Foundations Chapter 17 Nursing
Diagnosis 2025/2026 with actual
questions and detailaled verified
answers Already GradedA+
The nursing diagnosis Impaired Parenting related to mother's developmental delay is an example of
a(n):
A. Risk nursing diagnosis.
B. Problem-focused nursing diagnosis.
C. Health promotion nursing diagnosis.
D. Wellness nursing diagnosis. - correct answer <<<✨✨✨B
This is an example of a problem-focused nursing diagnosis with a related factor, based on NANDA-I
diagnostic terminology. Most health promotion diagnoses do not have established related factors based
on NANDA-I; their use is optional. Wellness diagnoses are not one of the types of NANDA-I diagnoses.
A nurse interviewed and conducted a physical examination of a patient. Among the assessment data the
nurse gathered were an increased respiratory rate, the patient reporting difficulty breathing while lying
flat, and pursed-lip breathing. This data set is an example of:
A. Collaborative data set.
B. Diagnostic label.
C. Related factors.
D. Data cluster. - correct answer <<<✨✨✨D
A data cluster is a set of cues (i.e., the signs or symptoms gathered during assessment).
,A nurse is reviewing a patient's list of nursing diagnoses in the medical record. The most recent nursing
diagnosis is Diarrhea related to intestinal colitis. For which of the following reasons is this an incorrectly
stated diagnostic statement?
A. Identifying the clinical sign instead of an etiology
B. Identifying a diagnosis on the basis of prejudicial judgment
C. Identifying the diagnostic study rather than a problem caused by the diagnostic study
D. Identifying the medical diagnosis instead of the patient's response to the diagnosis. - correct answer
<<<✨✨✨D
Intestinal colitis is a medical diagnosis. The related factor in a nursing diagnostic statement is always
within the domain of nursing practice and a condition that responds to nursing interventions. Nursing
interventions do not change a medical diagnosis.
A nurse is assigned to a new patient admitted to the nursing unit following admission through the
emergency department. The nurse collects a nursing history and interviews the patient. What are the
steps for making a nursing diagnosis in the correct order, beginning with the first step?
1. Considers context of patient's health problem and selects a related factor
2. Reviews assessment data, noting objective and subjective clinical information
3. Clusters clinical cues that form a pattern
4. Chooses diagnostic label
A. 2, 3, 4, 1
B. 3, 2, 4, 1
C. 2, 3, 1, 4
D. 1, 4, 3, 2 - correct answer <<<✨✨✨A
This is the correct steps for making a nursing diagnosis.
, A nursing student reports to a lead charge nurse that his assigned patient seems to be less alert and his
blood pressure is lower, dropping from 140/80 to 110/60. The nursing student states, "I believe this is a
nursing diagnosis of Deficient Fluid Volume." The lead charge nurse immediately goes to the patient's
room with the student to assess the patient's orientation, heart rate, skin turgor, and urine output for
last 8 hours. The lead charge nurse suspects that the student has made which type of diagnostic error?
A. Insufficient cluster of cues
B. Disorganization
C. Insufficient number of cues
D. Evidence that another diagnosis is more likely - correct answer <<<✨✨✨C
It is likely the charge nurse suspects that the student has not collected enough cues to support the
diagnosis. A change in blood pressure and mental status changes are significant findings that can be
attributed to fluid volume excess and other diagnoses. The recommendation of the symptom cluster by
the registered nurse would allow the student to have sufficient data to confirm a deficient fluid volume.
A nurse in a mother-baby clinic learns that a 16-year-old has given birth to her first child and has not
been to a well-baby class yet. The nurse's assessment reveals that the infant cries when breastfeeding
and has difficulty latching on to the nipple. The infant has not gained weight over the last 2 weeks. The
nurse identifies the patient's nursing diagnosis as Ineffective Breastfeeding. Which of the following is the
best "related to" factor?
A. Infant crying at breast
B. Infant unable to latch on to breast correctly
C. Mother's deficient knowledge
D. Lack of infant weight gain - correct answer <<<✨✨✨C
In this scenario the related factor is the mother's deficient knowledge. A related factor is a condition,
historical factor, or etiology that gives a context for the defining characteristics, in this case the infant
crying, inability to latch on to breast, and absent weight gain.
A nurse assesses a young woman who works part time but also cares for her mother at home. The nurse
reviews clusters of data that include the patient's report of frequent awakenings at night, reduced
Diagnosis 2025/2026 with actual
questions and detailaled verified
answers Already GradedA+
The nursing diagnosis Impaired Parenting related to mother's developmental delay is an example of
a(n):
A. Risk nursing diagnosis.
B. Problem-focused nursing diagnosis.
C. Health promotion nursing diagnosis.
D. Wellness nursing diagnosis. - correct answer <<<✨✨✨B
This is an example of a problem-focused nursing diagnosis with a related factor, based on NANDA-I
diagnostic terminology. Most health promotion diagnoses do not have established related factors based
on NANDA-I; their use is optional. Wellness diagnoses are not one of the types of NANDA-I diagnoses.
A nurse interviewed and conducted a physical examination of a patient. Among the assessment data the
nurse gathered were an increased respiratory rate, the patient reporting difficulty breathing while lying
flat, and pursed-lip breathing. This data set is an example of:
A. Collaborative data set.
B. Diagnostic label.
C. Related factors.
D. Data cluster. - correct answer <<<✨✨✨D
A data cluster is a set of cues (i.e., the signs or symptoms gathered during assessment).
,A nurse is reviewing a patient's list of nursing diagnoses in the medical record. The most recent nursing
diagnosis is Diarrhea related to intestinal colitis. For which of the following reasons is this an incorrectly
stated diagnostic statement?
A. Identifying the clinical sign instead of an etiology
B. Identifying a diagnosis on the basis of prejudicial judgment
C. Identifying the diagnostic study rather than a problem caused by the diagnostic study
D. Identifying the medical diagnosis instead of the patient's response to the diagnosis. - correct answer
<<<✨✨✨D
Intestinal colitis is a medical diagnosis. The related factor in a nursing diagnostic statement is always
within the domain of nursing practice and a condition that responds to nursing interventions. Nursing
interventions do not change a medical diagnosis.
A nurse is assigned to a new patient admitted to the nursing unit following admission through the
emergency department. The nurse collects a nursing history and interviews the patient. What are the
steps for making a nursing diagnosis in the correct order, beginning with the first step?
1. Considers context of patient's health problem and selects a related factor
2. Reviews assessment data, noting objective and subjective clinical information
3. Clusters clinical cues that form a pattern
4. Chooses diagnostic label
A. 2, 3, 4, 1
B. 3, 2, 4, 1
C. 2, 3, 1, 4
D. 1, 4, 3, 2 - correct answer <<<✨✨✨A
This is the correct steps for making a nursing diagnosis.
, A nursing student reports to a lead charge nurse that his assigned patient seems to be less alert and his
blood pressure is lower, dropping from 140/80 to 110/60. The nursing student states, "I believe this is a
nursing diagnosis of Deficient Fluid Volume." The lead charge nurse immediately goes to the patient's
room with the student to assess the patient's orientation, heart rate, skin turgor, and urine output for
last 8 hours. The lead charge nurse suspects that the student has made which type of diagnostic error?
A. Insufficient cluster of cues
B. Disorganization
C. Insufficient number of cues
D. Evidence that another diagnosis is more likely - correct answer <<<✨✨✨C
It is likely the charge nurse suspects that the student has not collected enough cues to support the
diagnosis. A change in blood pressure and mental status changes are significant findings that can be
attributed to fluid volume excess and other diagnoses. The recommendation of the symptom cluster by
the registered nurse would allow the student to have sufficient data to confirm a deficient fluid volume.
A nurse in a mother-baby clinic learns that a 16-year-old has given birth to her first child and has not
been to a well-baby class yet. The nurse's assessment reveals that the infant cries when breastfeeding
and has difficulty latching on to the nipple. The infant has not gained weight over the last 2 weeks. The
nurse identifies the patient's nursing diagnosis as Ineffective Breastfeeding. Which of the following is the
best "related to" factor?
A. Infant crying at breast
B. Infant unable to latch on to breast correctly
C. Mother's deficient knowledge
D. Lack of infant weight gain - correct answer <<<✨✨✨C
In this scenario the related factor is the mother's deficient knowledge. A related factor is a condition,
historical factor, or etiology that gives a context for the defining characteristics, in this case the infant
crying, inability to latch on to breast, and absent weight gain.
A nurse assesses a young woman who works part time but also cares for her mother at home. The nurse
reviews clusters of data that include the patient's report of frequent awakenings at night, reduced
