,NU 171/NU171 Final Exam | Maternal Child Nursing (2026) Q&A |
Galen College
1. Which statement best describes the primary purpose of the assessment phase in
the nursing process?
A) To establish a definitive medical diagnosis
B) To collect subjective and objective data about the client
C) To implement nursing interventions based on provider orders
D) To evaluate the effectiveness of the planned care
Correct Answer: To collect subjective and objective data about the client
Rationale: The assessment phase is the first step of the nursing process and
involves gathering comprehensive data through interviews, physical examination,
and review of records. This data forms the foundation for identifying nursing
diagnoses and planning care. Es tablishing a medical diagnosis is the provider's
responsibility, while implementation and evaluation occur in later phases.
2. What is the primary purpose of the diagnosis phase in the nursing process?
A) To identify the client's medical condition
B) To analyze assessment data and identify actual or potential health problems
C) To prescribe medications and treatments
D) To document the client's response to interventions
Correct Answer: To analyze assessment data and identify actual or potential health
problems
Rationale: During the diagnosis phase, the nurse analyzes collected data to identify
actual or potential health problems that are within the scope of nursing practice.
This leads to the formulation of nursing diagnoses, which guide the planning of care.
Medical diag nosis is determined by the provider, and prescribing treatments is not
within the nursing scope.
,3. Which action by the nurse best demonstrates the planning phase of the nursing
process?
A) Administering a prescribed analgesic to a client in pain
B) Prioritizing nursing diagnoses and establishing client - centered goals
C) Obtaining a client's vital signs and health history
D) Reassessing a client's pain level after medication administration
Correct Answer: Prioritizing nursing diagnoses and establishing client - centered
goals
Rationale: The planning phase involves prioritizing nursing diagnoses, setting
measurable client - centered goals, and selecting appropriate interventions.
Administering medications is part of the implementation phase. Obtaining vital signs
and health history is asses sment. Reassessing pain is evaluation.
4. A nurse is implementing a care plan for a client with impaired mobility. Which
action is most appropriate during this phase?
A) Reviewing the client's admission data
B) Formulating a nursing diagnosis of impaired physical mobility
C) Assisting the client to turn and reposition every two hours
D) Evaluating whether the client met the goal of ambulating
Correct Answer: Assisting the client to turn and reposition every two hours
Rationale: Implementation involves carrying out the planned nursing interventions.
Turning and repositioning is a direct nursing action to address impaired mobility.
Reviewing admission data is assessment. Formulating a nursing diagnosis is part of
the diagnosis pha se. Evaluating goal achievement is the evaluation phase.
5. During which phase of the nursing process does the nurse determine whether
client goals have been met?
A) Assessment
B) Diagnosis
, C) Planning
D) Evaluation
Correct Answer: Evaluation
Rationale: Evaluation is the final phase of the nursing process, where the nurse
determines the effectiveness of interventions and whether client goals have been
achieved. If goals are not met, the nurse modifies the plan of care. The other phases
involve data colle ction, analysis, and planning interventions.
6. Which finding is the most reliable indicator that a client is in true labor?
A) Irregular contractions that subside with walking
B) Progressive cervical dilation and effacement
C) Bloody show without regular contractions
D) Rupture of membranes before contractions begin
Correct Answer: Progressive cervical dilation and effacement
Rationale: True labor is confirmed by progressive cervical change, which does not
occur in false labor. Irregular contractions, bloody show, and rupture of membranes
can occur in various situations and are not definitive indicators of true labor.
Cervical dilation a nd effacement are objective, measurable signs that labor is
progressing.
7. A client at 38 weeks' gestation reports irregular contractions that stop when she
walks. The nurse identifies these as which type of contractions?
A) True labor contractions
B) Braxton Hicks contractions
C) Active labor contractions
D) Transition phase contractions
Correct Answer: Braxton Hicks contractions
Galen College
1. Which statement best describes the primary purpose of the assessment phase in
the nursing process?
A) To establish a definitive medical diagnosis
B) To collect subjective and objective data about the client
C) To implement nursing interventions based on provider orders
D) To evaluate the effectiveness of the planned care
Correct Answer: To collect subjective and objective data about the client
Rationale: The assessment phase is the first step of the nursing process and
involves gathering comprehensive data through interviews, physical examination,
and review of records. This data forms the foundation for identifying nursing
diagnoses and planning care. Es tablishing a medical diagnosis is the provider's
responsibility, while implementation and evaluation occur in later phases.
2. What is the primary purpose of the diagnosis phase in the nursing process?
A) To identify the client's medical condition
B) To analyze assessment data and identify actual or potential health problems
C) To prescribe medications and treatments
D) To document the client's response to interventions
Correct Answer: To analyze assessment data and identify actual or potential health
problems
Rationale: During the diagnosis phase, the nurse analyzes collected data to identify
actual or potential health problems that are within the scope of nursing practice.
This leads to the formulation of nursing diagnoses, which guide the planning of care.
Medical diag nosis is determined by the provider, and prescribing treatments is not
within the nursing scope.
,3. Which action by the nurse best demonstrates the planning phase of the nursing
process?
A) Administering a prescribed analgesic to a client in pain
B) Prioritizing nursing diagnoses and establishing client - centered goals
C) Obtaining a client's vital signs and health history
D) Reassessing a client's pain level after medication administration
Correct Answer: Prioritizing nursing diagnoses and establishing client - centered
goals
Rationale: The planning phase involves prioritizing nursing diagnoses, setting
measurable client - centered goals, and selecting appropriate interventions.
Administering medications is part of the implementation phase. Obtaining vital signs
and health history is asses sment. Reassessing pain is evaluation.
4. A nurse is implementing a care plan for a client with impaired mobility. Which
action is most appropriate during this phase?
A) Reviewing the client's admission data
B) Formulating a nursing diagnosis of impaired physical mobility
C) Assisting the client to turn and reposition every two hours
D) Evaluating whether the client met the goal of ambulating
Correct Answer: Assisting the client to turn and reposition every two hours
Rationale: Implementation involves carrying out the planned nursing interventions.
Turning and repositioning is a direct nursing action to address impaired mobility.
Reviewing admission data is assessment. Formulating a nursing diagnosis is part of
the diagnosis pha se. Evaluating goal achievement is the evaluation phase.
5. During which phase of the nursing process does the nurse determine whether
client goals have been met?
A) Assessment
B) Diagnosis
, C) Planning
D) Evaluation
Correct Answer: Evaluation
Rationale: Evaluation is the final phase of the nursing process, where the nurse
determines the effectiveness of interventions and whether client goals have been
achieved. If goals are not met, the nurse modifies the plan of care. The other phases
involve data colle ction, analysis, and planning interventions.
6. Which finding is the most reliable indicator that a client is in true labor?
A) Irregular contractions that subside with walking
B) Progressive cervical dilation and effacement
C) Bloody show without regular contractions
D) Rupture of membranes before contractions begin
Correct Answer: Progressive cervical dilation and effacement
Rationale: True labor is confirmed by progressive cervical change, which does not
occur in false labor. Irregular contractions, bloody show, and rupture of membranes
can occur in various situations and are not definitive indicators of true labor.
Cervical dilation a nd effacement are objective, measurable signs that labor is
progressing.
7. A client at 38 weeks' gestation reports irregular contractions that stop when she
walks. The nurse identifies these as which type of contractions?
A) True labor contractions
B) Braxton Hicks contractions
C) Active labor contractions
D) Transition phase contractions
Correct Answer: Braxton Hicks contractions
