Lewis Medical-Surgical Nursing in Canada 4th Edition Test Bank
Chapter 01: Introduction to Medical-Surgical Nursing Practice in Canada
Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE :
1. The nurse is caring for a client with a new diagnosis of pneumonia and
T T T T T T T T T T T T T
explains to the client that together they will plan the client’s care and set
T T T T T T T T T T T T T T
goals for discharge. The client asks, “How is that different from what the
T T T T T T T T T T T T T
doctor does?” Which response by the nurse is most appropriate?
T T T T T T T T T
a. “The role of the nurse is to administer medications and other treatments prescribed
T T T T T T T T T T T T
by your doctor.”
T T
b. “The nurse’s job is to help the doctor by collecting data and communicating when
T T T T T T T T T T T T T T
there are problems.” T T
c. “Nurses perform many of the procedures done by physicians, but nurses are here in
T T T T T T T T T T T T T
the hospital for a longer time than doctors.”
T T T T T T T
d. “In addition to caring for you while you are sick, the nurses will assist you to
T T T T T T T T T T T T T T T
develop an individualized plan to maintain your health.”
T T T T T T T
ANS: D T
This response is consistent with the Canadian Nurses Association (CNA) definition of nursing.
T T T T T T T T T T T T T
Registered nurses are self-regulated health care professionals who work autonomously and in
T T T T T T T T T T T T
collaboration with others. RNs enable individuals, families, groups, communities and populations to
T T T T T T T T T T T T
achieve their optimal level of health. RNs coordinate health care, deliver direct services, and support
T T T T T T T T T T T T T T T
clients in their self-care decisions and actions in situations of health, illness, injury, and disability in all
T T T T T T T T T T T T T T T T T
stages of life. The other responses describe some of the dependent and collaborative functions of the
T T T T T T T T T T T T T T T T
nursing role but do not accurately describe the nurse’s role in the health care system.
T T T T T T T T T T T T T T
DIF: Cognitive Level: Comprehension TOP: Nursing Process: T T T T T
Implementation MSC: NCLEX: Safe and Effective Care Environment T T T T T T T
2. When caring for clients using evidence-informed practice, which of the following does the nurse use?
T T T T T T T T T T T T T T
a. Clinical judgement based on experience T T T T
b. Evidence from a clinical research study T T T T T
c. The best available evidence to guide clinical expertise
T T T T T T T
d. Evaluation of data showing that the client outcomes are met T T T T T T T T T
ANS: C T
Evidence-informed nursing practice is a continuous interactive process involving the explicit, T T T T T T T T T T T
conscientious, and judicious consideration of the best available evidence to provide care. Four primary
T T T T T T T T T T T T T T
elements are: (a) clinical state, setting, and circumstances; (b) client preferences and actions; (c) best
T T T T T T T T T T T T T T T
research evidence, and (d) health care resources. Clinical judgement based on the nurse’s clinical
T T T T T T T T T T T T T T
experience is part of EIP, but clinical decision making also should incorporate current research and
T T T T T T T T T T T T T T T
research-based guidelines. Evidence from one clinical research study does not provide an adequate
T T T T T T T T T T T T T
substantiation for interventions. Evaluation of client outcomes is important, but interventions should be
T T T T T T T T T T T T T
based on research from randomized control studies with a large number of subjects.
T T T T T T T T T T T T
, Lewis Medical-Surgical Nursing in Canada 4th Edition Test Bank
DIF: Cognitive Level: Comprehension TOP: Nursing Process: T T T T T
Planning MSC: NCLEX: Safe and Effective Care Environment
T T T T T T T
3. Which of the following best explains the nurses’ primary use of the nursing process when providing
T T T T T T T T T T T T T T T T
care to clients?
T T
a. To explain nursing interventions to other health care professionals
T T T T T T T T
b. As a problem-solving tool to identify and treat clients’ health care needs
T T T T T T T T T T T
c. As a scientific-based process of diagnosing the client’s health care problems
T T T T T T T T T T
d. To establish nursing theory that incorporates the biopsychosocial nature of humans
T T T T T T T T T T
ANS: B T
The nursing process is an assertive problem-solving approach to the identification and treatment of
T T T T T T T T T T T T T T
clients’ problems. Diagnosis is only one phase of the nursing process. The primary use of the nursing
T T T T T T T T T T T T T T T T T
process is in client care, not to establish nursing theory or explain nursing interventions to other health care
T T T T T T T T T T T T T T T T T T
professionals.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: T T T T T
Implementation MSC: NCLEX: Safe and Effective Care Environment T T T T T T T
4. The nurse is caring for a critically ill client in the intensive care unit and plans an every-2-hour turning
T T T T T T T T T T T T T T T T T T T
schedule to prevent skin breakdown. Which type of nursing function is demonstrated with this turning
T T T T T T T T T T T T T T T
schedule?
a. Dependent
b. Cooperative
c. Independent
d. Collaborative
ANS: D T
When implementing collaborative nursing actions, the nurse is responsible primarily for monitoring
T T T T T T T T T T T T
for complications of acute illness or providing care to prevent or treat complications. Independent
T T T T T T T T T T T T T T
nursing actions are focused on health promotion, illness prevention, and client advocacy. A dependent
T T T T T T T T T T T T T T
action would require a physician order to implement. Cooperative nursing functions are not described
T T T T T T T T T T T T T T
as one of the formal nursing functions.
T T T T T T
DIF: Cognitive Level: Application TOP: Nursing Process: T T T T T
Implementation MSC: NCLEX: Safe and Effective Care Environment T T T T T T T
5. The nurse is caring for a client who has been admitted to the hospital for surgery and tells the nurse, “I
T T T T T T T T T T T T T T T T T T T T T
do not feel right about leaving my children with my neighbour.” Which action should the nurse take
T T T T T T T T T T T T T T T T T
next?
a. Reassure the client that these feelings are common for parents.
T T T T T T T T T
b. Have the client call the children to ensure that they are doing well.
T T T T T T T T T T T T
c. Call the neighbour to determine whether adequate childcare is being provided.
T T T T T T T T T T
d. Gather more data about the client’s feelings about the childcare arrangements.
T T T T T T T T T T
ANS: D T
Since a complete assessment is necessary in order to identify a problem and choose an appropriate
T T T T T T T T T T T T T T T T
intervention, the nurse’s first action should be to obtain more information. The other actions may be
T T T T T T T T T T T T T T T T
appropriate, but more assessment is needed before the best intervention can be chosen.
T T T T T T T T T T T T
, Lewis Medical-Surgical Nursing in Canada 4th Edition Test Bank
DIF: Cognitive Level: Application TOP: Nursing Process: T T T T T
Assessment MSC: NCLEX: Psychosocial Integrity T T T T
6. The nurse is caring for a client who has left-sided paralysis as the result of a stroke and assesses a
T T T T T T T T T T T T T T T T T T T T
pressure injury on the client’s left hip. Which of the following is the most appropriate nursing
T T T T T T T T T T T T T T T T
diagnosis for this client? T T T
a. Impaired physical mobility related to decrease in muscle control (left-sided
T T T T T T T T T
paralysis)
b. Risk for impaired tissue integrity as evidenced by insufficient knowledge about
T T T T T T T T T T
protecting tissue integrity T T
c. Impaired skin integrity related to pressure over bony prominence (impaired
T T T T T T T T T
circulation)
d. Ineffective peripheral tissue perfusion related to sedentary lifestyle T T T T T T T
ANS: C T
The client’s major problem is the impaired skin integrity as demonstrated by the presence of a pressure
T T T T T T T T T T T T T T T T T
injury. The nurse is able to treat the cause of impaired circulation and pressure over bony prominence
T T T T T T T T T T T T T T T T T
by frequently repositioning the client. Although left-sided weakness is a problem for the client, the
T T T T T T T T T T T T T T T
nurse cannot treat the weakness. The “risk for” diagnosis is not appropriate for this client, who already
T T T T T T T T T T T T T T T T T
has impaired tissue integrity. The client does have ineffective peripheral tissue perfusion, but the
T T T T T T T T T T T T T T
impaired skin integrity diagnosis indicates more clearly what the health problem is.
T T T T T T T T T T T
DIF: Cognitive Level: Application TOP: Nursing Process: T T T T T
Diagnosis MSC: NCLEX: Physiological Integrity
T T T T
7. The nurse caring for a client with an infection has a nursing diagnosis of deficient fluid volume related
T T T T T T T T T T T T T T T T T T
to excessive fluid loss through normal route (diaphoresis). Which of the following is an appropriate
T T T T T T T T T T T T T T T
client outcome? T
a. Client has a balanced intake and output.T T T T T T
b. Client’s bedding is changed when it becomes damp.
T T T T T T T
c. Client understands the need for increased fluid intake.
T T T T T T T
d. Client’s skin remains cool and dry throughout hospitalization.
T T T T T T T
ANS: A T
This statement gives measurable data showing resolution of the problem of deficient fluid volume that was
T T T T T T T T T T T T T T T T
identified in the nursing diagnosis statement. The other statements would not indicate that the problem
T T T T T T T T T T T T T T T
of deficient fluid volume was resolved.
T T T T T
DIF: Cognitive Level: Application TOP: Nursing Process: T T T T T
Planning MSC: NCLEX: Physiological Integrity
T T T T
8. Which of the following represents a nursing activity that is carried out during the evaluation phase of
T T T T T T T T T T T T T T T T T
the nursing process?
T T
a. Determining if interventions have been effective in meeting client outcomes. T T T T T T T T T
b. Documenting the nursing care plan in the progress notes in the medical record. T T T T T T T T T T T T
c. Deciding whether the client’s health problems have been completely resolved.
T T T T T T T T T
d. Asking the client to evaluate whether the nursing care provided was satisfactory.
T T T T T T T T T T T
ANS: A T
, Lewis Medical-Surgical Nursing in Canada 4th Edition Test Bank
Evaluation consists of determining whether the desired client outcomes have been met and whether the
T T T T T T T T T T T T T T T
nursing interventions were appropriate. The other responses do not describe the evaluation phase.
T T T T T T T T T T T T
DIF: Cognitive Level: Comprehension TOP: Nursing Process: T T T T T
Evaluation MSC: NCLEX: Safe and Effective Care Environment
T T T T T T T
9. Which of the following would the nurse perform during the assessment phase of the nursing process?
T T T T T T T T T T T T T T T
a. Obtains data with which to diagnose client problems.
T T T T T T T
b. Uses client data to develop priority nursing diagnoses.
T T T T T T T
c. Teaches interventions to relieve client health problems.
T T T T T T
d. Assists the client to identify realistic outcomes to health problems.
T T T T T T T T T
ANS: A T
During the assessment phase, the nurse gathers information about the client. The other responses are
T T T T T T T T T T T T T T T
examples of the intervention, diagnosis, and planning phases of the nursing process.
T T T T T T T T T T T
DIF: Cognitive Level: Knowledge TOP: Nursing Process: T T T T T
Assessment MSC: NCLEX: Safe and Effective Care Environment
T T T T T T T
10. Which of the following is an example of a correctly written nursing diagnosis statement?
T T T T T T T T T T T T T
a. Altered tissue perfusion related to heart failure.
T T T T T T
b. Risk for impaired tissue integrity related to sacral redness.
T T T T T T T T
c. Ineffective coping related to insufficient sense of control. T T T T T T T
d. Altered urinary elimination related to urinary tract infection.
T T T T T T T
ANS: C T
This diagnosis statement includes a NANDA nursing diagnosis and an etiology that describes a client’s
T T T T T T T T T T T T T T T
response to a health problem that can be treated by nursing. The use of a medical diagnosis (as in the
T T T T T T T T T T T T T T T T T T T T
responses beginning “Altered tissue perfusion” and “Altered urinary elimination”) is not appropriate.
T T T T T T T T T T T
The response beginning “Risk for impaired tissue integrity” uses the defining characteristics as the etiology.
T T T T T T T T T T T T T T
DIF: Cognitive Level: Comprehension TOP: Nursing Process: T T T T T
Diagnosis MSC: NCLEX: Safe and Effective Care Environment
T T T T T T T
11. Which of the following includes the components required for a complete nursing diagnosis statement?
T T T T T T T T T T T T T
a. A problem and the suggested client goals or outcomes.
T T T T T T T T
b. A problem, its cause, and objective data that support the problem.
T T T T T T T T T T
c. A problem with all its possible causes and the planned interventions.
T T T T T T T T T T
d. A problem with its etiology and the signs and symptoms of the problem.
T T T T T T T T T T T T
ANS: D T
The PES format is used when writing nursing diagnoses. The subjective, as well as objective, data
T T T T T T T T T T T T T T T T
should be included in the defining characteristics. Interventions and outcomes are not included in the
T T T T T T T T T T T T T T T
nursing diagnosis statement.T T
DIF: Cognitive Level: Knowledge TOP: Nursing Process: T T T T T
Diagnosis MSC: NCLEX: Safe and Effective Care Environment
T T T T T T T
Chapter 01: Introduction to Medical-Surgical Nursing Practice in Canada
Lewis: Medical-Surgical Nursing in Canada, 4th Canadian Edition
MULTIPLE CHOICE :
1. The nurse is caring for a client with a new diagnosis of pneumonia and
T T T T T T T T T T T T T
explains to the client that together they will plan the client’s care and set
T T T T T T T T T T T T T T
goals for discharge. The client asks, “How is that different from what the
T T T T T T T T T T T T T
doctor does?” Which response by the nurse is most appropriate?
T T T T T T T T T
a. “The role of the nurse is to administer medications and other treatments prescribed
T T T T T T T T T T T T
by your doctor.”
T T
b. “The nurse’s job is to help the doctor by collecting data and communicating when
T T T T T T T T T T T T T T
there are problems.” T T
c. “Nurses perform many of the procedures done by physicians, but nurses are here in
T T T T T T T T T T T T T
the hospital for a longer time than doctors.”
T T T T T T T
d. “In addition to caring for you while you are sick, the nurses will assist you to
T T T T T T T T T T T T T T T
develop an individualized plan to maintain your health.”
T T T T T T T
ANS: D T
This response is consistent with the Canadian Nurses Association (CNA) definition of nursing.
T T T T T T T T T T T T T
Registered nurses are self-regulated health care professionals who work autonomously and in
T T T T T T T T T T T T
collaboration with others. RNs enable individuals, families, groups, communities and populations to
T T T T T T T T T T T T
achieve their optimal level of health. RNs coordinate health care, deliver direct services, and support
T T T T T T T T T T T T T T T
clients in their self-care decisions and actions in situations of health, illness, injury, and disability in all
T T T T T T T T T T T T T T T T T
stages of life. The other responses describe some of the dependent and collaborative functions of the
T T T T T T T T T T T T T T T T
nursing role but do not accurately describe the nurse’s role in the health care system.
T T T T T T T T T T T T T T
DIF: Cognitive Level: Comprehension TOP: Nursing Process: T T T T T
Implementation MSC: NCLEX: Safe and Effective Care Environment T T T T T T T
2. When caring for clients using evidence-informed practice, which of the following does the nurse use?
T T T T T T T T T T T T T T
a. Clinical judgement based on experience T T T T
b. Evidence from a clinical research study T T T T T
c. The best available evidence to guide clinical expertise
T T T T T T T
d. Evaluation of data showing that the client outcomes are met T T T T T T T T T
ANS: C T
Evidence-informed nursing practice is a continuous interactive process involving the explicit, T T T T T T T T T T T
conscientious, and judicious consideration of the best available evidence to provide care. Four primary
T T T T T T T T T T T T T T
elements are: (a) clinical state, setting, and circumstances; (b) client preferences and actions; (c) best
T T T T T T T T T T T T T T T
research evidence, and (d) health care resources. Clinical judgement based on the nurse’s clinical
T T T T T T T T T T T T T T
experience is part of EIP, but clinical decision making also should incorporate current research and
T T T T T T T T T T T T T T T
research-based guidelines. Evidence from one clinical research study does not provide an adequate
T T T T T T T T T T T T T
substantiation for interventions. Evaluation of client outcomes is important, but interventions should be
T T T T T T T T T T T T T
based on research from randomized control studies with a large number of subjects.
T T T T T T T T T T T T
, Lewis Medical-Surgical Nursing in Canada 4th Edition Test Bank
DIF: Cognitive Level: Comprehension TOP: Nursing Process: T T T T T
Planning MSC: NCLEX: Safe and Effective Care Environment
T T T T T T T
3. Which of the following best explains the nurses’ primary use of the nursing process when providing
T T T T T T T T T T T T T T T T
care to clients?
T T
a. To explain nursing interventions to other health care professionals
T T T T T T T T
b. As a problem-solving tool to identify and treat clients’ health care needs
T T T T T T T T T T T
c. As a scientific-based process of diagnosing the client’s health care problems
T T T T T T T T T T
d. To establish nursing theory that incorporates the biopsychosocial nature of humans
T T T T T T T T T T
ANS: B T
The nursing process is an assertive problem-solving approach to the identification and treatment of
T T T T T T T T T T T T T T
clients’ problems. Diagnosis is only one phase of the nursing process. The primary use of the nursing
T T T T T T T T T T T T T T T T T
process is in client care, not to establish nursing theory or explain nursing interventions to other health care
T T T T T T T T T T T T T T T T T T
professionals.
DIF: Cognitive Level: Comprehension TOP: Nursing Process: T T T T T
Implementation MSC: NCLEX: Safe and Effective Care Environment T T T T T T T
4. The nurse is caring for a critically ill client in the intensive care unit and plans an every-2-hour turning
T T T T T T T T T T T T T T T T T T T
schedule to prevent skin breakdown. Which type of nursing function is demonstrated with this turning
T T T T T T T T T T T T T T T
schedule?
a. Dependent
b. Cooperative
c. Independent
d. Collaborative
ANS: D T
When implementing collaborative nursing actions, the nurse is responsible primarily for monitoring
T T T T T T T T T T T T
for complications of acute illness or providing care to prevent or treat complications. Independent
T T T T T T T T T T T T T T
nursing actions are focused on health promotion, illness prevention, and client advocacy. A dependent
T T T T T T T T T T T T T T
action would require a physician order to implement. Cooperative nursing functions are not described
T T T T T T T T T T T T T T
as one of the formal nursing functions.
T T T T T T
DIF: Cognitive Level: Application TOP: Nursing Process: T T T T T
Implementation MSC: NCLEX: Safe and Effective Care Environment T T T T T T T
5. The nurse is caring for a client who has been admitted to the hospital for surgery and tells the nurse, “I
T T T T T T T T T T T T T T T T T T T T T
do not feel right about leaving my children with my neighbour.” Which action should the nurse take
T T T T T T T T T T T T T T T T T
next?
a. Reassure the client that these feelings are common for parents.
T T T T T T T T T
b. Have the client call the children to ensure that they are doing well.
T T T T T T T T T T T T
c. Call the neighbour to determine whether adequate childcare is being provided.
T T T T T T T T T T
d. Gather more data about the client’s feelings about the childcare arrangements.
T T T T T T T T T T
ANS: D T
Since a complete assessment is necessary in order to identify a problem and choose an appropriate
T T T T T T T T T T T T T T T T
intervention, the nurse’s first action should be to obtain more information. The other actions may be
T T T T T T T T T T T T T T T T
appropriate, but more assessment is needed before the best intervention can be chosen.
T T T T T T T T T T T T
, Lewis Medical-Surgical Nursing in Canada 4th Edition Test Bank
DIF: Cognitive Level: Application TOP: Nursing Process: T T T T T
Assessment MSC: NCLEX: Psychosocial Integrity T T T T
6. The nurse is caring for a client who has left-sided paralysis as the result of a stroke and assesses a
T T T T T T T T T T T T T T T T T T T T
pressure injury on the client’s left hip. Which of the following is the most appropriate nursing
T T T T T T T T T T T T T T T T
diagnosis for this client? T T T
a. Impaired physical mobility related to decrease in muscle control (left-sided
T T T T T T T T T
paralysis)
b. Risk for impaired tissue integrity as evidenced by insufficient knowledge about
T T T T T T T T T T
protecting tissue integrity T T
c. Impaired skin integrity related to pressure over bony prominence (impaired
T T T T T T T T T
circulation)
d. Ineffective peripheral tissue perfusion related to sedentary lifestyle T T T T T T T
ANS: C T
The client’s major problem is the impaired skin integrity as demonstrated by the presence of a pressure
T T T T T T T T T T T T T T T T T
injury. The nurse is able to treat the cause of impaired circulation and pressure over bony prominence
T T T T T T T T T T T T T T T T T
by frequently repositioning the client. Although left-sided weakness is a problem for the client, the
T T T T T T T T T T T T T T T
nurse cannot treat the weakness. The “risk for” diagnosis is not appropriate for this client, who already
T T T T T T T T T T T T T T T T T
has impaired tissue integrity. The client does have ineffective peripheral tissue perfusion, but the
T T T T T T T T T T T T T T
impaired skin integrity diagnosis indicates more clearly what the health problem is.
T T T T T T T T T T T
DIF: Cognitive Level: Application TOP: Nursing Process: T T T T T
Diagnosis MSC: NCLEX: Physiological Integrity
T T T T
7. The nurse caring for a client with an infection has a nursing diagnosis of deficient fluid volume related
T T T T T T T T T T T T T T T T T T
to excessive fluid loss through normal route (diaphoresis). Which of the following is an appropriate
T T T T T T T T T T T T T T T
client outcome? T
a. Client has a balanced intake and output.T T T T T T
b. Client’s bedding is changed when it becomes damp.
T T T T T T T
c. Client understands the need for increased fluid intake.
T T T T T T T
d. Client’s skin remains cool and dry throughout hospitalization.
T T T T T T T
ANS: A T
This statement gives measurable data showing resolution of the problem of deficient fluid volume that was
T T T T T T T T T T T T T T T T
identified in the nursing diagnosis statement. The other statements would not indicate that the problem
T T T T T T T T T T T T T T T
of deficient fluid volume was resolved.
T T T T T
DIF: Cognitive Level: Application TOP: Nursing Process: T T T T T
Planning MSC: NCLEX: Physiological Integrity
T T T T
8. Which of the following represents a nursing activity that is carried out during the evaluation phase of
T T T T T T T T T T T T T T T T T
the nursing process?
T T
a. Determining if interventions have been effective in meeting client outcomes. T T T T T T T T T
b. Documenting the nursing care plan in the progress notes in the medical record. T T T T T T T T T T T T
c. Deciding whether the client’s health problems have been completely resolved.
T T T T T T T T T
d. Asking the client to evaluate whether the nursing care provided was satisfactory.
T T T T T T T T T T T
ANS: A T
, Lewis Medical-Surgical Nursing in Canada 4th Edition Test Bank
Evaluation consists of determining whether the desired client outcomes have been met and whether the
T T T T T T T T T T T T T T T
nursing interventions were appropriate. The other responses do not describe the evaluation phase.
T T T T T T T T T T T T
DIF: Cognitive Level: Comprehension TOP: Nursing Process: T T T T T
Evaluation MSC: NCLEX: Safe and Effective Care Environment
T T T T T T T
9. Which of the following would the nurse perform during the assessment phase of the nursing process?
T T T T T T T T T T T T T T T
a. Obtains data with which to diagnose client problems.
T T T T T T T
b. Uses client data to develop priority nursing diagnoses.
T T T T T T T
c. Teaches interventions to relieve client health problems.
T T T T T T
d. Assists the client to identify realistic outcomes to health problems.
T T T T T T T T T
ANS: A T
During the assessment phase, the nurse gathers information about the client. The other responses are
T T T T T T T T T T T T T T T
examples of the intervention, diagnosis, and planning phases of the nursing process.
T T T T T T T T T T T
DIF: Cognitive Level: Knowledge TOP: Nursing Process: T T T T T
Assessment MSC: NCLEX: Safe and Effective Care Environment
T T T T T T T
10. Which of the following is an example of a correctly written nursing diagnosis statement?
T T T T T T T T T T T T T
a. Altered tissue perfusion related to heart failure.
T T T T T T
b. Risk for impaired tissue integrity related to sacral redness.
T T T T T T T T
c. Ineffective coping related to insufficient sense of control. T T T T T T T
d. Altered urinary elimination related to urinary tract infection.
T T T T T T T
ANS: C T
This diagnosis statement includes a NANDA nursing diagnosis and an etiology that describes a client’s
T T T T T T T T T T T T T T T
response to a health problem that can be treated by nursing. The use of a medical diagnosis (as in the
T T T T T T T T T T T T T T T T T T T T
responses beginning “Altered tissue perfusion” and “Altered urinary elimination”) is not appropriate.
T T T T T T T T T T T
The response beginning “Risk for impaired tissue integrity” uses the defining characteristics as the etiology.
T T T T T T T T T T T T T T
DIF: Cognitive Level: Comprehension TOP: Nursing Process: T T T T T
Diagnosis MSC: NCLEX: Safe and Effective Care Environment
T T T T T T T
11. Which of the following includes the components required for a complete nursing diagnosis statement?
T T T T T T T T T T T T T
a. A problem and the suggested client goals or outcomes.
T T T T T T T T
b. A problem, its cause, and objective data that support the problem.
T T T T T T T T T T
c. A problem with all its possible causes and the planned interventions.
T T T T T T T T T T
d. A problem with its etiology and the signs and symptoms of the problem.
T T T T T T T T T T T T
ANS: D T
The PES format is used when writing nursing diagnoses. The subjective, as well as objective, data
T T T T T T T T T T T T T T T T
should be included in the defining characteristics. Interventions and outcomes are not included in the
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nursing diagnosis statement.T T
DIF: Cognitive Level: Knowledge TOP: Nursing Process: T T T T T
Diagnosis MSC: NCLEX: Safe and Effective Care Environment
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