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