The Nursing Process

Question 1

what are the characteristics of the nursing process

Answer 1

• cyclical
• patient centered
• focus on problem solving
• focus on decision making
• interpersonal and collaberative
• use of critical thinking

Question 2

purpose of the nursing process

Answer 2

• gather data
• cluster data
• engage in critical thinking
• foster clinical reasoning
• make decisions
• plan care
• evaluate care

Question 3

assessment involves

Answer 3

• collect data
• organize data
• validate data
• document data

Question 4

nursing diagnosis involves

Answer 4

• analyzing data
• identify health problems, risks, and strenghts
• formulate diagnostic statements

Question 5

planning involves

Answer 5

• prioritizing problems and diagnosis
• formulate goals and designed health outcomes
• identify nursing interventions

Question 6

implementation involves

Answer 6

• reasses the patient
• determine the nurse need for assistance
• implement nursing interventions
• supervise delegated care
• document nursing activities

Question 7

evaluation involves

Answer 7

• collecting data related to outcomes
• complete data with outcomes
• relate nursing actions to patient goals/outcomes
• draw conclusion about problem status
• continue, modify, or end the patients care plan

Question 8

initial assesment

Answer 8

• explores the presenting problem
• identifies contributing factors

Question 9

intitial assesment includes

Answer 9

• physical assesment
• health history
• psychosocial assesment

Question 10

focused assesment

Answer 10

• gathers specific details about the presenting concern to either confirm or rule out abnormalities

Question 11

time lapsed assesment

Answer 11

• to reevalute the patients status and identify whether the condition has improved, worsened, or stayed the same

Question 12

emergency assesment

Answer 12

• to ensure the patient has a patient airway, is breahting, and has adwquate circulation
• to identify the primary cause of the problem

Question 13

subjective data

Answer 13

what the patient says

Question 14

objective data

Answer 14

what the nurse observes or collects from others

Question 15

sources of data

Answer 15

• patient and family
• physical assesment
• the enviorment
• medical records and interprofessional team
• liturature

Question 16

what are the 9 social determents of health

Answer 16

• Income and social status
• social support networks
• employment and working conditions
• physical environments
• education
• healthy child developments
• biological and genetic endowment
• health services
• personal health practices and coping skills

Question 17

what are gordons functional health patterns

Answer 17

• health perception management
• nutritional metabolic
• elimination
• activity excersize
• sleep / rest
• cognitive perceptual
• self perception / self concept
• roles / relationships
• sexuality / reproduction
• coping / stress tolerance
• values / beleifs

Question 18

Mazlows Hierarchy of Needs (top to bottom)

Answer 18

self-actualisation
esteem needs
social needs
saftey needs
physiological needs

Question 19

self actualization includes

Answer 19

mortality, creativity, spontanetiy, problem solving, lack of prejudice, acceptance of facts

Question 20

esteem includes

Answer 20

self esteem, confidence, achievement, respect of others, respect of others

Question 21

social needs / love and belonging includes

Answer 21

friendship, family and sexual intimacy

Question 22

saftey inculdes

Answer 22

security of body, employment, resources, morality, family, health

Question 23

physiological needs include

Answer 23

breathing, food, water, homestasis, excretion

Question 24

what are the 5 steps of the nursing process

Answer 24

Assessment
Nursing Diagnosis
Planning
Intervention
Evaluation

Question 25

what are the three steps of formulating a nursing diagnosis

Answer 25

1. Choose the NANDA label (actal, risk, wellness, syndrome) 2. determine etiology (likely cause) "realted to ..." 3. list signs and symptoms "as evidence by"

Question 26

initial planning

Answer 26

- based on admission assesment - directs patient care

Question 27

ongoing planning

Answer 27

continually changing plans based on patient responce to care (assessment and evaluation)

Question 28

discharge planning

Answer 28

anticipates and plans for the care needs when the patient moves through the health care system to home or to another care facility

Question 29

SMART goals stand for

Answer 29

Specific Measurable Achievable Relevant Timely

Question 30

short term goals ar emore common in

Answer 30

acute care

Question 31

Independent nursing interventions

Answer 31

nurse can accomplish without an order form the physician or NP

Question 32

dependent nursing interventions

Answer 32

initiated by the physicians orders

Question 33

collaberative nursing interventions

Answer 33

nurse and another health care professional collaberate on interventions - usually nurse completes them and the physician approves them

Question 34

Direct care

Answer 34

- anything that involves working directly with the patient

Question 35

indirect care

Answer 35

- communicates with HCP about the patients care - delegating, supervising, evaluating the work of others - planning and documenting care

Question 36

evaluating of SMART goals

Answer 36

- Goal met - goal partically met - goal not met