Nursing Process

Question 1

Is a systematic, rational method of planning and providing individualized nursing care.

Answer 1

Nursing process

Question 2

Who originated the term nursing process? When?

Answer 2

Hall (1955), Johnson (1959), Orlando (1961), Widenbach (1963)

Question 3

The use of the nursing process in clinical practice gained additional legitimacy in?(year) when the phases were included in American Nurses Association (ANA)

Answer 3

1973

Question 4

Characteristics of the nursing process:

Answer 4

Cyclic and dynamic
Client-centered
Focused on problem solving and decision making
Interpersonal and collaborative style
Universal applicability

Question 5

Data in each phase provides data in the next phase.

Answer 5

Cyclic and dynamic

Question 6

Regularly repeated event or sequence of events that are continuously changing.

Answer 6

Cyclic and dynamic

Question 7

The nurse organizes the plan of care according to the client problems and needs rather than nursing goals.

Answer 7

Client-centered

Question 8

It is involved in every phase of the nursing process.

Answer 8

Decision-making

Question 9

This facilitates the individualization of the nurse’s plan of care.

Answer 9

Decision-making

Question 10

It requires the nurse to communicate directly and consistently with clients and families to meet their needs.

Answer 10

Interpersonal and collaborative

Question 11

Obtaining an information and that clarifies the nature of the problem and suggests possible solutions.

Answer 11

Problem solving

Question 12

A critical thinking process for choosing the best actions to meet a desired goal.

Answer 12

Decision-making

Question 13

It is an adaptation of problem solving and decision making.

Answer 13

Nursing process

Question 14

Nursing process is used as a framework for nursing care in all types of healthcare settings, with clients of all age groups.

Answer 14

Universal applicability

Question 15

Intellectually disciplines process of actively and skillfully conceptualizing, applying, analyzing, and/or evaluating information gathered from, or generated observation, experience, reflection, reasoning or communication, as a guide to belief and action.

Answer 15

Critical thinking

Question 16

Collection, organization, validation, documentation of data

Answer 16

Assessment

Question 17

Purpose of assessment

Answer 17

To establish database about the client’s response to health concerns or illness and the ability to manage healthcare needs

Question 18

Analysis of data
Identification of health problems, risks, and strengths
Formulation of diagnostic statements

Answer 18

Diagnosing

Question 19

Prioritization of problems/diagnoses
Formulation of goals/desired outcomes

Answer 19

Planning

Question 20

Selection of nursing interventions
Writing of nursing orders

Answer 20

Planning

Question 21

Purpose of planning

Answer 21

To develop a health care plan reflective of specific objective.

Question 22

Reassessment of the client
Determination of the nurse’s need for assistance

Answer 22

Implementation

Question 23

Implementation of nursing interventions
Supervision of delegated care

Answer 23

Implementation

Question 24

Documentation of nursing activities

Answer 24

Implementation

Question 25

Collection of data related to outcomes Comparison of data with outcomes.

Answer 25

Evaluation

Question 26

A systematic and continuous collection, organization, validation, and documentation of data (information).

Answer 26

Assessment

Question 27

The process of gathering information about client's health status.

Answer 27

Data collection

Question 28

Covert data

Answer 28

Symptoms

Question 29

Overt data

Answer 29

Signs

Question 30

Apparent only to the person affected and can be verified only by the person.

Answer 30

Subjective data

Question 31

Detectable by an observer or can be measured or tested against accepted standard.

Answer 31

Objective data

Question 32

Conscious, deliberate skill involving the use of senses.

Answer 32

Observation

Question 33

Planned communication or a conversation with a purpose.

Answer 33

Interview

Question 34

Highly structured and elicits specific information.

Answer 34

Directive interview

Question 35

Nurse allows client to control purpose, subject matter and pacing.

Answer 35

Non-directive interview

Question 36

Major method used in the physical health assessment.

Answer 36

Examining

Question 37

A systematic data collection method that uses observation to detect health problems through the use of the techniques: inspection, auscultation, palpation, and percussion.

Answer 37

Physical assessment

Question 38

Information that does not change over time such as race or blood type.

Answer 38

Constant data

Question 39

Data that can change quickly, frequently, or rarely and include such data as blood pressure, level of pain, and age.

Answer 39

Variable data

Question 40

The nurse uses the written format or computerized format that organizes the assessment data systematically.

Answer 40

Nursing health history Nursing assessment or nursing databases form

Question 41

Is the process of making clinical judgment about a client's actual or potential health problems.

Answer 41

Diagnosing

Question 42

Diagnosing refers to the reasoning process, whereas the term __________ is a statement or conclusion regarding the nature of a phenomenon.

Answer 42

Diagnosis

Question 43

Contains a diagnostic phrase or diagnostic label followed by an etiology phase.

Answer 43

Nursing diagnosis

Question 44

Is a statement of the client's problem

Answer 44

Diagnostic phrase or label

Question 45

The causal relationship between the client's problem or risk factors.

Answer 45

Etiology

Question 46

It is the act of "double-checking" or verifying data to confirm that the data is accurate and factual.

Answer 46

Validation of data

Question 47

The process of determining the relatedness of facts and determining whether any patterns are present, whether the data represent isolated incidents and whether the data are significant.

Answer 47

Clustering cues

Question 48

Can be an aid to mobilizing health and regenerative processes.

Answer 48

Strength

Question 49

Formulation of diagnostic statements?

Answer 49

PES Format (Problem, Etiology, Signs and Symptoms)

Question 50

Statement's of client's health need/concern/problem (based from NANDA)

Answer 50

Problem

Question 51

Factors contributing to or probable causes of responses.

Answer 51

Etiology

Question 52

Defining characteristics manifested by the client.

Answer 52

Signs and symptoms

Question 53

Provides the basis for selecting nursing interventions to achieve outcomes for which the nurse is accountable.

Answer 53

NANDA

Question 54

Types of Nursing Diagnoses: Present at the time of assessment; based on associated manifestations.

Answer 54

Actual

Question 55

Types of Nursing Diagnoses: A clinical judgment that a problem does not exist, but the presence of risk factors indicates that a problem is likely to develop unless nurses intervene.

Answer 55

Potential/High-risk

Question 56

Types of Nursing Diagnoses: Describes human responses to levels of wellness in an individual, family or community that have a readiness for enhancement

Answer 56

Wellness

Question 57

Types of Nursing Diagnoses: Evidence about a health problem is incomplete or unclear; requires more data either to support or refuse it.

Answer 57

Possible Nursing Diagnosis

Question 58

Types of Nursing Diagnoses: Associated with a cluster of other diagnosis.

Answer 58

Syndrome diagnosis

Question 59

The process of designing nursing activities required to prevent, reduce or eliminate client's health problems.

Answer 59

Planning

Question 60

Is the process of establishing a preferential sequence for addressing nursing diagnosis and interventions.

Answer 60

Priority setting

Question 61

Considerations in setting priorities:

Answer 61

Triage concept Maslow's Hierarchy of Needs Availability of resources Patient's preferences

Question 62

Statement reflective of desired changes in the behavior of the client which a health intervention seeks to bring about.

Answer 62

Goal

Question 63

A positive behavior/what a nurse wants to happen to the patient after a series of intervention.

Answer 63

Terminal behavior

Question 64

Types of Terminal Behavior: Concerns with knowledge, understanding, remembering, intellectual, capacity, decision-making.

Answer 64

Cognitive

Question 65

Types of Terminal Behavior: Refers to feelings, emotions, attitude

Answer 65

Affective

Question 66

Types of Terminal Behavior: Refers to physical capabilities, performances, technical skills

Answer 66

Psychomotor

Question 67

Types of Terminal Behavior: Refers to changes in bodily responses

Answer 67

Physiologic

Question 68

Describe specific and measurable client responses and help the nurse evaluate the effectiveness of the nursing intervention.

Answer 68

Client's goals/desired outcomes

Question 69

Types of desired outcomes: Require care for a short time - acute care setting

Answer 69

Short term

Question 70

Types of desired outcomes: Chronic health problems and those who live in nursing homes, rehab centers, extended care facilities.

Answer 70

Long term

Question 71

Components of goals/desired outcomes:

Answer 71

Subject Condition Terminal behavior Parameter

Question 72

Components of goals: Patient and problem

Answer 72

Subject

Question 73

Components of goals: Time under which the change in behavior is achieved

Answer 73

Condition

Question 74

Components of goals: An observable activity the patient demonstrates

Answer 74

Terminal behavior

Question 75

Components of goals: Reflect acceptable performance

Answer 75

Parameter

Question 76

Characteristics of a good goal/objective:

Answer 76

(SMART) Specific Measurable Attainable Realistic Time framed

Question 77

The blueprint of the nursing process/nursing practice

Answer 77

Nursing care plan

Question 78

Brief discussion on how the etiology resulted to a problem

Answer 78

Inference

Question 79

The "doing" phase

Answer 79

Implementation

Question 80

The execution of the nursing care plan

Answer 80

Implementation

Question 81

Measures provided by the nurse through which changes in patient's behavior are brought about.

Answer 81

Nursing intervention

Question 82

Principles involved in selecting nursing interventions and activities

Answer 82

Prioritization Rationalization Use of available resources

Question 83

Categories of Interventions according to Legal implication

Answer 83

Independent Collaborative

Question 84

Categories of interventions according to approach

Answer 84

Facilitative Developmental Supportive

Question 85

Interventions which concern on removal of barriers to health care

Answer 85

Facilitative

Question 86

Actions that improve patient's ability to cope with health-illness situation

Answer 86

Developmental

Question 87

Interventions done to patient who cannot do usual work

Answer 87

Supportive

Question 88

Interventions that are implemented to patient's by virtue of the nurse's education, practice and training

Answer 88

Supplemental

Question 89

Considerations when selecting nursing interventions:

Answer 89

Economy of time, effort and materials Safety Respect and privacy Appropriateness

Question 90

Degree of assistance for patients:

Answer 90

Wholly compensatory Partly compensatory Educative-supportive

Question 91

Value determine of the efficiency of care based on previously established goal

Answer 91

Evaluation

Question 92

Purposes of evaluation:

Answer 92

Documenting responses to interventions Evaluating effectiveness of interventions Evaluating outcome achievement Reviewing health care plan

Question 93

Types of evaluation: Done every after specific care given to check its efficiency and effectiveness

Answer 93

On-going

Question 94

Types of evaluation: Scheduled evaluation, done every after series of interventions

Answer 94

Intermittent

Question 95

Types of evaluation: Done at the end of the processes after all interventions had been implemented

Answer 95

Terminal

Question 96

Steps in evaluation:

Answer 96

Evaluate expected outcome/goal achievement Terminate for goals achieved Re-assess and revise care plan as needed

Question 97

Approaches to qualify evaluation:

Answer 97

Structure Process Outcome impact

Question 98

Dimensions of evaluation:

Answer 98

Efficiency Effectiveness Adequacy of interventions Appropriateness

Question 99

Four types of assessments

Answer 99

Initial nursing assessment Problem-focused assessment Emergency assessment Time-lapsed assessment

Question 100

Nursing assessments focus on a client's ____________ to a health problem.

Answer 100

responses