1020C final exam Questions with
Complete Solutions Rated A+
nursing care plans - Answer incorporate aspects of multidisciplinary clinical pathways
assessment - Answer organized and ongoing appraisal of patient's well-being; includes primary
data (pt interview), secondary data, subjective data (symptoms and health hx), objective data
(signs, physical exams, lab results)
diagnosis - Answer identifies actual/potential problem or response to problem
actual diagnosis - Answer problem that is present during time of assessment with
etiology/underlying cause (related to...) and symptoms/signs (as evidenced by...)
risk diagnosis - Answer describes human responses to health conditions or life processes that
may develop in a vulnerable individual, family, or community.
- do NOT have related factors or defining characteristics because they have not occurred yet;
instead they have risk factors.
ex.: risk for lonliness, risk for acute confusion
health-promotion diagnosis - Answer determination of the client's motivation and desire to
increase well-being and actualize human health potential as expressed by a readiness to
enhance specific health behaviors
planning - Answer prioritizes diagnoses, establishes goals, identifies interventions to address
goals
-need short and long term goals
-includes collaboration and delegation
during the planning portion of nursing process, goals must be... - Answer SMART:
singular/specific, measurable, attainable, realistic, time framed
implementation - Answer initiation of interventions
- any action verb indicates intervention. can be independent, dependent, or collaborative
- care can be direct, indirect, or include care plans
evaluation - Answer determining the effects of the interventions that were instituted for the
patient and leading to further assessment and intervention
, - continue?
- revise or adapt?
what is the idea that the nursing process is cycling? - Answer one aspect of care leads into and
informs the next; nurse must continually reassess the patient, revise care as needed, and
evaluate whether needs or goals are being met
delegation - Answer transfer of responsibility for performing tasks (indirect intervention);
nurse still remains accountable; nursing process cannot be delegated; RN is most responsible for
incorporating delegation into practice
rights of delegation - Answer right task, right circumstances, right person, right
direction/communication, right supervision
RUQ contains - Answer right portion of the liver, the gallbladder, right kidney, a small portion
of the stomach, the duodenum, the head of the pancreas, portions of the ascending and
transverse colon, and parts of small intestine
- pain in this region is associated with infection and inflammation in the gallbladder and liver or
peptic ulcers in the stomach
LUQ contains - Answer left portion of the liver, part of the stomach, the pancreas, left kidney,
spleen, portions of the transverse and descending colon, and parts of the small intestine
- pain in this region is associated with malrotation of the intestine and colon.
RLQ contains - Answer In the right lower quadrant sits the cecum, appendix, part of the small
intestines, the right half of the female reproductive system, and the right ureter
- pain in this region is most commonly associated with appendicitis
LLQ contains - Answer The left lower quadrant houses the majority of the small intestine,
some of the large intestine, the left half of the female reproductive system, and the left ureter
- pain in this region is generally associated with colitis (inflammation of the large intestine) as
well as pelvic inflammatory disease and ovarian cysts in females
clinical judgement - Answer interpretations and inferences that influence actions in clinical
practice
-holistic view of patient situation
-process orientation
-reasoning and interpretation
Complete Solutions Rated A+
nursing care plans - Answer incorporate aspects of multidisciplinary clinical pathways
assessment - Answer organized and ongoing appraisal of patient's well-being; includes primary
data (pt interview), secondary data, subjective data (symptoms and health hx), objective data
(signs, physical exams, lab results)
diagnosis - Answer identifies actual/potential problem or response to problem
actual diagnosis - Answer problem that is present during time of assessment with
etiology/underlying cause (related to...) and symptoms/signs (as evidenced by...)
risk diagnosis - Answer describes human responses to health conditions or life processes that
may develop in a vulnerable individual, family, or community.
- do NOT have related factors or defining characteristics because they have not occurred yet;
instead they have risk factors.
ex.: risk for lonliness, risk for acute confusion
health-promotion diagnosis - Answer determination of the client's motivation and desire to
increase well-being and actualize human health potential as expressed by a readiness to
enhance specific health behaviors
planning - Answer prioritizes diagnoses, establishes goals, identifies interventions to address
goals
-need short and long term goals
-includes collaboration and delegation
during the planning portion of nursing process, goals must be... - Answer SMART:
singular/specific, measurable, attainable, realistic, time framed
implementation - Answer initiation of interventions
- any action verb indicates intervention. can be independent, dependent, or collaborative
- care can be direct, indirect, or include care plans
evaluation - Answer determining the effects of the interventions that were instituted for the
patient and leading to further assessment and intervention
, - continue?
- revise or adapt?
what is the idea that the nursing process is cycling? - Answer one aspect of care leads into and
informs the next; nurse must continually reassess the patient, revise care as needed, and
evaluate whether needs or goals are being met
delegation - Answer transfer of responsibility for performing tasks (indirect intervention);
nurse still remains accountable; nursing process cannot be delegated; RN is most responsible for
incorporating delegation into practice
rights of delegation - Answer right task, right circumstances, right person, right
direction/communication, right supervision
RUQ contains - Answer right portion of the liver, the gallbladder, right kidney, a small portion
of the stomach, the duodenum, the head of the pancreas, portions of the ascending and
transverse colon, and parts of small intestine
- pain in this region is associated with infection and inflammation in the gallbladder and liver or
peptic ulcers in the stomach
LUQ contains - Answer left portion of the liver, part of the stomach, the pancreas, left kidney,
spleen, portions of the transverse and descending colon, and parts of the small intestine
- pain in this region is associated with malrotation of the intestine and colon.
RLQ contains - Answer In the right lower quadrant sits the cecum, appendix, part of the small
intestines, the right half of the female reproductive system, and the right ureter
- pain in this region is most commonly associated with appendicitis
LLQ contains - Answer The left lower quadrant houses the majority of the small intestine,
some of the large intestine, the left half of the female reproductive system, and the left ureter
- pain in this region is generally associated with colitis (inflammation of the large intestine) as
well as pelvic inflammatory disease and ovarian cysts in females
clinical judgement - Answer interpretations and inferences that influence actions in clinical
practice
-holistic view of patient situation
-process orientation
-reasoning and interpretation
