Nursing Process

Question 1

Six phases of the nursing process

Answer 1

assessment
diagnosis
planning
implementation
outcome
evaluation

Question 2

** Where does data come from?

Answer 2

Laboratory data
Diagnostic tests
Physical examination
Health records

Question 3

Four phases of the interview process

Answer 3

• preparatory
• introductory
• maintenance
• concluding

Question 4

Four steps of physical assessment

Answer 4

• inspection: visual
• palpation: touch
• percussion: tapping
• auscultation: stethoscope

Question 5

Nursing diagnosis

Answer 5

human response to actual or potential healthcare problems

Question 6

t/f nursing dx is the same thing as medical dx

Answer 6

false

Question 7

what does r/t mean in nursing diagnosis

Answer 7

related to

Question 8

three parts of actual nursing diagnosis

Answer 8

diagnostic label
r/t related factors
as evidenced by defining characteristics

Question 9

two parts of risk nursing diagnosis

Answer 9

diagnostic label r/t risk factors

Question 10

PES

Answer 10

Problem
Etiology
Signs/symptoms

Question 11

accurate or inaccurate nursing dx:

constipation related to decreased activity and fluids as evidenced by small, hard, formed stool every 4 days

Answer 11

accurate

Question 12

accurate or inaccurate nursing dx:

altered bowel function related to production of hard stool

Answer 12

inaccurate

Question 13

5 rights of delegation

Answer 13

right person
right task
right circumstance
right communication
right evaluation

Question 14

What can’t be delegated

Answer 14

Assessment
patient teaching
clinical judgment
evaluation