ATI RN
Fundamentals of Nursing Nursing Process Questions Questions
Question 1 of 5
A nurse writes the following nursing diagnosis for a client with Alzheimer�s disease: 'Disturbed Thought Processes related to Alzheimer�s disease as evidenced by incoherent language.' Which part of this diagnosis is considered the problem statement?
Correct Answer: A
Rationale: The correct answer is A: "Disturbed thought processes." This is the problem statement because it identifies the client's main issue, which is the disturbance in their thought processes. The "related to" part (B) indicates the cause, "Alzheimer's disease" (C) is the etiology, and "incoherent language" (D) is the evidence. By focusing on the problem statement, the nurse can develop appropriate interventions to address the client's disturbed thought processes.
Question 2 of 5
A nurse is reviewing a patient�s care plan. Which information will the nurse identify as a nursing intervention?
Correct Answer:
Rationale: Correct Answer: A: The patient will ambulate in the hallway twice this shift using crutches correctly. Rationale: 1. This choice outlines a specific nursing intervention - ambulating with crutches. 2. It includes clear actions for the patient to ambulate and specifies using crutches correctly. 3. It addresses the patient's physical mobility needs actively. 4. It focuses on promoting independence and functional ability. Summary of other choices: B: This choice includes the nursing diagnosis and the plan but lacks the specificity of the correct answer. C: This choice includes the nursing diagnosis and specifies the use of crutches but lacks the clarity of correct implementation. D: This choice only identifies the patient's condition without providing a specific nursing intervention.
Question 3 of 5
The following statements are on a patient�s nursing care plan. Which statement will the nurse use as an outcome for a goal of care? The patient will verbalize a decreased pain level less than 3 on a 0 to 10 scale by the
Correct Answer: A
Rationale: The correct answer is A because it is specific, measurable, achievable, relevant, and time-bound (SMART) - the patient verbalizing a decreased pain level less than 3 on a 0 to 10 scale by the end of this shift. This outcome is immediate, concrete, and directly related to the goal of managing pain. Choice B is incorrect as it lacks specificity and a clear timeframe for evaluation. Choice C is incorrect because the outcome is vague and does not specify when the patient needs to understand the dietary changes. Choice D is incorrect because the timeframe is provided but the outcome is not specific enough and does not directly relate to the goal of pain management.
Question 4 of 5
A nurse completes a thorough database and carries out nursing interventions based on priority diagnoses. Which action will the nurse take next?
Correct Answer: D
Rationale: The correct answer is D: Evaluation. After implementing nursing interventions based on priority diagnoses, the nurse must evaluate the effectiveness of these interventions to determine if the desired outcomes have been achieved. Evaluation is crucial to assess the progress, make necessary modifications, and ensure the effectiveness of the care provided. Assessment (A) is already completed before interventions are carried out. Planning (B) involves developing a care plan based on assessment findings. Implementation (C) is the actual carrying out of the interventions. Therefore, the next step after implementing nursing interventions is to evaluate their effectiveness.
Question 5 of 5
A nurse is using assessment data gathered about a patient and combining critical thinking to develop a nursing diagnosis. What is the nurse doing?
Correct Answer: C
Rationale: The correct answer is C: Diagnostic reasoning. The nurse is using assessment data to analyze, interpret, and make a judgement about the patient's condition. This process involves critical thinking skills to develop a nursing diagnosis. Choice A (Assigning clinical cues) is incorrect because it refers to identifying specific signs and symptoms. Choice B (Defining characteristics) is incorrect as it pertains to the features of a diagnosed condition. Choice D (Diagnostic labeling) is incorrect because it focuses on naming a specific nursing diagnosis. Diagnostic reasoning encompasses the entire process of analyzing data, making connections, and formulating a nursing diagnosis based on critical thinking.
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