QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
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A patient with a diagnosis of Impaired Skin Integrity shows signs of
wound healing, including decreased drainage and granulation tissue
formation. What should the nurse do regarding the care plan?
A. Remove the nursing diagnosis immediately
B. Continue current interventions and monitor progress
C. Increase the frequency of dressing changes
D. Request a surgical consult
C. Reassess the patient and revise the care plan with stronger
fallprevention strategies
A patient admitted with Risk for Falls experiences an actual fall in the
hallway. What is the best nursing action?
A. Remove the fall risk diagnosis and document the fall
B. Leave the plan unchanged since a fall was expected
C. Reassess the patient and revise the care plan with stronger fall-
prevention strategies
D. Wait for the provider to give new orders
C. Reevaluate and consider updating or discontinuing the nursing
diagnosis
A patient with Ineffective Airway Clearance is now able to cough and
clear secretions effectively. What should the nurse do next?
A. Remove all respiratory interventions
,B. Immediately discharge the patient
C. Reevaluate and consider updating or discontinuing the nursing
diagnosis
D. Increase the frequency of pulmonary assessments
B. Update the nursing diagnosis to include Risk for Infection and
implement new interventions
Which of the following is the best example of a complete and
correctly written patient- centered outcome/goal?
A. The patient will understand diabetes management.
B. The patient will eat better to control blood glucose.
C. The patient will verbalize three signs of hypoglycemia by the end
of the teaching session today.
D. The nurse will provide patient education about insulin
administration.
D. All of the above
A nurse writes the following goal for a patient with impaired physical
mobility: "The patient will improve mobility." Which part of the
SMART criteria is missing?
A. Specific
B. Time-bound
C. Measurable
D. All of the above
,B. The patient will verbalize three lifestyle changes to reduce
blood pressure by discharge.
A patient is newly diagnosed with hypertension. Which of the
following outcome statements is best written?
A. The patient will understand how to manage hypertension.
B. The patient will verbalize three lifestyle changes to reduce blood
pressure by discharge.
C. The patient will start eating a low-sodium diet eventually.
D. The nurse will instruct the patient on hypertension medications.
C. The patient will be repositioned every 2 hours.
Which of the following is an incomplete goal statement?
A. The patient will walk 100 feet with assistance twice a day by
postoperative day 3.
B. The patient will verbalize pain level <4 on a 0-10 scale within 30
minutes of receiving analgesia.
C. The patient will be repositioned every 2 hours.
D. The patient will state the purpose of all prescribed medications by
the end of the shift.
C. The patient will report anxiety as less than 3 on a 0-10 scale
within 24 hours.
Which revision of the following outcome statement makes it
SMARTcompliant? Original Statement: "The patient will feel
less anxious." A. The patient will have no signs of anxiety.
B. The patient will verbalize reduced anxiety before bedtime.
, C. The patient will report anxiety as less than 3 on a 0-10 scale within
24 hours.
D. The nurse will provide support to decrease patient anxiety.
B. Specific, Measurable, Achievable, Relevant, Time-bound
Which of the following best defines the components of a SMART
goal?
A. Specific, Medically-based, Accurate, Realistic, Timely
B. Specific, Measurable, Achievable, Relevant, Time-bound
C. Safe, Measurable, Appropriate, Responsive, Thorough
D. Simple, Motivating, Achievable, Responsible, Time-sensitive
C. The patient will call for assistance before getting out of bed
within the next 24 hours.
A patient who was stable post-operatively is now febrile and
complaining of incisional pain. What action should the nurse take in
regard to the plan of care?
A. Assume this is normal and reassess in 6 hours
B. Update the nursing diagnosis to include Risk for Infection and
implement new interventions
C. Administer prescribed analgesics only
D. Document and wait for routine rounding
C. The patient will verbalize three signs of hypoglycemia by the
end of the teaching session today.
Which of the following goal statements for a patient with risk for falls
is written as a SMART goal?