Test Bank for Understanding Medical- TABLE OF CONTENTS
Unit 1 Understanding Health Care Issues
Surgical Nursing th 1. Critical Thinking and the Nursing Process
2. Evidence-Based Practice
Edition Linda S. Williams Paula D. 3. Issues in Nursing Practice
4. Cultural Influences on Nursing Care
5. Complementary and Alternative Modalities
Hopper
Unit 2 Understanding Health and Illness
6. Nursing Care of Patients with Fluid, Electrolyte, and Acid-Base Imbalances
7. Nursing Care of Patients Receiving Intravenous Therapy
8. Nursing Care of Patients with Infections
9. Nursing Care of Patients in Shock
10. Nursing Care of Patients in Pain
11. Nursing Care of Patients With Cancer
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y
12. Nursing Care of Patients Having Surgery
13. Nursing Care of Patients with Emergent Conditions and Disaster/Bioterrorism Response
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g
Unit 3 Understanding Life Span Influences on Health and Illness
14. Developmental Considerations and Chronic Illness in the Nursing Care of Adults
15. Nursing Care of Older Adult Patients
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g
16. Patient Care Settings
17. Nursing Care of Patients at the End of Life
a
a
Unit 4 Understanding the Immune System
18. Immune System Function, Assessment and Therapeutic Measures
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M
19. Nursing Care of Patients With Immune Disorders
20. Nursing Care of Patients With HIV Disease and AIDS
Unit 5 Understanding the Cardiovascular System
21. Cardiovascular System Function, Assessment and Therapeutic Measures
22. Nursing Care of Patients With Hypertension
23. Nursing Care of Patients With Valvular, Inflammatory and Infectious Cardiac or Venous Disorders
24. Nursing Care of Patients With Occlusive Cardiovascular Disorders
25. Nursing Care of Patients With Cardiac Arrhythmias
26. Nursing Care of Patients With Heart Failure
Unit 6 Understanding the Hematologic and Lymphatic Systems
27. Hematologic and Lymphatic System Function, Assessment, and Therapeutic Measures
28. Nursing Care of Patients With Hematologic and Lymphatic Disorders
Unit 7 Understanding the Respiratory System
29. Respiratory System Function, Assessment, and Therapeutic Measures
30. Nursing Care of Patients With Upper Respiratory Tract Disorders
31. Nursing Care of Patients With Lower Respiratory Tract Disorders
, Chapter 1. Critical Thinking and the Nursing Process
Unit 8 Understanding the Gastrointestinal, Hepatic, and Pancreatic Systems
MULTIPLE CHOICE
32. Gastrointestinal, Hepatobiliary, and Pancreatic Systems Function, Assessment and Therapeutic Measures
33. Nursing Care of Patients With Upper Gastrointestinal Disorders
1. The nurse is caring for a group of patients on a medical-surgical unit. Which patient should
34. Nursing Care of Patients With Lower Gastrointestinal Disorders the licensed practical nurse/licensed vocational nurse (LPN/LVN) assess first?
35. Nursing Care of Patients With Liver, Pancreatic, and Gallbladder Disorders 1. A patient with a blood glucose of 42 mg/dL
2. A patient who reports a pain level of 2
Unit 9 Understanding the Urinary System 3. A patient who has just received a diagnosis of cancer
36. Urinary System Function, Assessment, and Therapeutic Measures 4. A patient who has a respiratory rate of 22
37. Nursing Care of Patients With Disorders of the Urinary System ANS: 1
Chapter: Chapter 1 Critical Thinking and the Nursing Process
Unit 10 Understanding the Endocrine System
Objective: 7. Prioritize patient care activities based on the Maslow hierarchy of human
38. Endocrine System Function and Assessment
needs.
39. Nursing Care of Patients With Endocrine Disorders
Pages: 6–7
40. Nursing Care of Patients With Disorders of the Endocrine Pancreas
Heading: Prioritize Care
Unit 11 Understanding the Genitourinary and Reproductive System Integrated Process: Clinical Problem-Solving Process (Nursing Process)
41. Genitourinary and Reproductive System Function and Assessment Client Need: SECE—Coordinated Care
y
y
42. Nursing Care of Women With Reproductive System Disorders Cognitive Level: Application [Applying]
43. Nursing Care of Male Patients With Genitourinary Disorders Concept: Patient-Centered Care
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g
44. Nursing Care of Patients With Sexually Transmitted Infections Difficulty: Difficult
Unit 12 Understanding the Musculoskeletal System Feedback
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g
45. Musculoskeletal Function and Assessment 1 This patient has a dangerously low blood glucose level and requires immediate
46. Nursing Care of Patients With Musculoskeletal and Connective Tissue Disorders intervention.
a
a
2 This patient will need to be assessed, but is not as high a priority.
Unit 13 Understanding the Neurologic System 3 According to Maslow, psychosocial needs are not as high of a priority as
47. Neurologic System Function, Assessment, and Therapeutic Measures physiological needs.
M
M
48. Nursing Care of Patients With Central Nervous System Disorders 4 A respiratory rate of 22 is within normal range.
49. Nursing Care of Patients With Cerebrovascular Disorders
50. Nursing Care of Patients With Peripheral Nervous System Disorders
PTS: 1 CON: Patient-Centered Care
Unit 14 Understanding the Sensory System
2. The LPN/LVN enters the room of a patient who is angry and yells, ―I asked 5 minutes ago
51. Sensory System Function, Assessment, and Therapeutic Measures: Vision and Hearing
52. Nursing Care of Patients With Sensory Disorders: Vision and Hearing
for my pain medication. I’m going to call the CEO of the hospital if you don’t get it for me
now.‖ Which statement by the nurse demonstrates intellectual empathy?
Unit 15 Understanding the Integumentary System 1. ―We are short-staffed today, so it will take me longer to meet your needs.‖
53. Integumentary System Function, Assessment and Therapeutic Measures 2. ―I am sorry you had to wait, I know you must be in a lot of pain.‖
54. Nursing Care of Patients With Skin Disorders 3. ―I had another patient who had severe pain, and I had to get to them first.‖
55. Nursing Care of Patients With Burns 4. ―I will get you the number for the CEO, but he is aware of how busy we are.‖
ANS: 2
Unit 16 Understanding Mental Health Care
Chapter: Chapter 1 Critical Thinking and the Nursing Process
56. Mental Health Function, Assessment, and Therapeutic Measures
Objective: 2. Describe attitudes and skills that promote good critical thinking
57. Nursing Care of Patients With Mental Health Disorders
Page: 2
Heading: Intellectual Empathy
Integrated Process: Communication and Documentation
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
, Concept: Communication
Difficulty: Moderate Objective: 4. Identify the role of a licensed practical nurse/licensed vocational nurse in using
the nursing process.
Feedback Page: 3
1 This statement does not consider an individual’s situation. Heading: Clinical Judgement
2 This statement demonstrates intellectual empathy by considering this patient’s Integrated Process: Clinical Problem-solving Process (Nursing Process)
situation and will likely alleviate the patient’s anger. Client Need: SECE—Coordinated Care
3 This statement does not consider a patient’s situation and does not demonstrate Cognitive Level: Application [Applying]
intellectual empathy. Concept: Patient-Centered Care
4 This statement addresses the patient’s statement of wanting to call the CEO, but Difficulty: Moderate
does not demonstrate intellectual empathy by considering the patient’s situation.
Feedback
PTS: 1 CON: Communication 1 The patient who has a fractured femur is having acute pain. Repositioning a
patient with a new fracture is not likely to relieve pain.
3. The nurse is collecting data on a patient. Which data are described as subjective? 2 Giving the medication before the prescribed time is beyond the nurse’s scope of
1. Respiratory rate of 26 per minute practice.
2. Patient report of shortness of breath 3 The patient should not have to wait for pain relief, so the LPN should inform the
3. Coarse lung sounds bilaterally RN or physician so new pain relief orders can be obtained.
4. Cough producing green sputum 4 The nurse needs to do more than expect the patient to wait for pain relief.
ANS: 2
y
y
Chapter: Chapter 1 Critical Thinking and the Nursing Process PTS: 1 CON: Patient-Centered Care
Objective: 5. Differentiate between objective and subjective data.
5. The nurse is prioritizing care based on Maslow hierarchy of needs. Which need does the
g
g
Page: 4
Heading: Subjective Data nurse identify as having the highest priority?
Integrated Process: Communication and Documentation 1. Job-related stress
g
g
Client Need: Communication and Documentation 2. Feeling of loneliness
Cognitive Level: Application (Applying) 3. Pain level of 9 on 0-to-10 scale
4. Lack of confidence
a
a
Concept: Communication
Difficulty: Moderate ANS: 3
Chapter: Chapter 1 Critical Thinking and the Nursing Process
M
M
Feedback Objective: 7. Prioritize patient care activities based on the Maslow hierarchy of human
1 Respiratory rate of 26 per minute is an example of objective data. needs
2 A patient reporting symptoms to the nurse is an example of subjective data. Page: 7
3 Coarse lung sounds is an example of objective data. Heading: Prioritize Care
4 A productive cough is an example of objective data. Integrated Process: Caring
Client Need: SECE – Coordinated Care
PTS: 1 CON: Communication Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
4. A patient with a newly fractured femur reports a pain level of 8/10 and analgesic medication Difficulty: Moderate
is not due for another 50 minutes. Which action should the nurse take first?
1. Reposition the patient. Feedback
2. Give the medication in 30 minutes. 1 Job-related stress falls under safety according to Maslow and is addressed after
3. Notify the registered nurse (RN) or physician. physiological needs.
4. Tell the patient it is too early for pain medication. 2 According to Maslow, loneliness is addressed under social needs following
physiological and safety.
ANS: 3 3 Pain is a physiological need and is the highest priority.
Chapter: Chapter 1 Critical Thinking and the Nursing Process 4 Lack of confidence falls under esteem according to Maslow and is addressed
following physiological, safety, and social needs.
, Feedback
1 These statements are interpretations of the data and use words that have vague
PTS: 1 CON: Patient-Centered Care
meanings, which should be avoided when documenting.
6. The nurse is planning care and setting goals for a newly admitted patient. Who should the 2 These statements are interpretations of the data and use words that have vague
nurse include when conducting these nursing actions? meanings, which should be avoided when documenting.
1. Patient 3 These statements are interpretations of the data and use words that have vague
2. Nurse manager meanings, which should be avoided when documenting.
3. Hospital chaplain 4 Objective data are pieces of factual information obtained through physical
4. Patient’s health care provider (HCP) assessment and diagnostic tests that are observable or knowable through the five
senses. The nurse should document exactly what is seen.
ANS: 1
Chapter: Chapter 1 Critical Thinking and the Nursing Process
PTS: 1 CON: Communication
Objective: 4. Identify the role of a licensed practical nurse/licensed vocational nurse is using
the nursing process.
8. The nurse is caring for a patient using the nursing process. Which step should the nurse take
Page: 6
first?
Heading: Prioritize Care
1. Implementation
Integrated Process: Communication and Documentation
2. Planning
Client Need: SECE—Management of Care
3. Nursing diagnosis
Cognitive Level: Application [Applying]
4. Assessment
Concept: Communication
Difficulty: Moderate ANS: 4
y
y
Chapter: Chapter 1 Critical Thinking and the Nursing Process
Feedback Objective: 4. Identify the role of a licensed practical nurse/licensed vocational nurse in using
g
g
1 Planning care and setting goals is an action performed with the patient. The the nursing process.
patient must be in agreement with the plan for it to be successful in meeting the Page: 4
desired outcomes. Heading: Data Collection
g
g
2 The nurse manager may or may not be aware of the patient’s care needs. Integrated Process: Clinical Problem-Solving Process (Nursing Process)
3 The hospital chaplain may not be aware of the patient’s needs. Client Need: SECE: Coordinated Care
a
a
4 The focus of nursing care is different from that of the HCP. Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
PTS: 1 CON: Communication Difficulty: Moderate
M
M
7. While caring for a patient 4 hours after a surgical procedure, the LPN/LVN notes Feedback
1 The steps of the nursing process are data collection/assessment, nursing
serosanguineous drainage on the dressing. Which statement should the nurse use to
document this finding? diagnosis, planning, implementation, and evaluation.
1. ―Normal drainage noted.‖ 2 The steps of the nursing process are data collection/assessment, nursing
2. ―Moderate drainage recently noted.‖ diagnosis, planning, implementation, and evaluation.
3. ―Scant serosanguineous drainage seen on dressing.‖ 3 The steps of the nursing process are data collection/assessment, nursing
4. ―Pale pink drainage 2 cm by 1 cm noted on dressing.‖ diagnosis, planning, implementation, and evaluation.
4 Assessment, or data collection, is the first step in the nursing process and is used
ANS: 4 to evaluate a patient’s condition before providing care. The other steps, in order,
Chapter: Chapter 1 Critical Thinking and the Nursing Process are nursing diagnosis, planning, implementation, and evaluation.
Objective: 6. Document subjective and objective data.
Page: 5
PTS: 1 CON: Patient-Centered Care
Heading: Documentation of Data
Integrated Process: Communication and Documentation
9. The nurse is administering morphine to a patient reporting a pain level of 8 on a 0-to-10
Client Need: PHYS—Physiological Adaptation
scale. This describes which step of the nursing process?
Cognitive Level: Application [Applying]
1. Assessment
Concept: Communication
Difficulty: Moderate
Unit 1 Understanding Health Care Issues
Surgical Nursing th 1. Critical Thinking and the Nursing Process
2. Evidence-Based Practice
Edition Linda S. Williams Paula D. 3. Issues in Nursing Practice
4. Cultural Influences on Nursing Care
5. Complementary and Alternative Modalities
Hopper
Unit 2 Understanding Health and Illness
6. Nursing Care of Patients with Fluid, Electrolyte, and Acid-Base Imbalances
7. Nursing Care of Patients Receiving Intravenous Therapy
8. Nursing Care of Patients with Infections
9. Nursing Care of Patients in Shock
10. Nursing Care of Patients in Pain
11. Nursing Care of Patients With Cancer
y
y
12. Nursing Care of Patients Having Surgery
13. Nursing Care of Patients with Emergent Conditions and Disaster/Bioterrorism Response
g
g
Unit 3 Understanding Life Span Influences on Health and Illness
14. Developmental Considerations and Chronic Illness in the Nursing Care of Adults
15. Nursing Care of Older Adult Patients
g
g
16. Patient Care Settings
17. Nursing Care of Patients at the End of Life
a
a
Unit 4 Understanding the Immune System
18. Immune System Function, Assessment and Therapeutic Measures
M
M
19. Nursing Care of Patients With Immune Disorders
20. Nursing Care of Patients With HIV Disease and AIDS
Unit 5 Understanding the Cardiovascular System
21. Cardiovascular System Function, Assessment and Therapeutic Measures
22. Nursing Care of Patients With Hypertension
23. Nursing Care of Patients With Valvular, Inflammatory and Infectious Cardiac or Venous Disorders
24. Nursing Care of Patients With Occlusive Cardiovascular Disorders
25. Nursing Care of Patients With Cardiac Arrhythmias
26. Nursing Care of Patients With Heart Failure
Unit 6 Understanding the Hematologic and Lymphatic Systems
27. Hematologic and Lymphatic System Function, Assessment, and Therapeutic Measures
28. Nursing Care of Patients With Hematologic and Lymphatic Disorders
Unit 7 Understanding the Respiratory System
29. Respiratory System Function, Assessment, and Therapeutic Measures
30. Nursing Care of Patients With Upper Respiratory Tract Disorders
31. Nursing Care of Patients With Lower Respiratory Tract Disorders
, Chapter 1. Critical Thinking and the Nursing Process
Unit 8 Understanding the Gastrointestinal, Hepatic, and Pancreatic Systems
MULTIPLE CHOICE
32. Gastrointestinal, Hepatobiliary, and Pancreatic Systems Function, Assessment and Therapeutic Measures
33. Nursing Care of Patients With Upper Gastrointestinal Disorders
1. The nurse is caring for a group of patients on a medical-surgical unit. Which patient should
34. Nursing Care of Patients With Lower Gastrointestinal Disorders the licensed practical nurse/licensed vocational nurse (LPN/LVN) assess first?
35. Nursing Care of Patients With Liver, Pancreatic, and Gallbladder Disorders 1. A patient with a blood glucose of 42 mg/dL
2. A patient who reports a pain level of 2
Unit 9 Understanding the Urinary System 3. A patient who has just received a diagnosis of cancer
36. Urinary System Function, Assessment, and Therapeutic Measures 4. A patient who has a respiratory rate of 22
37. Nursing Care of Patients With Disorders of the Urinary System ANS: 1
Chapter: Chapter 1 Critical Thinking and the Nursing Process
Unit 10 Understanding the Endocrine System
Objective: 7. Prioritize patient care activities based on the Maslow hierarchy of human
38. Endocrine System Function and Assessment
needs.
39. Nursing Care of Patients With Endocrine Disorders
Pages: 6–7
40. Nursing Care of Patients With Disorders of the Endocrine Pancreas
Heading: Prioritize Care
Unit 11 Understanding the Genitourinary and Reproductive System Integrated Process: Clinical Problem-Solving Process (Nursing Process)
41. Genitourinary and Reproductive System Function and Assessment Client Need: SECE—Coordinated Care
y
y
42. Nursing Care of Women With Reproductive System Disorders Cognitive Level: Application [Applying]
43. Nursing Care of Male Patients With Genitourinary Disorders Concept: Patient-Centered Care
g
g
44. Nursing Care of Patients With Sexually Transmitted Infections Difficulty: Difficult
Unit 12 Understanding the Musculoskeletal System Feedback
g
g
45. Musculoskeletal Function and Assessment 1 This patient has a dangerously low blood glucose level and requires immediate
46. Nursing Care of Patients With Musculoskeletal and Connective Tissue Disorders intervention.
a
a
2 This patient will need to be assessed, but is not as high a priority.
Unit 13 Understanding the Neurologic System 3 According to Maslow, psychosocial needs are not as high of a priority as
47. Neurologic System Function, Assessment, and Therapeutic Measures physiological needs.
M
M
48. Nursing Care of Patients With Central Nervous System Disorders 4 A respiratory rate of 22 is within normal range.
49. Nursing Care of Patients With Cerebrovascular Disorders
50. Nursing Care of Patients With Peripheral Nervous System Disorders
PTS: 1 CON: Patient-Centered Care
Unit 14 Understanding the Sensory System
2. The LPN/LVN enters the room of a patient who is angry and yells, ―I asked 5 minutes ago
51. Sensory System Function, Assessment, and Therapeutic Measures: Vision and Hearing
52. Nursing Care of Patients With Sensory Disorders: Vision and Hearing
for my pain medication. I’m going to call the CEO of the hospital if you don’t get it for me
now.‖ Which statement by the nurse demonstrates intellectual empathy?
Unit 15 Understanding the Integumentary System 1. ―We are short-staffed today, so it will take me longer to meet your needs.‖
53. Integumentary System Function, Assessment and Therapeutic Measures 2. ―I am sorry you had to wait, I know you must be in a lot of pain.‖
54. Nursing Care of Patients With Skin Disorders 3. ―I had another patient who had severe pain, and I had to get to them first.‖
55. Nursing Care of Patients With Burns 4. ―I will get you the number for the CEO, but he is aware of how busy we are.‖
ANS: 2
Unit 16 Understanding Mental Health Care
Chapter: Chapter 1 Critical Thinking and the Nursing Process
56. Mental Health Function, Assessment, and Therapeutic Measures
Objective: 2. Describe attitudes and skills that promote good critical thinking
57. Nursing Care of Patients With Mental Health Disorders
Page: 2
Heading: Intellectual Empathy
Integrated Process: Communication and Documentation
Client Need: Psychosocial Integrity
Cognitive Level: Application [Applying]
, Concept: Communication
Difficulty: Moderate Objective: 4. Identify the role of a licensed practical nurse/licensed vocational nurse in using
the nursing process.
Feedback Page: 3
1 This statement does not consider an individual’s situation. Heading: Clinical Judgement
2 This statement demonstrates intellectual empathy by considering this patient’s Integrated Process: Clinical Problem-solving Process (Nursing Process)
situation and will likely alleviate the patient’s anger. Client Need: SECE—Coordinated Care
3 This statement does not consider a patient’s situation and does not demonstrate Cognitive Level: Application [Applying]
intellectual empathy. Concept: Patient-Centered Care
4 This statement addresses the patient’s statement of wanting to call the CEO, but Difficulty: Moderate
does not demonstrate intellectual empathy by considering the patient’s situation.
Feedback
PTS: 1 CON: Communication 1 The patient who has a fractured femur is having acute pain. Repositioning a
patient with a new fracture is not likely to relieve pain.
3. The nurse is collecting data on a patient. Which data are described as subjective? 2 Giving the medication before the prescribed time is beyond the nurse’s scope of
1. Respiratory rate of 26 per minute practice.
2. Patient report of shortness of breath 3 The patient should not have to wait for pain relief, so the LPN should inform the
3. Coarse lung sounds bilaterally RN or physician so new pain relief orders can be obtained.
4. Cough producing green sputum 4 The nurse needs to do more than expect the patient to wait for pain relief.
ANS: 2
y
y
Chapter: Chapter 1 Critical Thinking and the Nursing Process PTS: 1 CON: Patient-Centered Care
Objective: 5. Differentiate between objective and subjective data.
5. The nurse is prioritizing care based on Maslow hierarchy of needs. Which need does the
g
g
Page: 4
Heading: Subjective Data nurse identify as having the highest priority?
Integrated Process: Communication and Documentation 1. Job-related stress
g
g
Client Need: Communication and Documentation 2. Feeling of loneliness
Cognitive Level: Application (Applying) 3. Pain level of 9 on 0-to-10 scale
4. Lack of confidence
a
a
Concept: Communication
Difficulty: Moderate ANS: 3
Chapter: Chapter 1 Critical Thinking and the Nursing Process
M
M
Feedback Objective: 7. Prioritize patient care activities based on the Maslow hierarchy of human
1 Respiratory rate of 26 per minute is an example of objective data. needs
2 A patient reporting symptoms to the nurse is an example of subjective data. Page: 7
3 Coarse lung sounds is an example of objective data. Heading: Prioritize Care
4 A productive cough is an example of objective data. Integrated Process: Caring
Client Need: SECE – Coordinated Care
PTS: 1 CON: Communication Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
4. A patient with a newly fractured femur reports a pain level of 8/10 and analgesic medication Difficulty: Moderate
is not due for another 50 minutes. Which action should the nurse take first?
1. Reposition the patient. Feedback
2. Give the medication in 30 minutes. 1 Job-related stress falls under safety according to Maslow and is addressed after
3. Notify the registered nurse (RN) or physician. physiological needs.
4. Tell the patient it is too early for pain medication. 2 According to Maslow, loneliness is addressed under social needs following
physiological and safety.
ANS: 3 3 Pain is a physiological need and is the highest priority.
Chapter: Chapter 1 Critical Thinking and the Nursing Process 4 Lack of confidence falls under esteem according to Maslow and is addressed
following physiological, safety, and social needs.
, Feedback
1 These statements are interpretations of the data and use words that have vague
PTS: 1 CON: Patient-Centered Care
meanings, which should be avoided when documenting.
6. The nurse is planning care and setting goals for a newly admitted patient. Who should the 2 These statements are interpretations of the data and use words that have vague
nurse include when conducting these nursing actions? meanings, which should be avoided when documenting.
1. Patient 3 These statements are interpretations of the data and use words that have vague
2. Nurse manager meanings, which should be avoided when documenting.
3. Hospital chaplain 4 Objective data are pieces of factual information obtained through physical
4. Patient’s health care provider (HCP) assessment and diagnostic tests that are observable or knowable through the five
senses. The nurse should document exactly what is seen.
ANS: 1
Chapter: Chapter 1 Critical Thinking and the Nursing Process
PTS: 1 CON: Communication
Objective: 4. Identify the role of a licensed practical nurse/licensed vocational nurse is using
the nursing process.
8. The nurse is caring for a patient using the nursing process. Which step should the nurse take
Page: 6
first?
Heading: Prioritize Care
1. Implementation
Integrated Process: Communication and Documentation
2. Planning
Client Need: SECE—Management of Care
3. Nursing diagnosis
Cognitive Level: Application [Applying]
4. Assessment
Concept: Communication
Difficulty: Moderate ANS: 4
y
y
Chapter: Chapter 1 Critical Thinking and the Nursing Process
Feedback Objective: 4. Identify the role of a licensed practical nurse/licensed vocational nurse in using
g
g
1 Planning care and setting goals is an action performed with the patient. The the nursing process.
patient must be in agreement with the plan for it to be successful in meeting the Page: 4
desired outcomes. Heading: Data Collection
g
g
2 The nurse manager may or may not be aware of the patient’s care needs. Integrated Process: Clinical Problem-Solving Process (Nursing Process)
3 The hospital chaplain may not be aware of the patient’s needs. Client Need: SECE: Coordinated Care
a
a
4 The focus of nursing care is different from that of the HCP. Cognitive Level: Application [Applying]
Concept: Patient-Centered Care
PTS: 1 CON: Communication Difficulty: Moderate
M
M
7. While caring for a patient 4 hours after a surgical procedure, the LPN/LVN notes Feedback
1 The steps of the nursing process are data collection/assessment, nursing
serosanguineous drainage on the dressing. Which statement should the nurse use to
document this finding? diagnosis, planning, implementation, and evaluation.
1. ―Normal drainage noted.‖ 2 The steps of the nursing process are data collection/assessment, nursing
2. ―Moderate drainage recently noted.‖ diagnosis, planning, implementation, and evaluation.
3. ―Scant serosanguineous drainage seen on dressing.‖ 3 The steps of the nursing process are data collection/assessment, nursing
4. ―Pale pink drainage 2 cm by 1 cm noted on dressing.‖ diagnosis, planning, implementation, and evaluation.
4 Assessment, or data collection, is the first step in the nursing process and is used
ANS: 4 to evaluate a patient’s condition before providing care. The other steps, in order,
Chapter: Chapter 1 Critical Thinking and the Nursing Process are nursing diagnosis, planning, implementation, and evaluation.
Objective: 6. Document subjective and objective data.
Page: 5
PTS: 1 CON: Patient-Centered Care
Heading: Documentation of Data
Integrated Process: Communication and Documentation
9. The nurse is administering morphine to a patient reporting a pain level of 8 on a 0-to-10
Client Need: PHYS—Physiological Adaptation
scale. This describes which step of the nursing process?
Cognitive Level: Application [Applying]
1. Assessment
Concept: Communication
Difficulty: Moderate
