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Diagnosis Handbook 13th Edition: An Evide
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nce-Based Guide to Planning Care
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byNMaryNBethNFlynnNMakic
@2024
,Section I: Nursing Diagnosis, the Nursing Process, and Evidence-
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Based Nursing
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1. What is the primary goal of a nursing diagnosis?
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a. To identify a medical diagnosis
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b. To determine the effectiveness of medications
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c. To identify patient problems that can be managed by nursing
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Ninterventions
d. To prioritize physician orders
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ANS: C N
Rationale: The primary goal of a nursing diagnosis is to identify patient problems
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Nthat can be managed by nursing interventions, focusing on patient care rather tha
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n medical diagnoses.
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NCLEX Preference: Understanding the distinction between nursing and medical
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Ndiagnoses is crucial for patient-centered care.
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2. Which component of the nursing diagnosis indicates the problem?
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a. Defining characteristics
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b. Related factors
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c. The actual diagnosis
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d. The patient’s history
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ANS: C N
Rationale: The actual diagnosis represents the problem identified in the nursing a
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ssessment. It is essential for formulating a care plan.
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NCLEX Preference: Clear identification of nursing diagnoses is necessary for effe
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ctive care planning.
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3. What does the "related to" (R/T) statement in a nursing diagnosis signify?
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a. It identifies the patient's response to the problem
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b. It indicates the underlying cause of the problem
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c. It lists the symptoms observed
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d. It describes the treatment plan
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ANS: B N
Rationale: The "related to" (R/T) statement indicates the underlying cause or con
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tributing factors of the patient’s problem, guiding intervention strategies.
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,NCLEX Preference: Understanding etiology is vital for targeted nursing interven
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tions.
4. Which nursing diagnosis format is used to articulate the problem clearly?
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a. Problem-focused diagnosis
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b. Risk diagnosis
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c. Health promotion diagnosis
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d. All of the above
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ANS: D N
Rationale: All formats—problem-focused, risk, and health promotion—
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articulate different aspects of patient care and are important in various clinical sit
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uations.
NCLEX Preference: Familiarity with different nursing diagnosis formats enhanc
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es clinical reasoning.
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5. In which phase of the nursing process is the nursing diagnosis formulated?
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a. Assessment
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b. DiagnosisN
c. Planning
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d. Implementation
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ANS: B N
Rationale: The nursing diagnosis is formulated during the diagnosis phase, after
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collecting and analyzing assessment data.
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NCLEX Preference: Understanding the nursing process phases is crucial for effe
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ctive care delivery.
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6. What is a defining characteristic in a nursing diagnosis?
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a. The cause of the problem
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b. The observable signs and symptoms
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c. The expected outcomes
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d. The patient's medical history
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ANS: B N
Rationale: Defining characteristics are the observable signs and symptoms that v
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alidate the nursing diagnosis and provide evidence of the problem.
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NCLEX Preference: Identifying defining characteristics is essential for accurate di
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agnosis and planning. N N
, 7. How can a nurse validate a nursing diagnosis?
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a. By relying solely on personal experience
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b. By collecting data from various sources, including the patient
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c. By discussing it only with physicians
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d. By documenting the diagnosis without evidence
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ANS: B N
Rationale: Validating a nursing diagnosis involves collecting data from multiple
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sources, including the patient, to ensure accuracy and relevance.
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NCLEX Preference: Validation of nursing diagnoses is critical for patient safety
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and effective care.
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8. What role does evidence-based practice play in nursing diagnoses?
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a. It complicates the diagnosis process
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b. It provides a scientific basis for nursing decisions
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c. It is optional for nursing practice
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d. It focuses solely on traditional methods
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ANS: B N
Rationale: Evidence- N
based practice provides a scientific basis for nursing decisions, improving patient
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outcomes and ensuring care is effective and relevant. NCLEX Preference: Know
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ledge of evidence-based practice is essential for modern nursing.
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9. What is the purpose of the planning phase in the nursing process?
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a. To assess the patient’s condition
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b. To develop a care plan with measurable goals
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c. To implement interventions immediately
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**d. To evaluate patient outcomes
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ANS: B N
Rationale: The planning phase involves developing a care plan with measurable
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goals and outcomes tailored to the patient’s needs.
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NCLEX Preference: Effective planning is key to successful patient outcomes.
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10. How should nursing diagnoses be prioritized?
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a. Based on the nurse’s preference
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