, may enter organs |||\\\ |||\\\ |||\\\ |||\\\
-Wound that is deep and goes through all layers into internal organs. Usually an accident or
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
knife wound. Something penetrates deep into tissues.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Abrasion - correct answer✔✔Superficial injury caused by rubbing, scraping of skin against
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
another surface ie/ Bed linens, Road rash from accident.|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Laceration - correct answer✔✔Open wound with jagged edges. Penetration by sharp object. |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Accident.
Contusion - correct answer✔✔Closed wound. Painful, swollen, discoloured, bruised. Blunt
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
trauma, punch to face. |||\\\ |||\\\ |||\\\
Wound Colors - correct answer✔✔Red: Healing with healthy red granulation tissue.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Means wound bed is ready for healing |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Yellow: Not ready to heal due to fibrous slough, old tissue, or exudate which has to be cleansed
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
and removed. This may take time.
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
Black: |||\\\
(Eschar)Indicates thick, leathery, dead, necrotic tissue. Usually needs to be debrided but in |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
some cases where people are terminal and healing is poor sometimes the eschar is just left
|||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\ |||\\\
alone to cover the wound. |||\\\ |||\\\ |||\\\ |||\\\
