NUR 152 Exam 2 Questions And Answers
List Maslow's hierarchy of needs in order from the top of the pyramid to the bottom. -
ANSWER Self-actualization
Self-esteem
Love and belonging
Safety and security
Physiological needs
List the steps of the nursing process in order. - ANSWER Assessment
Diagnosis
Planning outcomes
Planning interventions
Implementation
Evaluation
What is assessment? - ANSWER The systematic gathering of data related to the
physical, mental, spiritual, socioeconomic, and cultural status of an individual, group, or
community.
What are some of the characteristics of an assessment? - ANS Data gathering by a
systematic ongoing process Data classification Data documentation
What is subjective data? - ANS (symptoms)
Data that is perceived only by the person who has been affected
What the person tells the nurse
,What is objective data? - ANS (signs)
Data that can be observed and measured
Can be seen, heard, or felt by anyone other than the person with S/Sx
When must the nurse confirm data? - ANSWER Data are subjective/objective data that
do not agree or make sense
Data stated by client contradict each other times during interview
Data are way out of normal range
List factors present that interfere with accurate measurement
Assessment's relationship to diagnosis - ANSWER Data lead to the development of
client's actual or potential problems and strengths.
How does assessment relate to the planning of outcomes and interventions? ANS Data
help you identify realistic goals and choose interventions most likely to be acceptable to
and effective for the client.
How does assessment relate to implementation? ANS You gather data by observing the
client's responses as you implement interventions.
How does assessment relate to evaluation? ANS You observe client responses to
interventions; client responses are data.
What are some ways to prepare to interview (assess) a client? - ANSWER Know purpose
of interview and how data will be used
Read client chart
Form some goals and opening questions
Schedule uninterrupted time
Have forms and equipment
Compose yourself before entering room
,Provide privacy & remove distractions
How should a nurse prepare a client for assessment? - ANSWER Introduce yourself
Call the client by name
Inform the client what you will be doing and why
Assess readiness to discuss health issues
Assess and provide for comfort
Assess for anxiety
What are some guidelines to follow in assessing? - ANSWER Individualize your approach
Use active listening
Pay attention to nonverbal communication
Use mostly openended questions
Avoid health-care jargon
Curb your curiosity
Do not give advice or voice approval/disapproval
What are some things to think about and/or do after the assessment? - ANSWER Is my
data complete, accurate, validated?
Did I record data, not conclusions?
Did I follow up with special needs assessment if indicated?
Think about the client interview
Review the physical assessment, observation, and examination
What is the difference between medical diagnoses and nursing assessments? -
ANSWER Medical assessments :
Focus on disease and pathology-only medical doctors can perform
, Nursing diagnoses :
Refer to the client's responses to illness
What is the purpose of nursing diagnosis? - ANSWER Identify:
How the patient responds to actual or potential health and life processes
Factors that contribute to, or cause, health problems (etiologies)
Resources or strengths upon which the patient can draw to prevent or resolve problems
What is a medical diagnosis? - ANSWER Medical Diagnosis:
Describes a disease, illness, or injury for which the physician orders the primary
treatment. (only medical doctors can diagnose medical conditions)
What is a nursing diagnosis? - ANSWER Nursing Diagnosis:
A statement of client health status that nurses can independently identify, prevent, or
treat
What are a few examples of medical diagnoses? - ANSWER Right hip fracture
Cellulitis
COPD
What are a few examples of nursing diagnoses? - ANSWER Acute pain
Impaired mobility
Skin integrity impaired
Impaired gas exchange
Social isolation
What are the three components of an "actual" nursing diagnosis? - ANSWER Problem
Etiology
List Maslow's hierarchy of needs in order from the top of the pyramid to the bottom. -
ANSWER Self-actualization
Self-esteem
Love and belonging
Safety and security
Physiological needs
List the steps of the nursing process in order. - ANSWER Assessment
Diagnosis
Planning outcomes
Planning interventions
Implementation
Evaluation
What is assessment? - ANSWER The systematic gathering of data related to the
physical, mental, spiritual, socioeconomic, and cultural status of an individual, group, or
community.
What are some of the characteristics of an assessment? - ANS Data gathering by a
systematic ongoing process Data classification Data documentation
What is subjective data? - ANS (symptoms)
Data that is perceived only by the person who has been affected
What the person tells the nurse
,What is objective data? - ANS (signs)
Data that can be observed and measured
Can be seen, heard, or felt by anyone other than the person with S/Sx
When must the nurse confirm data? - ANSWER Data are subjective/objective data that
do not agree or make sense
Data stated by client contradict each other times during interview
Data are way out of normal range
List factors present that interfere with accurate measurement
Assessment's relationship to diagnosis - ANSWER Data lead to the development of
client's actual or potential problems and strengths.
How does assessment relate to the planning of outcomes and interventions? ANS Data
help you identify realistic goals and choose interventions most likely to be acceptable to
and effective for the client.
How does assessment relate to implementation? ANS You gather data by observing the
client's responses as you implement interventions.
How does assessment relate to evaluation? ANS You observe client responses to
interventions; client responses are data.
What are some ways to prepare to interview (assess) a client? - ANSWER Know purpose
of interview and how data will be used
Read client chart
Form some goals and opening questions
Schedule uninterrupted time
Have forms and equipment
Compose yourself before entering room
,Provide privacy & remove distractions
How should a nurse prepare a client for assessment? - ANSWER Introduce yourself
Call the client by name
Inform the client what you will be doing and why
Assess readiness to discuss health issues
Assess and provide for comfort
Assess for anxiety
What are some guidelines to follow in assessing? - ANSWER Individualize your approach
Use active listening
Pay attention to nonverbal communication
Use mostly openended questions
Avoid health-care jargon
Curb your curiosity
Do not give advice or voice approval/disapproval
What are some things to think about and/or do after the assessment? - ANSWER Is my
data complete, accurate, validated?
Did I record data, not conclusions?
Did I follow up with special needs assessment if indicated?
Think about the client interview
Review the physical assessment, observation, and examination
What is the difference between medical diagnoses and nursing assessments? -
ANSWER Medical assessments :
Focus on disease and pathology-only medical doctors can perform
, Nursing diagnoses :
Refer to the client's responses to illness
What is the purpose of nursing diagnosis? - ANSWER Identify:
How the patient responds to actual or potential health and life processes
Factors that contribute to, or cause, health problems (etiologies)
Resources or strengths upon which the patient can draw to prevent or resolve problems
What is a medical diagnosis? - ANSWER Medical Diagnosis:
Describes a disease, illness, or injury for which the physician orders the primary
treatment. (only medical doctors can diagnose medical conditions)
What is a nursing diagnosis? - ANSWER Nursing Diagnosis:
A statement of client health status that nurses can independently identify, prevent, or
treat
What are a few examples of medical diagnoses? - ANSWER Right hip fracture
Cellulitis
COPD
What are a few examples of nursing diagnoses? - ANSWER Acute pain
Impaired mobility
Skin integrity impaired
Impaired gas exchange
Social isolation
What are the three components of an "actual" nursing diagnosis? - ANSWER Problem
Etiology
