1, 2 & 3 | Questions with Answers & Rationales LATEST
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VERSION 1
SECTION 1: NURSING PROCESS & CLINICAL JUDGMENT (Questions 1–15)
1. A nurse is using the nursing process to care for a client. Which step involves
collecting subjective and objective data?
A) Diagnosis
B) Planning
C) Assessment
D) Evaluation
Answer: C – Assessment
Rationale: Assessment is the first step of the nursing process and involves systematic
collection of subjective and objective data.
2. The nurse identifies a client's actual or potential health problem in which step of
the nursing process?
A) Assessment
,B) Diagnosis
C) Planning
D) Implementation
Answer: B – Diagnosis
Rationale: Nursing diagnosis is the second step of the nursing process, where the nurse
analyzes assessment data to identify actual or potential health problems.
3. A nurse is developing a care plan for a client. Which action demonstrates the
"Planning" phase?
A) Obtaining vital signs
B) Establishing client-centered goals and outcomes
C) Administering prescribed medications
D) Documenting the client's response to care
Answer: B – Establishing client-centered goals and outcomes
Rationale: Planning involves setting measurable, achievable, client-centered goals and
outcomes.
4. The nurse administers pain medication to a client. This action represents which
phase of the nursing process?
,A) Assessment
B) Diagnosis
C) Implementation
D) Evaluation
Answer: C – Implementation
Rationale: Implementation is the phase where the nurse carries out the planned
interventions.
5. A nurse evaluates a client's response to a nursing intervention. What is the primary
purpose of this evaluation?
A) To determine if the client has new problems
B) To assess whether the intervention was effective and progress toward goals is being
made
C) To complete required documentation
D) To prepare for discharge
Answer: B – To assess whether the intervention was effective and progress toward
goals is being made
Rationale: Evaluation is the fifth step of the nursing process and determines whether the
, client is progressing toward the established goals and whether the interventions were
effective.
6. The nurse is collecting data from a client who reports feeling "dizzy and
nauseous." This is an example of:
A) Objective data
B) Subjective data
C) Secondary data
D) Primary data
Answer: B – Subjective data
Rationale: Subjective data is information the client reports verbally, such as symptoms the
client is experiencing.
7. The nurse measures a client's blood pressure and records it as 150/90 mm Hg. This
is an example of:
A) Subjective data
B) Objective data
C) Historical data
D) Secondary data