NUR 356. Final Exam
Subjective data - answer Patients verbal description of their health problems
Objective data - answer Observations or measurements of a patient's health status
A patient is admitted to the hospital with shortness of breath. As the nurse assesses this
patient, the nurse is using the process of: - answer data collection
When a nurse conducts an assessment, data about a patient often comes from which of
the following sources? (Select all that apply.)
A) An observation of how a patient turns and moves in bed
B) The unit policy and procedure manual
C) The care recommendations of a physical therapist
D) The results of a diagnostic x-ray film
E) Your experiences in caring for other patients with similar problems - answerA) An
observation of how a patient turns and moves in bed
C) The care recommendations of a physical therapist
D) The results of a diagnostic x-ray film
a ____________ is a set of cues, the signs or symptoms gathered during assessment. -
answerdata cluster
How do you formulate a good nursing diagnosis? - answer--Identify the correct
diagnostic label with associated defining characteristics or risk factors and a related
factor.
--A related factor allows you to individualize a nursing diagnosis for a specific patient.
what is included in a two-part format of a nursing diagnosis? - answer--health promotion
--problem-focused nursing diagnoses
what is included in a three-part format of a nursing diagnosis? - answerProblem:
diagnostic label or stem
Etiology: related to
Symptoms: as evidence by
After assessing a patient, a nurse develops a standard formal nursing diagnosis. What
is the rationale for the nurse's actions?
, A) To form a language that can be encoded only by nurses
B) To distinguish the nurse's role from the physician's role
C) To develop clinical judgment based on other's intuition
D) To help nurses focus on the scope of medical practice - answerB) To distinguish the
nurse's role from the physician's role
A nurse performs an assessment on a patient. Which assessment data will the nurse
use as an etiology for Acute pain?
A) Discomfort while changing position
B) Reports pain as a 7 on a 0 to 10 scale
C) Disruption of tissue integrity
D) Dull headache - answerC) Disruption of tissue integrity
A nurse is planning care for a patient with a nursing diagnosis of Impaired skin integrity.
The patient needs many nursing interventions, including a dressing change, several
intravenous antibiotics, and a walk. Which factors does the nurse consider when
prioritizing interventions? (Select all that apply.)
A) Rank all the patient's nursing diagnoses in order of priority.
B) Do not change priorities once they've been established.
C) Set priorities based solely on physiological factors.
D) Consider time as an influencing factor.
Utilize critical thinking.
E) Utilize critical thinking. - answerA) Rank all the patient's nursing diagnoses in order of
priority.
D) Consider time as an influencing factor.
Utilize critical thinking.
E) Utilize critical thinking.
Nurse-initiated interventions - answerIndependent—Actions that a nurse initiates
Subjective data - answer Patients verbal description of their health problems
Objective data - answer Observations or measurements of a patient's health status
A patient is admitted to the hospital with shortness of breath. As the nurse assesses this
patient, the nurse is using the process of: - answer data collection
When a nurse conducts an assessment, data about a patient often comes from which of
the following sources? (Select all that apply.)
A) An observation of how a patient turns and moves in bed
B) The unit policy and procedure manual
C) The care recommendations of a physical therapist
D) The results of a diagnostic x-ray film
E) Your experiences in caring for other patients with similar problems - answerA) An
observation of how a patient turns and moves in bed
C) The care recommendations of a physical therapist
D) The results of a diagnostic x-ray film
a ____________ is a set of cues, the signs or symptoms gathered during assessment. -
answerdata cluster
How do you formulate a good nursing diagnosis? - answer--Identify the correct
diagnostic label with associated defining characteristics or risk factors and a related
factor.
--A related factor allows you to individualize a nursing diagnosis for a specific patient.
what is included in a two-part format of a nursing diagnosis? - answer--health promotion
--problem-focused nursing diagnoses
what is included in a three-part format of a nursing diagnosis? - answerProblem:
diagnostic label or stem
Etiology: related to
Symptoms: as evidence by
After assessing a patient, a nurse develops a standard formal nursing diagnosis. What
is the rationale for the nurse's actions?
, A) To form a language that can be encoded only by nurses
B) To distinguish the nurse's role from the physician's role
C) To develop clinical judgment based on other's intuition
D) To help nurses focus on the scope of medical practice - answerB) To distinguish the
nurse's role from the physician's role
A nurse performs an assessment on a patient. Which assessment data will the nurse
use as an etiology for Acute pain?
A) Discomfort while changing position
B) Reports pain as a 7 on a 0 to 10 scale
C) Disruption of tissue integrity
D) Dull headache - answerC) Disruption of tissue integrity
A nurse is planning care for a patient with a nursing diagnosis of Impaired skin integrity.
The patient needs many nursing interventions, including a dressing change, several
intravenous antibiotics, and a walk. Which factors does the nurse consider when
prioritizing interventions? (Select all that apply.)
A) Rank all the patient's nursing diagnoses in order of priority.
B) Do not change priorities once they've been established.
C) Set priorities based solely on physiological factors.
D) Consider time as an influencing factor.
Utilize critical thinking.
E) Utilize critical thinking. - answerA) Rank all the patient's nursing diagnoses in order of
priority.
D) Consider time as an influencing factor.
Utilize critical thinking.
E) Utilize critical thinking.
Nurse-initiated interventions - answerIndependent—Actions that a nurse initiates
