CenteredNursingProcessApproach,1
2thEdition by LindaE. Mc Cuistion
Chapter 1-58
, Chapter 01: MULTIPLE CHOICE
1. The nursing process is a five-step decision-
making approach that includes all of the following steps, EXCEPT:
a. Assessment
b. Patient problem
c. Planning
d. Right Drug
ANS: D
The nursing process is a five-step decision-
making approach that includes: 1) assessment, 2) patient problem, 3)
planning, 4) implementa tion, and 5) evaluation. ―Right drug‖ is one of the
―Six Rights‖ of medication administration.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Planning MSC: NCLEX: Management of Care
2. The nurse is using data collected to set goals or expected outcomes
and intervention s that address the patient‘s problems. Which step of
the nursing process is the nurs e applying?
a. Assessment
b. Patient problem
c. Planning N
d. Evaluation
ANS: C
During the planning phase, the nurse uses the data collected to set goals or
expected outc omes and interventions which address the patient‘s
problems. The data was collected dur ing the
―Assessment‖ and ―Patient problem‖ steps. During the ―Evaluation‖
km
phase the nurse wo uld determine whether the goals and objectives set
during the planning phase were m et.
DIF:
Cognitive Level: Understanding (Comprehension
) TOP: Nursing Process: Nursing
Intervention MSC: NCLEX:
Management of Care
3. A 5-year-
old child with type 1 diabetes mellitus has had repeated hospitalizations
for episodes of hyperglycemia. The parents tell the nurse that they can‘t
keep track of everything that h as to be done to care for their child. The
nurse reviews medications, diet, and symptom management with the
parents and draws up a daily checklist for the family to use. The se
activities are completed in which step of the nursing process?
a. Assessment
b. Planning
,c. Implementation
d. Evaluation
ANS: C
, The implementation phase is the part of the nursing process in which
the nurse provi des education, drug administration, patient care, and
other interventions necessary to as sist the patient in accomplishing
established medication goals.
DIF:
Cognitive Level: Understanding (Comprehension
) TOP: Nursing Process: Nursing
Intervention MSC: NCLEX:
Management of Care
4. The nurse is preparing to administer a medication and reviews the
patient‘s chart for drug allergies, serum creatinine, and blood urea
nitrogen (BUN) levels. The nurse‘s actions are reflective of which
phase of the nursing process?
a. Assessment
b. Evaluation
c. Implementation
d. Planning
ANS: A
Assessment involves gathering information about the patient and the
drug, including an y previous use of the drug.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care
5. Which assessment is categorized as objective data?
a. A list of herbal supplements regularly used
b. Lab values associated with the drugs the patient is taking
c. The ages and relationship to the patient of all household members
d. Usual dietary patterns and fNo od intake
ANS: B
Objective data are measured and detected by another person and would
include lab val ues. The other examples are subjective data.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Assessment MSC: NCLEX: Management of Care
6. The nurse reviews a patient‘s database and learns that the patient lives
alone, is forgetfu l, and does not have an established routine. The
patient will be sent home with three n ew medications to be taken at
different times of the day. The nurse develops a daily m edication chart and
enlists a family member to put the patient‘s pills in a pill organizer
. This is an example of which phase of the nursing process?
a. Assessment
b. Evaluation
c. Implementation
d. Planning
ANS: C
The implementation phase involves education and patient care in order to assist
the patient to accomplish the goals of treatment.
DIF: