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Multiple Choice

This document contains 16 multiple choice questions about nursing assessment and diagnosis. The questions cover topics such as identifying subjective and objective data, types of assessments, components of nursing diagnoses, and selecting appropriate nursing interventions based on the etiology stated in a nursing diagnosis. The questions assess understanding of key concepts in collecting patient data, formulating nursing diagnoses, and developing care plans.

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Annalisa Telles
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439 views

Multiple Choice

This document contains 16 multiple choice questions about nursing assessment and diagnosis. The questions cover topics such as identifying subjective and objective data, types of assessments, components of nursing diagnoses, and selecting appropriate nursing interventions based on the etiology stated in a nursing diagnosis. The questions assess understanding of key concepts in collecting patient data, formulating nursing diagnoses, and developing care plans.

Uploaded by

Annalisa Telles
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PART II MULTIPLE-CHOICE: Read the following questions and choose the best answer.

Encircle the letter of the correct answer. (15pts)


1. When the client states that my head hurts and my vision is blurry, is what type of
source data?
a. Primary and objective
b. Secondary and subjective

c. Primary and subjective


d. Secondary and objective

2. A patients chart is what type of data?


a. Primary
b. Secondary

c. Tertiary
d. A and B

3. The major and only concern during this type of assessment is to determine the status of
the clients life sustaining physical functions:
a. Initial comprehensive assessment
b. Ongoing or partial assessment
c. Focused or problem oriented assessment
d. Emergency assessment
4. Major areas of subjective data include the following except:
a. Physical symptoms related to each body part or system
b. Biographical information
c. Physical characteristics
d. Family history
5. The following data are objective data except:
a. Bodily function
b. Past health history

c. Appearance
d. Behavior

6. An important step of assessment because it forms the database for entire nursing process
and provides data for all other members of the health care team:
a. Documenting data
b. Validating data

c. Collecting objective data


d. Collecting subjective data

7. Which of the following is an example of objective data?


a. The client complains nausea
b. The clients abdomen is soft and round
c. The physician says the client is experiencing chest pain
d. The clients spouse asks the he be returned to be bed because he is tired
8. Which of the following data the nurse should validate?
a. The clients pulse is 104
b. The chart says the client is allergic to penicillin
c. The clients says, I feel like my blood sugar is high
d. The clients temperature is 101.2 degree Farenheit

9. Consider the following nursing diagnosis: Ineffective breathing pattern related to


respiratory muscle fatigue as evidenced by use of accessory muscles. Which part
represents the etiology for this diagnosis?
a. Ineffective breathing pattern
b. Respiratory muscle fatigue

c. Use of accessory muscle


d. Related to

10. Consider the following nursing diagnosis: Chronic pain related to pain from stiff joints.
What is the error in this diagnosis?
a. It should have written as one part nursing diagnosis
b. It includes medical diagnosis
c. It says the same thing twice
d. It is judgmental
11. Which of the following wellness diagnosis is written correctly?
a. Readiness for Enhanced Health-Seeking Behaviors (low sodium diet)
b. Readiness for Enhanced Health-Seeking Behaviors r/t making clinic visit
c. Readiness for Health-Seeking Behavior (low sodium diet
d. Enhanced Health-Seeking Behavior
12. Which of the following correctly written diagnosis that the nurse should add to the
clients care plan?
a. Altered Nutrition: Less than body requirements
b. Pneumonia related to infectious process
c. Impaired Physical Mobility related to weakness in lower extremities
d. Acute pain related to abdominal incision
13. Which of the following is stated in the format of a collaborative problem?
a. Potential for Complication of Immobility: Decubitus Ulcer
b. Risk for decubitus ulcer related to immobility
c. Complication of immobility: Decubitus ulcer
d. Decubitus ulcer related to immobility
14. Which of the following nursing diagnoses uses the PES format?
a. Fluid volume deficit related to prolonged vomiting
b. Risk for impaired skin integrity as manifested by poor skin turgor and old age
c. Ineffective airway clearance related to infectious process as manifested by
excessive mucous and retained secretions
d. Ineffective airway clearance as manifested by secretions in the bronchi, presence
of allergies and airway spasm
15. Consider the following nursing diagnosis for client who in on bed rest: Risk for Impaired
Skin Integrity related to bed rest. Which of following nursing interventions was derived
from etiological portion of the nursing diagnosis?
a. Select high-protein foods each meal
b. Complete bed bath every morning
c. Offer a back rub as necessary
d. Turn and reposition every 2h
16.

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