NURS 171 UNIT 1 EXAM QUESTIONS
AND CORRECT ANSWERS
Which statements are correct about critical thinking and the nursing process? Select all
that apply.
When using the nursing process, critical thinking is not required.
Nurses use critical thinking for decisions unrelated to the nursing process.
Nursing process is a form of critical thinking.
Some nursing decisions do not require critical thinking.
Nursing process is the only form of critical thinking used in nursing. ✅Some nursing
decisions do not require critical thinking.
Nurses use critical thinking for decisions unrelated to the nursing process.
Nursing process is a form of critical thinking.
The nurse is performing an assessment on a client. What should be included in this
process? Select all that apply.
Ability to function
Cultural needs
Collection of vital signs
Auscultation of the lungs
Readiness to learn ✅Collection of vital signs
Readiness to learn
Ability to function
Auscultation of the lungs
Cultural needs
What is the purpose of the diagnosis step of the nursing process?
To determine a medical diagnosis of the patient's problems
To provide analysis of the nursing assessment
To migrate medical diagnosis to nursing terminology
To link assessment findings to planning goals ✅To provide analysis of the nursing
assessment
While creating a plan for client care, the nurse should include which considerations?
Select all that apply.
,Individual client needs
Realistic expectations
Colleagues' input
Length of stay
Client needs upon discharge ✅Client needs upon discharge
Colleagues' input
Individual client needs
Realistic expectations
A nurse is using critical thinking and clinical reasoning to evaluate the plan of care for a
hospitalized client. What should the nurse do after recognizing that the goals of the care
plan have not been met in a timely fashion?
Delete the plan of care, documenting the reason it was deleted.
Revise the plan of care with more realistic goals and time line for the client.
Contact the healthcare provider and determine why the client's condition is not
improving.
Discard the plan of care and create a new one. ✅Revise the plan of care with more
realistic goals and time line for the client.
Which of the following about the nursing process is correct?
Includes only the care that the nurse will deliver
Works alongside an individualized plan of care
Results in outcomes designed by the client
Composed of a linear process with unique, distinct steps ✅Works alongside an
individualized plan of care
The diagnosis step of the nursing process includes which activity?
Performing and documenting nursing actions
Evaluating goal achievement
Analyzing data
Assessing and diagnosing ✅Analyzing data
Which statement or command made by the nurse is an example of the evaluation phase
of the nursing process?
"Mr. Sullivan may be able to ambulate with the use of a walker and stand-by
assistance."
"Mr. Sullivan will be able to walk the length of the hallway before discharge."
"Ambulate Mr. Sullivan in the hallway three times today, please."
,"I wish Mr. Sullivan were able to walk the length of the hallway by now, but he is not
meeting this goal." ✅"I wish Mr. Sullivan were able to walk the length of the hallway by
now, but he is not meeting this goal."
The nurse is performing an assessment on a client. What should be included in this
process?
Religious and spiritual needs
Ability to pay for hospital stay
Who brought patient to the hospital
Level of education ✅Religious and spiritual needs
Which statement is correct about critical thinking and the nursing process?
Everything a nurse does requires critical thinking.
The nursing process is a critical-thinking, problem-solving model.
Nursing process is the only form of critical thinking used in nursing.
When using the nursing process, critical thinking is not needed. ✅The nursing process
is a critical-thinking, problem-solving model.
What is the best way for student nurses to improve critical-thinking skills?
Ask fellow students' opinions about clinical situations
Use the five points of the critical-thinking model
Communicate more often with clients when in clinical situations
Utilize the experienced nurse's judgment in making decisions ✅Utilize the experienced
nurse's judgment in making decisions
Which is an example of interpersonal communication?
The nurse stating to himself or herself, "I can't do this!"
Three nurses discussing the client's plan of care
The nurse talking to himself or herself about a situation
Multiple health-care professionals meeting to discuss a problem on the unit ✅Three
nurses discussing the client's plan of care
Rational: Interpersonal communication occurs between two or more people.
The nurse enters the room to discuss ostomy care with the client, who is lying in bed.
Which form of nonverbal language is most appropriate when speaking with the client?
Sit down to speak at eye level with the client.
Cross your arms when listening to the client.
Avoid using touch when supporting the client.
Refrain from making eye contact with the client. ✅Sit down to speak at eye level with
the client.
, Rational: Eye level shows the nurse feels equal with, rather than superior to, the client.
The nurse enters the room of a client who is unresponsive. Which intervention best
helps the nurse establish communication during the orientation phase?
Ask family members how the client would prefer to be addressed.
Address the client as "Mr." or "Mrs." as this shows respect toward the client.
Call the client by his or her first and last name.
Read the medical history to obtain information about how the client is to be addressed.
✅Ask family members how the client would prefer to be addressed.
Rational: Medical history may not include that information. The nurse should not
address the client by his/her first name unless granted access. May be inappropriate to
use Mr./Mrs.
The nurse is exploring personal issues with a client and wants to obtain more
information. Which question asked by the nurse would obtain the most information?
When did you first notice the problem?
Do you know why your spouse continues to hurt you?
Tell me what happened to encourage you to seek counseling
Are there any triggers that you know of that cause the abuse ✅Tell me what happened
to encourage you to seek counseling
When communicating with a client who is not fluent in English, what should the nurse
do?
Ask a family member to interpret.
Ask another staff member to interpret.
Use hand signals to ask questions.
Contact interpreter services for a translator who speaks the client's language.
✅Contact interpreter services for a translator who speaks the client's language.
Rational: Family members may not be able to interpret medical questions accurately.
May be a breach in confidentiality when involving another staff member.
An oncology nurse received a report on a 45-year-old client who was told he or she has
stage IV colon cancer an hour before. When the nurse enters the room, the client is
crying. What should the nurse do next?
Sit with the client and offer your hand.
Ask if the client wants his or her spouse called.
Ask if the client is hungry.
Tell the client everything will be okay. ✅Sit with the client and offer your hand.
AND CORRECT ANSWERS
Which statements are correct about critical thinking and the nursing process? Select all
that apply.
When using the nursing process, critical thinking is not required.
Nurses use critical thinking for decisions unrelated to the nursing process.
Nursing process is a form of critical thinking.
Some nursing decisions do not require critical thinking.
Nursing process is the only form of critical thinking used in nursing. ✅Some nursing
decisions do not require critical thinking.
Nurses use critical thinking for decisions unrelated to the nursing process.
Nursing process is a form of critical thinking.
The nurse is performing an assessment on a client. What should be included in this
process? Select all that apply.
Ability to function
Cultural needs
Collection of vital signs
Auscultation of the lungs
Readiness to learn ✅Collection of vital signs
Readiness to learn
Ability to function
Auscultation of the lungs
Cultural needs
What is the purpose of the diagnosis step of the nursing process?
To determine a medical diagnosis of the patient's problems
To provide analysis of the nursing assessment
To migrate medical diagnosis to nursing terminology
To link assessment findings to planning goals ✅To provide analysis of the nursing
assessment
While creating a plan for client care, the nurse should include which considerations?
Select all that apply.
,Individual client needs
Realistic expectations
Colleagues' input
Length of stay
Client needs upon discharge ✅Client needs upon discharge
Colleagues' input
Individual client needs
Realistic expectations
A nurse is using critical thinking and clinical reasoning to evaluate the plan of care for a
hospitalized client. What should the nurse do after recognizing that the goals of the care
plan have not been met in a timely fashion?
Delete the plan of care, documenting the reason it was deleted.
Revise the plan of care with more realistic goals and time line for the client.
Contact the healthcare provider and determine why the client's condition is not
improving.
Discard the plan of care and create a new one. ✅Revise the plan of care with more
realistic goals and time line for the client.
Which of the following about the nursing process is correct?
Includes only the care that the nurse will deliver
Works alongside an individualized plan of care
Results in outcomes designed by the client
Composed of a linear process with unique, distinct steps ✅Works alongside an
individualized plan of care
The diagnosis step of the nursing process includes which activity?
Performing and documenting nursing actions
Evaluating goal achievement
Analyzing data
Assessing and diagnosing ✅Analyzing data
Which statement or command made by the nurse is an example of the evaluation phase
of the nursing process?
"Mr. Sullivan may be able to ambulate with the use of a walker and stand-by
assistance."
"Mr. Sullivan will be able to walk the length of the hallway before discharge."
"Ambulate Mr. Sullivan in the hallway three times today, please."
,"I wish Mr. Sullivan were able to walk the length of the hallway by now, but he is not
meeting this goal." ✅"I wish Mr. Sullivan were able to walk the length of the hallway by
now, but he is not meeting this goal."
The nurse is performing an assessment on a client. What should be included in this
process?
Religious and spiritual needs
Ability to pay for hospital stay
Who brought patient to the hospital
Level of education ✅Religious and spiritual needs
Which statement is correct about critical thinking and the nursing process?
Everything a nurse does requires critical thinking.
The nursing process is a critical-thinking, problem-solving model.
Nursing process is the only form of critical thinking used in nursing.
When using the nursing process, critical thinking is not needed. ✅The nursing process
is a critical-thinking, problem-solving model.
What is the best way for student nurses to improve critical-thinking skills?
Ask fellow students' opinions about clinical situations
Use the five points of the critical-thinking model
Communicate more often with clients when in clinical situations
Utilize the experienced nurse's judgment in making decisions ✅Utilize the experienced
nurse's judgment in making decisions
Which is an example of interpersonal communication?
The nurse stating to himself or herself, "I can't do this!"
Three nurses discussing the client's plan of care
The nurse talking to himself or herself about a situation
Multiple health-care professionals meeting to discuss a problem on the unit ✅Three
nurses discussing the client's plan of care
Rational: Interpersonal communication occurs between two or more people.
The nurse enters the room to discuss ostomy care with the client, who is lying in bed.
Which form of nonverbal language is most appropriate when speaking with the client?
Sit down to speak at eye level with the client.
Cross your arms when listening to the client.
Avoid using touch when supporting the client.
Refrain from making eye contact with the client. ✅Sit down to speak at eye level with
the client.
, Rational: Eye level shows the nurse feels equal with, rather than superior to, the client.
The nurse enters the room of a client who is unresponsive. Which intervention best
helps the nurse establish communication during the orientation phase?
Ask family members how the client would prefer to be addressed.
Address the client as "Mr." or "Mrs." as this shows respect toward the client.
Call the client by his or her first and last name.
Read the medical history to obtain information about how the client is to be addressed.
✅Ask family members how the client would prefer to be addressed.
Rational: Medical history may not include that information. The nurse should not
address the client by his/her first name unless granted access. May be inappropriate to
use Mr./Mrs.
The nurse is exploring personal issues with a client and wants to obtain more
information. Which question asked by the nurse would obtain the most information?
When did you first notice the problem?
Do you know why your spouse continues to hurt you?
Tell me what happened to encourage you to seek counseling
Are there any triggers that you know of that cause the abuse ✅Tell me what happened
to encourage you to seek counseling
When communicating with a client who is not fluent in English, what should the nurse
do?
Ask a family member to interpret.
Ask another staff member to interpret.
Use hand signals to ask questions.
Contact interpreter services for a translator who speaks the client's language.
✅Contact interpreter services for a translator who speaks the client's language.
Rational: Family members may not be able to interpret medical questions accurately.
May be a breach in confidentiality when involving another staff member.
An oncology nurse received a report on a 45-year-old client who was told he or she has
stage IV colon cancer an hour before. When the nurse enters the room, the client is
crying. What should the nurse do next?
Sit with the client and offer your hand.
Ask if the client wants his or her spouse called.
Ask if the client is hungry.
Tell the client everything will be okay. ✅Sit with the client and offer your hand.
