CLINICAL DECISION MAKING ACTUAL EXAM
QUESTIONS AND COMPLETE STUDY GUIDE
2026
▶ How do you prioritize nursing diagnosis? Answer: A nursing diagnosis
encompasses Maslow's Hierarchy of Needs and helps to prioritize and plan
care based on patient-centered outcomes. In 1943, Abraham Maslow
developed a hierarchy based on basic fundamental needs innate for all
individuals. Basic physiological needs/goals must be met before higher
needs/goals can be achieved such as self-esteem and self-actualization.
Physiological and safety needs provide the basis for the implementation of
nursing care and nursing interventions. Thus, they are at the base of
Maslow's pyramid, laying the foundation for physical and emotional health.
Priority setting can be defined as the ordering of nursing problems using
notions of urgency and/or importance, in order to establish a preferential
order for nursing actions.
An example of an actual nursing diagnosis is: Sleep deprivation. Describes
human responses to health conditions/life processes that may develop in a
vulnerable individual/family/community.
▶ Maslow's Hierarchy of Needs Answer: Basic Physiological needs:
Nutrition (water and food), elimination (Toileting), airway (suction)-breathing
(oxygen)-circulation (pulse, cardiac monitor, blood pressure) (ABC's),
sleep, sex, shelter, and exercise.
Safety and Security: Injury prevention (side rails, call lights, hand hygiene,
isolation, suicide precautions, fall precautions, car seats, helmets, seat
belts), fostering a climate of trust and safety (therapeutic relationship),
patient education (modifiable risk factors for stroke, heart disease).
Love and Belonging: Foster supportive relationships, methods to avoid
social isolation (bullying), employ active listening techniques, therapeutic
communication, sexual intimacy.
, Self-Esteem: Acceptance in the community, workforce, personal
achievement, sense of control or empowerment, accepting one's physical
appearance or body habitus.
Self-Actualization: Empowering environment, spiritual growth, ability to
recognize the point of view of others, reaching one's maximum potential.
Maslow's hierarchy of needs can be the basis for the nurse to make a
priority nursing diagnosis. Maslow's hierarchy of five levels are: Biological
and Physiological needs. Safety needs.
▶ Planning Answer: During the planning step of the nursing process, the
nurse works in partnership with the patient and family to establish priorities,
identify and write expected patient outcomes, select evidence-based
nursing interventions, and communicate the plan of nursing care
The planning stage is where goals and outcomes are formulated that
directly impact patient care based on EBP(evidence based practice)
guidelines. These patient-specific goals and the attainment of such assist in
ensuring a positive outcome. Nursing care plans are essential in this phase
of goal setting. Care plans provide a course of direction for personalized
care tailored to an individual's unique needs. Overall condition and
comorbid conditions play a role in the construction of a care plan. Care
plans enhance communication, documentation, reimbursement, and
continuity of care across the healthcare continuum.
▶ Goals should be: Answer: 1.Specific
2.Measurable or Meaningful
3.Attainable or Action-Oriented
4.Realistic or Results-Oriented
5.Timely or Time-Oriented
Ex: I plan to administer oxygen to my patient who O2 sat is 88
2. I plan to teach my pt breathing exercise.
▶ Implementation/Interventions Answer: Implementation is the step which
involves action or doing and the actual carrying out of nursing interventions
outlined in the plan of care. This phase requires nursing interventions such
as applying a cardiac monitor or oxygen, direct or indirect care, medication
administration, standard treatment protocols and EDP standards.
QUESTIONS AND COMPLETE STUDY GUIDE
2026
▶ How do you prioritize nursing diagnosis? Answer: A nursing diagnosis
encompasses Maslow's Hierarchy of Needs and helps to prioritize and plan
care based on patient-centered outcomes. In 1943, Abraham Maslow
developed a hierarchy based on basic fundamental needs innate for all
individuals. Basic physiological needs/goals must be met before higher
needs/goals can be achieved such as self-esteem and self-actualization.
Physiological and safety needs provide the basis for the implementation of
nursing care and nursing interventions. Thus, they are at the base of
Maslow's pyramid, laying the foundation for physical and emotional health.
Priority setting can be defined as the ordering of nursing problems using
notions of urgency and/or importance, in order to establish a preferential
order for nursing actions.
An example of an actual nursing diagnosis is: Sleep deprivation. Describes
human responses to health conditions/life processes that may develop in a
vulnerable individual/family/community.
▶ Maslow's Hierarchy of Needs Answer: Basic Physiological needs:
Nutrition (water and food), elimination (Toileting), airway (suction)-breathing
(oxygen)-circulation (pulse, cardiac monitor, blood pressure) (ABC's),
sleep, sex, shelter, and exercise.
Safety and Security: Injury prevention (side rails, call lights, hand hygiene,
isolation, suicide precautions, fall precautions, car seats, helmets, seat
belts), fostering a climate of trust and safety (therapeutic relationship),
patient education (modifiable risk factors for stroke, heart disease).
Love and Belonging: Foster supportive relationships, methods to avoid
social isolation (bullying), employ active listening techniques, therapeutic
communication, sexual intimacy.
, Self-Esteem: Acceptance in the community, workforce, personal
achievement, sense of control or empowerment, accepting one's physical
appearance or body habitus.
Self-Actualization: Empowering environment, spiritual growth, ability to
recognize the point of view of others, reaching one's maximum potential.
Maslow's hierarchy of needs can be the basis for the nurse to make a
priority nursing diagnosis. Maslow's hierarchy of five levels are: Biological
and Physiological needs. Safety needs.
▶ Planning Answer: During the planning step of the nursing process, the
nurse works in partnership with the patient and family to establish priorities,
identify and write expected patient outcomes, select evidence-based
nursing interventions, and communicate the plan of nursing care
The planning stage is where goals and outcomes are formulated that
directly impact patient care based on EBP(evidence based practice)
guidelines. These patient-specific goals and the attainment of such assist in
ensuring a positive outcome. Nursing care plans are essential in this phase
of goal setting. Care plans provide a course of direction for personalized
care tailored to an individual's unique needs. Overall condition and
comorbid conditions play a role in the construction of a care plan. Care
plans enhance communication, documentation, reimbursement, and
continuity of care across the healthcare continuum.
▶ Goals should be: Answer: 1.Specific
2.Measurable or Meaningful
3.Attainable or Action-Oriented
4.Realistic or Results-Oriented
5.Timely or Time-Oriented
Ex: I plan to administer oxygen to my patient who O2 sat is 88
2. I plan to teach my pt breathing exercise.
▶ Implementation/Interventions Answer: Implementation is the step which
involves action or doing and the actual carrying out of nursing interventions
outlined in the plan of care. This phase requires nursing interventions such
as applying a cardiac monitor or oxygen, direct or indirect care, medication
administration, standard treatment protocols and EDP standards.
