NSG3100NursingProcessCh.5-9Revised1/11/2024
NSG3100
NursingProcessNCLEXQuestions
KEY
MULTIPLECHOICE
1. ANS: A
The nursing process is the foundation of professional nursing practice. It is the framework within
which nurses provide care to patients in an organized and effective manner. Paul describes critical
thinking as a complex process during which individuals think about their thinking to provide clarity
and increase precision and relevance in a specific situation while attempting to be fair and consisten
Critical thinking using the nursing process allows nurses to collect essential patient data, articulate
the specific needs of individual patients, and effectively communicate those needs, realistic goals,
and customized interventions with members of the health care team. Thinkinglikeanurse is
facilitated by nurses using the nursing process in the development of individualized patient plans of
care.
DIF: Remembering REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
2. ANS: A
During the assessment step, patient care data are gathered through observation, interviews, and
physical assessment. In the diagnosis step, patient data are analyzed, validated, and clustered to
identify patient problems. Each problem is then stated in standardized language as a specific Nursing
diagnosis to provide greater clarity and universal understanding by all care providers. The
implementation step includes initiating specific nursing interventions and treatments designed to
help the patient achieve established goals or outcomes. In the evaluation step, the nurse determines
whether the patient’s goals are met, examines the effectiveness of interventions, and decides whether
the plan of care should be discontinued, continued, or revised.
DIF: Understanding REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
3. ANS: C
Objective data consist of observable information that the nurse gathers on the basis of what can be
seen, measured, or tested. Subjective data are spoken. Primary data consist of information obtained
directly from a patient. Secondary data are collected from family members, friends, other health care
professionals, or written sources such as medical records and test results.
DIF: Understanding REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
4. ANS: A
During the assessment step, patient care data are gathered through observation, interviews, and
physical assessment. During the planning step of the nursing process, the nurse prioritizes the
Nursing diagnoses and identifies short- and long-term goals that are realistic, measurable, and
patient focused, with specific outcome identification for evaluation purposes. The implementation
step includes initiating specific nursing interventions and treatments designed to help the patient
achieve established goals or outcomes. In the evaluation step, the nurse determines whether the
patient’s goals are met, examines the effectiveness of interventions, and decides whether the plan of
care should be discontinued, continued, or revised.
, NSG3100NursingProcessCh.5-9Revised1/11/2024
DIF: Understanding REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
5. ANS: C
The implementation step includes initiating specific nursing interventions and treatments designed to
help the patient achieve established goals or outcomes. During the assessment step, patient care data
are gathered through observation, interviews, and physical assessment. During the planning step of
the nursing process, the nurse prioritizes the nursing diagnoses and identifies short- and long-term
goals that are realistic, measurable, and patient focused, with specific outcome identification for
evaluation purposes. In the evaluation step, the nurse determines whether the patient’s goals are met
examines the effectiveness of interventions, and decides whether the plan of care should be
discontinued, continued, or revised.
DIF: Understanding REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
6. ANS: A
During the assessment step, patient care data are gathered through observation, interviews, and
physical assessment. During the planning step of the nursing process, the nurse prioritizes the
nursing diagnoses and identifies short- and long-term goals that are realistic, measurable, and patient
focused, with specific outcome identification for evaluation purposes. The implementation step
includes initiating specific nursing interventions and treatments designed to help the patient achieve
established goals or outcomes. In the evaluation step, the nurse determines whether the patient’s
goals are met, examines the effectiveness of interventions, and decides whether the plan of care
should be discontinued, continued, or revised.
DIF: Understanding REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
7. ANS: B
During the planning step of the nursing process, the nurse prioritizes the nursing diagnoses and
identifies short- and long-term goals that are realistic, measurable, and patient focused, with specific
outcome identification for evaluation purposes. During the assessment step, patient care data are
gathered through observation, interviews, and physical assessment. The implementation step
includes initiating specific nursing interventions and treatments designed to help the patient achieve
established goals or outcomes. In the evaluation step, the nurse determines whether the patient’s
goals are met, examines the effectiveness of interventions, and decides whether the plan of care
should be discontinued, continued, or revised.
DIF: Understanding REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
8. ANS: B
All short- and long-term goals must be: (1) patient focused, (2) realistic, and (3) measurable. For
example, a patient-focused, realistic, and measurable short-term goal may be written for a patient
with the nursing diagnosis of Activityintolerance: The patient walks to the bathroom without
experiencing shortness of breath within 48 hours after surgery.
DIF: Understanding REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
9. ANS: D
, NSG3100NursingProcessCh.5-9Revised1/11/2024
Care plans developed using the nursing process as a standardized framework hold nurses and other
health care team members accountable for their actions. If the nurse’s priority goals and the patient’
goals are being met, the plan of care is effective. If not, the nurse needs to use critical thinking sk
knowledge, clinical judgment, and the nursing process to modify the plan to better address identified
concerns. Ignoring the patient is not a therapeutic response. The nurse should respect the patient’s
fear and assess further without simply documenting that the patient is unwilling.
DIF: Applying REF: Concepts: Care Coordination TOP: Nursing Process: Implementation
BNK: Chapter 05: Introduction to the Nursing Process
10. ANS: C
The implementation step includes initiating specific nursing interventions and treatments designed to
help the patient achieve established goals or outcomes. During the assessment step, patient care data
are gathered through observation, interviews, and physical assessment. In the diagnosis step, patient
data are analyzed, validated, and clustered to identify patient problems. Each problem is then stated
in standardized language as a specific Nursing diagnosis to provide greater clarity and universal
understanding by all care providers. In the evaluation step, the nurse determines whether the
patient’s goals are met, examines the effectiveness of interventions, and decides whether the plan of
care should be discontinued, continued, or revised.
DIF: Remembering REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
11. ANS: A
Priority of nursing diagnoses is determined by the patient’s preference as well as the severity of the
symptoms. The patient is concerned about the loss of hair because this will affect body image. For
the patient, this is a prime focus. It is possible that the patient may experience nausea as a result o
the chemotherapy drugs. The patient will not be able to eat properly if the nausea is not controlled
thus decreasing nutritional intake. There is a potential for bleeding as a result of the low platelet
count created by the drugs. All of these must be addressed, but the primary diagnosis, in this case,
would be body image.
DIF: Analyzing REF: Concepts: Care Coordination TOP: Nursing Process: Evaluation
BNK: Chapter 05: Introduction to the Nursing Process
12. ANS: A
During the assessment step, patient care data are gathered through observation, interviews, and
physical assessment. In the diagnosis step, patient data are analyzed, validated, and clustered to
identify patient problems. Each problem is then stated in standardized language as a specific nursing
diagnosis to provide greater clarity and universal understanding by all care providers. The
implementation step includes initiating specific nursing interventions and treatments designed to
help the patient achieve established goals or outcomes. In the evaluation step, the nurse determines
whether the patient’s goals are met, examines the effectiveness of interventions, and decides whether
the plan of care should be discontinued, continued, or revised.
DIF: Remembering REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
13. ANS: A
NSG3100
NursingProcessNCLEXQuestions
KEY
MULTIPLECHOICE
1. ANS: A
The nursing process is the foundation of professional nursing practice. It is the framework within
which nurses provide care to patients in an organized and effective manner. Paul describes critical
thinking as a complex process during which individuals think about their thinking to provide clarity
and increase precision and relevance in a specific situation while attempting to be fair and consisten
Critical thinking using the nursing process allows nurses to collect essential patient data, articulate
the specific needs of individual patients, and effectively communicate those needs, realistic goals,
and customized interventions with members of the health care team. Thinkinglikeanurse is
facilitated by nurses using the nursing process in the development of individualized patient plans of
care.
DIF: Remembering REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
2. ANS: A
During the assessment step, patient care data are gathered through observation, interviews, and
physical assessment. In the diagnosis step, patient data are analyzed, validated, and clustered to
identify patient problems. Each problem is then stated in standardized language as a specific Nursing
diagnosis to provide greater clarity and universal understanding by all care providers. The
implementation step includes initiating specific nursing interventions and treatments designed to
help the patient achieve established goals or outcomes. In the evaluation step, the nurse determines
whether the patient’s goals are met, examines the effectiveness of interventions, and decides whether
the plan of care should be discontinued, continued, or revised.
DIF: Understanding REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
3. ANS: C
Objective data consist of observable information that the nurse gathers on the basis of what can be
seen, measured, or tested. Subjective data are spoken. Primary data consist of information obtained
directly from a patient. Secondary data are collected from family members, friends, other health care
professionals, or written sources such as medical records and test results.
DIF: Understanding REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
4. ANS: A
During the assessment step, patient care data are gathered through observation, interviews, and
physical assessment. During the planning step of the nursing process, the nurse prioritizes the
Nursing diagnoses and identifies short- and long-term goals that are realistic, measurable, and
patient focused, with specific outcome identification for evaluation purposes. The implementation
step includes initiating specific nursing interventions and treatments designed to help the patient
achieve established goals or outcomes. In the evaluation step, the nurse determines whether the
patient’s goals are met, examines the effectiveness of interventions, and decides whether the plan of
care should be discontinued, continued, or revised.
, NSG3100NursingProcessCh.5-9Revised1/11/2024
DIF: Understanding REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
5. ANS: C
The implementation step includes initiating specific nursing interventions and treatments designed to
help the patient achieve established goals or outcomes. During the assessment step, patient care data
are gathered through observation, interviews, and physical assessment. During the planning step of
the nursing process, the nurse prioritizes the nursing diagnoses and identifies short- and long-term
goals that are realistic, measurable, and patient focused, with specific outcome identification for
evaluation purposes. In the evaluation step, the nurse determines whether the patient’s goals are met
examines the effectiveness of interventions, and decides whether the plan of care should be
discontinued, continued, or revised.
DIF: Understanding REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
6. ANS: A
During the assessment step, patient care data are gathered through observation, interviews, and
physical assessment. During the planning step of the nursing process, the nurse prioritizes the
nursing diagnoses and identifies short- and long-term goals that are realistic, measurable, and patient
focused, with specific outcome identification for evaluation purposes. The implementation step
includes initiating specific nursing interventions and treatments designed to help the patient achieve
established goals or outcomes. In the evaluation step, the nurse determines whether the patient’s
goals are met, examines the effectiveness of interventions, and decides whether the plan of care
should be discontinued, continued, or revised.
DIF: Understanding REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
7. ANS: B
During the planning step of the nursing process, the nurse prioritizes the nursing diagnoses and
identifies short- and long-term goals that are realistic, measurable, and patient focused, with specific
outcome identification for evaluation purposes. During the assessment step, patient care data are
gathered through observation, interviews, and physical assessment. The implementation step
includes initiating specific nursing interventions and treatments designed to help the patient achieve
established goals or outcomes. In the evaluation step, the nurse determines whether the patient’s
goals are met, examines the effectiveness of interventions, and decides whether the plan of care
should be discontinued, continued, or revised.
DIF: Understanding REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
8. ANS: B
All short- and long-term goals must be: (1) patient focused, (2) realistic, and (3) measurable. For
example, a patient-focused, realistic, and measurable short-term goal may be written for a patient
with the nursing diagnosis of Activityintolerance: The patient walks to the bathroom without
experiencing shortness of breath within 48 hours after surgery.
DIF: Understanding REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
9. ANS: D
, NSG3100NursingProcessCh.5-9Revised1/11/2024
Care plans developed using the nursing process as a standardized framework hold nurses and other
health care team members accountable for their actions. If the nurse’s priority goals and the patient’
goals are being met, the plan of care is effective. If not, the nurse needs to use critical thinking sk
knowledge, clinical judgment, and the nursing process to modify the plan to better address identified
concerns. Ignoring the patient is not a therapeutic response. The nurse should respect the patient’s
fear and assess further without simply documenting that the patient is unwilling.
DIF: Applying REF: Concepts: Care Coordination TOP: Nursing Process: Implementation
BNK: Chapter 05: Introduction to the Nursing Process
10. ANS: C
The implementation step includes initiating specific nursing interventions and treatments designed to
help the patient achieve established goals or outcomes. During the assessment step, patient care data
are gathered through observation, interviews, and physical assessment. In the diagnosis step, patient
data are analyzed, validated, and clustered to identify patient problems. Each problem is then stated
in standardized language as a specific Nursing diagnosis to provide greater clarity and universal
understanding by all care providers. In the evaluation step, the nurse determines whether the
patient’s goals are met, examines the effectiveness of interventions, and decides whether the plan of
care should be discontinued, continued, or revised.
DIF: Remembering REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
11. ANS: A
Priority of nursing diagnoses is determined by the patient’s preference as well as the severity of the
symptoms. The patient is concerned about the loss of hair because this will affect body image. For
the patient, this is a prime focus. It is possible that the patient may experience nausea as a result o
the chemotherapy drugs. The patient will not be able to eat properly if the nausea is not controlled
thus decreasing nutritional intake. There is a potential for bleeding as a result of the low platelet
count created by the drugs. All of these must be addressed, but the primary diagnosis, in this case,
would be body image.
DIF: Analyzing REF: Concepts: Care Coordination TOP: Nursing Process: Evaluation
BNK: Chapter 05: Introduction to the Nursing Process
12. ANS: A
During the assessment step, patient care data are gathered through observation, interviews, and
physical assessment. In the diagnosis step, patient data are analyzed, validated, and clustered to
identify patient problems. Each problem is then stated in standardized language as a specific nursing
diagnosis to provide greater clarity and universal understanding by all care providers. The
implementation step includes initiating specific nursing interventions and treatments designed to
help the patient achieve established goals or outcomes. In the evaluation step, the nurse determines
whether the patient’s goals are met, examines the effectiveness of interventions, and decides whether
the plan of care should be discontinued, continued, or revised.
DIF: Remembering REF: Concepts: Care Coordination
TOP: Nursing Process: Assessment BNK: Chapter 05: Introduction to the Nursing Process
13. ANS: A
