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