week 4- nursing process ADPIE Questions And Answers Rated A+ New Update Assured Satisfaction

3 parts of formatting a nursing diagnosis - Answer-problem, etiology, defining characteristics 4 types of nursing assessments - Answer-initial comprehensive, focused, emergency, time-lapsed A home care nurse determines how much nursing care is needed by an elderly stroke patient living with her daughter - Answer-planning A home care nurse helps the physical therapist exercise the patient's limbs - Answer-implementing A male client is admitted to the hospital with blunt chest trauma after a motor vehicle accident. The first nursing priority for this client would be to: A. Assess the client's airway B. Provide pain relief C. Encourage deep breathing and coughing D. Splint the chest wall with a pillow - Answer-A A nurse analyzes data to determine what health problems might exist. - Answer-diagnosing A nurse consults with a patient's support people and other healthcare professionals to learn more about a patient'sproblem. - Answer-assessing A nurse decides whether to continue, modify, or terminate the healthcare plan - Answer-evaluating A nurse documents respiratory care performed on a patient. - Answer-implementing A nurse explains to a student that the nursing process is a dynamic process. Which of the following actions by the nurse best demonstrates this concept during the work shift? A. Nurse and client agree upon health care goals for the client B. Nurse reviews the client's history on the medical record C. Nurse explains to the client the purpose of each administered medication D. Nurse rapidly reset priorities for client care based on a change in the client's condition - Answer-D A nurse identifies the strengths a patient with cancer possesses. - Answer-diagnosing A nurse is revising a client's care plan. During which step of the nursing process does such a revision take place? A. Assessment B. Planning C.Implementation D. Evaluation - Answer-Da nurse performs an initial patient interview - Answer-assessing A nurse reviews a patient's past medical records. - Answer-assessing A nurse sets a goal for an obese teenager to lose 2 pounds a week. - Answer-planning A nurse sits down with the healthcare team halfway through treatment of a patient to see how effective the treatment has been. - Answer-evaluating A nurse weighs a patient after 3 weeks to determine whether his/her new diet has been effective. - Answer-evaluating Access to protected health information is restricted - Answer-confidentiality Actions Based on Patient Response to Plan of Care - Answer-terminate, modify, continue Actions nurse performs to achieve goals/desired outcomes - Answer-nursing interventions and activities An individual, family, or community state, behavior or perception that is measured along a continuum in response to nursing interventions. - Answer-nursing outcomes classification asking patient to demonstrate new skill - Answer-psychomotor asking patient to repeat information or apply new knowledge - Answer-cognitiveAssesment used to compare current status to baseline - Answer-Time-lapsed assessment Assessment performed specific to already identified problem to collect ongoing data and identify new or overlooked problems - Answer-focused assessment assessment performed to identify life threatening problems - Answer-emergency assessment Clinical judgment about individual, family, or community experiences/responses to actual and potential health problems or life process - Answer-nursing diagnosis Deals with disease or medical condition - Answer-medical diagnosis