CHAPTER 2 — NURSING CONCEPTS, THE NURSING PROCESS, AND
TRENDS IN NURSING
1. The best description of the nursing process is:
A. A linear decision-making method
B. A systematic, cyclic problem-solving approach
C. A physician-directed protocol
D. A rigid step-by-step checklist
Answer: B
Rationale: The nursing process is dynamic and cyclical—assessment, diagnosis, planning,
implementation, evaluation—ensuring individualized, evidence-based care.
2. The nurse collects data through observation, interview, and physical exam. This defines which
step?
A. Assessment
B. Planning
C. Evaluation
D. Implementation
Answer: A
Rationale: Assessment gathers subjective and objective data to form a database for client care.
3. Which statement reflects an appropriate nursing diagnosis?
A. Hypertension
B. Risk for impaired skin integrity related to immobility
C. Administer antihypertensive medication as prescribed
D. Take vital signs every 4 hours
Answer: B
Rationale: A nursing diagnosis identifies a client’s response to a problem and is within nursing
scope.
,4. Prioritization of nursing diagnoses follows which principle?
A. Least invasive first
B. ABCs – Airway, Breathing, Circulation
C. Client preference only
D. Physician order sequence
Answer: B
Rationale: Airway, breathing, circulation always guide priority decisions.
5. An expected outcome must be:
A. Broad and general
B. Observable, measurable, and time-limited
C. Defined only by the physician
D. Optional
Answer: B
Rationale: Goals/outcomes should be SMART – specific, measurable, attainable, realistic, and
timed.
6. Which is an example of an independent nursing intervention?
A. Administering IV antibiotics
B. Teaching a client about deep-breathing exercises
C. Giving a narcotic medication
D. Performing a surgical dressing change under sterile technique ordered by MD
Answer: B
Rationale: Education within nursing scope requires no provider order.
7. Documentation of care is important because it:
A. Is optional if time allows
B. Serves as legal evidence and communication among caregivers
C. Only benefits students
D. Replaces verbal reports
Answer: B
Rationale: Accurate charting provides continuity, accountability, and legal protection.
8. Which phase of the nursing process determines whether interventions were effective?
A. Assessment
B. Evaluation
C. Planning
D. Implementation
,Answer: B
Rationale: Evaluation compares actual outcomes with expected results.
9. The primary purpose of nursing standards is to:
A. Punish nurses
B. Define minimal competent performance
C. Increase paperwork
D. Replace facility policies
Answer: B
Rationale: Standards safeguard the public by defining professional expectations.
10. The nurse–client relationship is founded on:
A. Friendship
B. Professional boundaries and trust
C. Social conversation
D. Financial interest
Answer: B
Rationale: Therapeutic relationships maintain professional boundaries focused on client well-
being.
11. When delegating to unlicensed assistive personnel (UAP), the nurse must:
A. Transfer accountability
B. Retain overall responsibility for outcomes
C. Let the UAP decide priorities
D. Supervise only if time permits
Answer: B
Rationale: Delegation transfers tasks but not accountability for safe results.
12. The nurse identifies the ethical principle violated when patient confidentiality is breached:
A. Fidelity
B. Autonomy
C. Beneficence
D. Veracity
Answer: A
Rationale: Fidelity involves keeping promises, including maintaining confidentiality.
, 13. Evidence-based practice integrates:
A. Tradition only
B. Research evidence, clinical expertise, and client preferences
C. Intuition and opinion
D. Hospital policy alone
Answer: B
Rationale: EBP uses best current evidence with clinical judgment and patient values.
14. The nurse notes that care is not meeting goals and revises the plan. This illustrates:
A. Implementation
B. Evaluation leading to modification
C. Assessment only
D. Documentation error
Answer: B
Rationale: Evaluation findings guide necessary plan revisions.
15. Critical thinking in nursing includes:
A. Rote memorization
B. Analyzing data and drawing logical conclusions
C. Accepting others’ opinions blindly
D. Avoiding reflection
Answer: B
Rationale: Critical thinking applies reasoning to complex patient situations.
16. Which example reflects the assessment phase?
A. Recording a pain score of 8/10
B. Administering analgesic medication
C. Teaching about pain control
D. Reassessing pain after medication
Answer: A
Rationale: Collecting subjective/objective pain data is assessment.
17. Which example demonstrates an outcome statement?
A. Encourage patient to walk
B. Patient will ambulate 50 feet using a walker by end of shift
C. Nurse will record ambulation
D. Patient reports pain
TRENDS IN NURSING
1. The best description of the nursing process is:
A. A linear decision-making method
B. A systematic, cyclic problem-solving approach
C. A physician-directed protocol
D. A rigid step-by-step checklist
Answer: B
Rationale: The nursing process is dynamic and cyclical—assessment, diagnosis, planning,
implementation, evaluation—ensuring individualized, evidence-based care.
2. The nurse collects data through observation, interview, and physical exam. This defines which
step?
A. Assessment
B. Planning
C. Evaluation
D. Implementation
Answer: A
Rationale: Assessment gathers subjective and objective data to form a database for client care.
3. Which statement reflects an appropriate nursing diagnosis?
A. Hypertension
B. Risk for impaired skin integrity related to immobility
C. Administer antihypertensive medication as prescribed
D. Take vital signs every 4 hours
Answer: B
Rationale: A nursing diagnosis identifies a client’s response to a problem and is within nursing
scope.
,4. Prioritization of nursing diagnoses follows which principle?
A. Least invasive first
B. ABCs – Airway, Breathing, Circulation
C. Client preference only
D. Physician order sequence
Answer: B
Rationale: Airway, breathing, circulation always guide priority decisions.
5. An expected outcome must be:
A. Broad and general
B. Observable, measurable, and time-limited
C. Defined only by the physician
D. Optional
Answer: B
Rationale: Goals/outcomes should be SMART – specific, measurable, attainable, realistic, and
timed.
6. Which is an example of an independent nursing intervention?
A. Administering IV antibiotics
B. Teaching a client about deep-breathing exercises
C. Giving a narcotic medication
D. Performing a surgical dressing change under sterile technique ordered by MD
Answer: B
Rationale: Education within nursing scope requires no provider order.
7. Documentation of care is important because it:
A. Is optional if time allows
B. Serves as legal evidence and communication among caregivers
C. Only benefits students
D. Replaces verbal reports
Answer: B
Rationale: Accurate charting provides continuity, accountability, and legal protection.
8. Which phase of the nursing process determines whether interventions were effective?
A. Assessment
B. Evaluation
C. Planning
D. Implementation
,Answer: B
Rationale: Evaluation compares actual outcomes with expected results.
9. The primary purpose of nursing standards is to:
A. Punish nurses
B. Define minimal competent performance
C. Increase paperwork
D. Replace facility policies
Answer: B
Rationale: Standards safeguard the public by defining professional expectations.
10. The nurse–client relationship is founded on:
A. Friendship
B. Professional boundaries and trust
C. Social conversation
D. Financial interest
Answer: B
Rationale: Therapeutic relationships maintain professional boundaries focused on client well-
being.
11. When delegating to unlicensed assistive personnel (UAP), the nurse must:
A. Transfer accountability
B. Retain overall responsibility for outcomes
C. Let the UAP decide priorities
D. Supervise only if time permits
Answer: B
Rationale: Delegation transfers tasks but not accountability for safe results.
12. The nurse identifies the ethical principle violated when patient confidentiality is breached:
A. Fidelity
B. Autonomy
C. Beneficence
D. Veracity
Answer: A
Rationale: Fidelity involves keeping promises, including maintaining confidentiality.
, 13. Evidence-based practice integrates:
A. Tradition only
B. Research evidence, clinical expertise, and client preferences
C. Intuition and opinion
D. Hospital policy alone
Answer: B
Rationale: EBP uses best current evidence with clinical judgment and patient values.
14. The nurse notes that care is not meeting goals and revises the plan. This illustrates:
A. Implementation
B. Evaluation leading to modification
C. Assessment only
D. Documentation error
Answer: B
Rationale: Evaluation findings guide necessary plan revisions.
15. Critical thinking in nursing includes:
A. Rote memorization
B. Analyzing data and drawing logical conclusions
C. Accepting others’ opinions blindly
D. Avoiding reflection
Answer: B
Rationale: Critical thinking applies reasoning to complex patient situations.
16. Which example reflects the assessment phase?
A. Recording a pain score of 8/10
B. Administering analgesic medication
C. Teaching about pain control
D. Reassessing pain after medication
Answer: A
Rationale: Collecting subjective/objective pain data is assessment.
17. Which example demonstrates an outcome statement?
A. Encourage patient to walk
B. Patient will ambulate 50 feet using a walker by end of shift
C. Nurse will record ambulation
D. Patient reports pain
