Question 1

The nurse is developing a plan of care for a recently admitted client to the medical-surgical unit. Which is the basis for the plan and implementation of the client's care?

Accepted Answer

The nursing diagnosis forms the basis for the plan and implementation of the client's care. It is a clinical judgment about an individual, family, or community response to a health problem or life processes. It guides the nurse in selecting and implementing interventions that are aimed at achieving client goals. Objective and subjective data provide additional information to support the nursing diagnosis, but the nursing diagnosis is the foundation of the plan of care. Client goals are also developed in response to the nursing diagnosis, but they are not the basis for the plan of care.

Question 2

The nurse is preparing the care plan for a client who admitted to the unit after an abdominal hysterectomy to manage endometriosis. Which goal statements reflect the need for further development by the nurse?

Accepted Answer

The answer of The nurse is preparing the care plan...

Question 3

The health care organization is planning to change the type of documentation done on the client care units. The nurses have requested a system that will reduce time spent writing out routine tasks and will still allow for documentation of exceptions. Which type of documentation will best meet the needs of the nursing staff?

Accepted Answer

Flow sheets provide a systematic way for nurses to document routine tasks and vital signs, while still allowing for documentation of exceptions. This type of documentation can save time and promote efficiency in the nursing workflow.

Question 4

The nurse is reviewing flow chart entries for a client experiencing pain. Which chart entries represent subjective data?

Accepted Answer

Subjective data are those that are reported by the client, and in this case, the client's complaints of leg tenderness and leg cramps are both subjective. The other options provide objective data, such as redness and swelling of the leg, laboratory values of the white blood cell count, and observable behaviors during assessment.

Question 5

When using Leavall and Clark's model as a framework for preparing a community health program, which program objective best reflect the concepts presented by this model?

Accepted Answer

Leavell and Clark's model emphasizes the interrelationships between the agent (disease-causing factors), host (the individual's biological and genetic factors), and environment, and how they contribute to health or illness. Option C reflects this concept of health, whereas the other options do not address the model's framework.

Question 6

During step 3 of the nursing process, which activity is performed?

Accepted Answer

During step 3 of the nursing process, which is the planning phase, the statement of client goals is performed. This involves setting objectives for the patient's care.

Question 7

The nurse educator is presenting information about the APIE method of charting as it will be implemented by the facility in a few weeks. Which statements by the participants indicate an appropriate understanding of this method of charting?

Accepted Answer

The answer of The nurse educator is presenting information about...

Question 8

The nurse manager is reviewing SOAP entries in the medical record for a novice nurse. Which entry indicates that the nurse needs further instruction concerning documentation?

Accepted Answer

While all of the options could potentially be improved, the entry in option B is the weakest as it only states a client report without any objective findings to support it. A stronger entry would include objective data such as vital signs or physical exam findings to support the client's report of feeling fatigued.

Question 9

The student nurse is preparing a care plan for an assigned client. When writing the nursing diagnose for this client, which elements are required?

Accepted Answer

The answer of The student nurse is preparing a care...

Quiz 1: Health Assessment