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Nursing process (Chapter 2)

1.       The five phases of nursing, Includes:
A)     Planning
B)      Evaporation
C)      All of the above

2.       The five phases of nursing, Excludes
A)     Assessment
B)      Nursing outlook
C)      Nursing diagnosis

3.       When used effectively, the nursing process offers several important advantages:
A)     Provides a consistent and orderly professional structure.
B)      Administering antibiotic to toddlers
C)      Form general adjustment to the profession

4.       Assessment involves
A)      Data collection used to identity a patient’s actual and potential health needs
B)      Historic and behavioral pattern of patient in recent time
C)      Health history and bodily movement of patient in recent time

5.       According to American Nurses Association guidelines, data should accurately reflect the patient’s
A)     Behavioral pattern, motive and recent activity
B)      Life experiences and his pattern of living
C)      The need for independence and free life choices

6.       When obtaining a health history from a patient, ask first about:
A)     Health insurance coverage
B)      Tailor your approach
C)      Biographic data.

7.       The accuracy and completeness of your patient’s answers largely depends on
A)     Your skill as an interviewer
B)      Your skill as a peace maker
C)      Your skill as data analyst

8.        To obtain the most benefit from a health history interview, ensure that the patient:
A)     Feels needed and persistent
B)      Feels comfortable, respected and understand that he can trust you.
C)      Pertinent laboratory and medical information

9.       Generally, in asking the patient question, it should include:
A)     Allow the patient time to think and reflect
B)      Allow the patient time to go home and get all information
C)      Allow the patient time to conduct himself properly

10.   Generally, in asking the patient question, it should exclude:
A)     Encourage the patient to talk
B)      Encourage patient to describe a particular experience
C)      None of the above

11.   Physical surroundings, psychological atmosphere, interview structure and questioning style can all affect the interview flow and outcome:
A)     True
B)      False
C)      Maybe

12.   ------------ to help prevent interruption, while interviewing patient
A)     Force the door
B)      Open the door
C)      Close the door

13.   Interview techniques to avoid, include:
A)     Moving up and down with patient
B)      Asking ‘’why’’ or ‘’how’’ questions
C)      Forcing patient to speak on family health history

14.   Interview techniques to avoid, exclude:
A)     Giving advice
B)      Changing the subject matter
C)      None of the above


15.   Begin by introducing--------------------
A)     The hospital to the patient
B)      Yourself to the patient
C)      The doctor to the patient

16.   You will need to take ------------- so that you can accurately remember what the patient tells you:
A)     Your phone
B)      Some note
C)      Care of your health

17.    Making eye contact and not backing the patient indicate:
A)     Understanding that will assure the patient that you are listening
B)      Understanding and assessment of the patient’s body language
C)      Understanding of the patients health history and needs

18.   The first technique in your physical assessment sequence is:
A)     Percussion
B)      Palpation
C)      Inspection

19.   Health history includes two types of questions:
A)     Open-ending and closed-endeavor
B)      Open-limit and closed-limit
C)      Open-ended and closed-ended

20.   The health history has:
A)     Four major sections
B)      Five major sections
C)      Six major sections

21.   Obtaining health history, these include the major sections:
A)     Biological date
B)      Health and illness patterns
C)      Emotional issues and mode swing

22.   Obtaining health history, these exclude the major sections:
A)     Role and relationship patterns
B)      Summary of health history data
C)      Character detection

23.   The four techniques of physical assessment:
A)     Introduction, preparation, palpation, auscultation
B)      Inspection, palpation, prerecession, adulteration
C)       Inspection, palpation, percussion, auscultation



24.   When palpating the abdomen, begin by palpating:
A)     Deeply
B)      Firmly
C)      Lightly

25.   As you palpate each body system, evaluate the following features (For 65 – 69)
Texture_________
A)     Rough or moving?
B)      Rough or straight?
C)      Rough or smooth?

26.   Temperature_______________
A)     Warm, hot or cold?
B)      Wet, hot or few?
C)      Warm, dry or cold?

27.   Moisture _________________
A)     Dry, warm or most?
B)      Dry, wet or moist?
C)      Drag, warm or moist?

28.   Motion _________________
A)     Still or vibrating?
B)      Sink or vibrant?
C)      Stem or vibrating?

29.     Consistency of structures __________
A)     Sand or fluid-filled?
B)      Still or filled-fluid?
C)      Solid or fluid-filled?

30.   Percussion technique helps you to locate:
A)     Organ borders, identify organ shape and position, and determine if an organ is solid or filled with fluid or gas
B)      Organic bones, identify organ condition and waste, and determine if an organ is solid or filled with fluid or gas
C)      All of the above

31.   Percussion requires:
A)     Organic bones, identify organ condition and waste, and determine if an organ is solid or filled with fluid or gas
B)      A skilled touch and an ear trained to detect slight variation in sound
C)      Still or filled-fluid to properly detect slight variation in sound

32.   You can perform percussion using :
A)     Soft-sound or hard method
B)      Left or right method
C)      Direct or indirect method


33.   Auscultation is:
A)     Usually the first assessment step
B)      Usually the finest assessment step
C)      Usually the last assessment step

34.   To prevent the spread of infection among patient:
A)     Clean the heads and end pieces of the stethoscope with alcohol or a disinfectant after every use
B)      Clean the hands and legs of the stethoscope with drinking water or a disinfectant after every use
C)      Clean the pin and bags of the stethoscope with alcohol or a disinfectant after every use

35.   As you practice percussion, you will recognize:
A)     Different movements
B)      Different sounds
C)      None of the above

36.   You will base your nursing diagnosis not on?
A)     A double  sign or symptom but on clear-movement  of assessment findings
B)      A single sign or symptom but on cluster of assessment findings
C)      A multiple sign or symptom but on cluster of assignment findings

37.   NANDA international define nursing diagnosis as:
A)     A clinical judgement about individual or national responses to actual health problems or life processes
B)      A clinical judgement about individual, family or community responses to actual or potential health problems or life processes
C)      A critical judgement about people or community responses to actual or health problems or life processes

38.   Nursing diagnoses provide the basis for the selection of nursing interventions to achieve:
A)     invoice for which the nurse is accountable
B)      incomes of all for which the nurse is accountable
C)      Outcomes for which the nurse is accountable

39.   The first step in developing a nursing diagnosis is to:
A)     Identify the patients problem
B)      Identify the parents problem
C)      Identity the parents problem

40.   Expected outcomes are defined as:
A)     Goals the patient should reach as a e result of planned nursing interventions
B)      Goals set by the medical team for each patient
C)      What the patient and his family ask you to accomplish

41.   In identifying the problem, it can either be:
A)     Actual or potential
B)      Fix or non-fix
C)      Real or imaginary


42.   The diagnostic statement consists of:
A)     A nursing diagram and the etiology (cause) related to it
B)      A nursing diagnosis and the etiology (cause) related to it
C)      A nursing perfection and the etiology (cause) related to it

43.   Etiology is:
A)     A stress reliever or something that brings about a response, effect, or change.
B)      A stressor or something that brings about a response, effect, or change
C)      A strengthener or something that brings about a response, effect,  or change

44.   A stressor is:
A)     Results from the presence of a stress agent or the absence of an equilibrium factor
B)      Results from the presentation of a stress agent or the absence of an equilibrium factor
C)      Results from the presence of a stress agent or the influence of an equilibrium factor

45.   Causative agents may include:
A)     Birth defect
B)      Physical movement
C)      No one of the above

46.   Causative agents may exclude:
A)     Injuries
B)      Lifestyle
C)      Bad breath

47.   One system of categorizing diagnoses uses:
A)     Marshal’s hierarchy of needs
B)      Maslow’s hierarchy of needs
C)      Mashing’s hierarchy of needs

48.   A written care plan serves as:
A)     A communication tool among different  team members that helps ensure continuity of care
B)      A communication tool among health care team members that helps ensure continuity of care
C)      A commandment  tool among health care team members that helps ensure continuity of care

49.   The plan consist of two parts namely:
A)     Patient outcomes and expected incomes
B)      Patient incomes and expected outcomes
C)      Patient outcomes and expected outcomes

50.   Maslow’s hierarchy of needs   (For 90-94)
Self-actualization:
A)     Recognition and modernization of one’s potential, growth, health and autonomy
B)      Recreation and realization of one’s potential, greater strength, health and autonomy
C)      Recognition and realization of one’s potential, growth, health and autonomy


51.   Self-esteem:
A)     Sense of self-worth, self-respect, indebtedness , dignity, privacy and self-reliance
B)      Sense of self-worth, self-respect, independence, dignity, privacy and self-reliance
C)      Sense of self-worth, self-respect, independence, dignity, practice and self-reliance

52.   Love and belonging:
A)     Affiliation, affection, intimacy, support and reassurance
B)      Affiliation, affection, intimacy, systems and reassurance
C)      Affliction, affection, intimacy, support and reassurance

53.   Safety and security:
A)     Safety from physiologic and psychological threat, protection, continuity, stability and lack of danger
B)      Safety from philosophical and psychological threat, protection, continuity, stability and lack of danger
C)      Safety from physiologic and psychological threat, protection, community help, stability and lack of danger

54.   Physiologic needs:
A)     Oxygen, food, investigation, temperature control, movement, rest and comfort
B)      Oxygen, food, elimination, temperature control, movement, rest and comfort
C)      Oxygen, food, elimination, temperature comfort, movement, rest and comfort

55.   Before you implement a care plan:
A)     Review your intervention options and then weigh their potential to succeed
B)      Review your intervention optimal and then weigh their potential to fail
C)      Reserve your intervention options and then weigh their potential to fail

56.   Ensuring a successful care plan include:
A)     Be realistic
B)      Be a coach
C)      None of the above

57.   Ensuring a successful care plan exclude
A)     Tailor your approach
B)      Avoid vague terms
C)      Reading out loud to the patient

58.   Your care should help the patient attain
A)     The highest functional leverage possible while posting minimal risk and not creating new problems
B)      The lowest functional level possible while posting minimal risk and not creating new problems
C)      The highest functional level possible while posing minimal risk and not creating new problems

59.   The implementation phase is when you put your care plan into:
A)     Forms
B)      Groups
C)      Action



60.   While you coordinate implementation, you should also seek help from:
A)     The parent, the patient’s family and other caregivers
B)      The patient, the patient’s neighbor and other caregivers
C)      The patient, the patient’s family and other caregivers

61.   After enough time has elapsed for the care plan to effect desired changes, you are ready for?
A)     Evaporation
B)      Exaggeration
C)      Evaluation

62.   _________ is the final step in the nursing process:
A)     Evaporation
B)      Exaggeration
C)      Evaluation

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