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