Nursing Process: PIE

Question 1

_____ process of designing an action plan through which lifestyle behaviors can be prevented, reduced or eliminated.

Answer 1

Planning

Question 2

It involves decision making and problem solving.

Answer 2

Planning

Question 3

What is the end product of the planning phase?

Answer 3

NURSING CARE PLAN

Question 4

3 types of planning

Answer 4

• initial planning
• on going planning
• discharge planning

Question 5

A plan that develops a preliminary plan of care by the nurse during admission assessment

Answer 5

Initial planning

Question 6

It is a continuous updating of client’s plan of care. Nurse can _____ the initial plan further

Answer 6

• ongoing planning
• individualize

Question 7

Occurs at the beginning of a shift as the nurse plans the care to be given that day

Answer 7

• ongoing planning

Question 8

Using ongoing assessment data, the nurse carries out daily planning for the following purposes:

• To determine whether the client’s _____ has______
• To______ for the client’s care during the ________
• To decide which ________ on during the shift
• To________ the nurse’s activities so that more than one problem can be addressed at each client contact.

Answer 8

• health status, changed
• set priorities, shift
• problems to focus
• coordinate

Question 9

A plan that involves critical anticipation and planning for clients needs after discharge

Answer 9

• discharge planning

Question 10

Tasks Involved with Planning

-__________ list of nursing diagnoses.
- Identifying and writing client-centered long- and short-term ______ and______.
- Developing specific_________
-__________ entire nursing plan in client’s record.

Answer 10

• prioritizing
• goals, outcomes
• nursing interventions
• recording

Question 11

What theory is used in prioritizing the client’s setting or situation

Answer 11

Maslow’s hierarchy of needs

Question 12

What is the sequence for addressing nursing diagnoses and interventions.

Answer 12

• life- threatening problems
• health- threatening problems
• low priority

Question 13

Which of these problems is a priority?

• Ineffective Airway Clearance
• Deficient fluid volume
• Anxiety related to difficulty breathing
• Risk for interrupted family processes
• Impaired nutrition
• Sleep pattern disturbance

Answer 13

(H)
(H)
(M)
(L)
(L)
(L)

Question 14

Why should there be goals?

• Provide______ for planning interventions.
• Serve as________ for_______ client progress.
• Enable the client and nurse to determine when the problem has been_______.
• Help________ the client & nurse by providing a sense of________.

Answer 14

• direction
• criteria, evaluating
• resolved
• motivate, achievement

Question 15

Two types of goal/ outcome

Answer 15

• short term outcome
• long term outcome

Question 16

Short term outcome is used when a client is only admitted in the hospital for few _____. While long term outcome is used for patients that will stay over ______

Answer 16

• Hours or days
• weeks or months

Question 17

Objective formulation must be _____

Answer 17

SMART
Specific
Measurable
Attainable
Realistic
Time-bounded

Question 18

What are the essential components of objectives?

Answer 18

• criterion
• subject
• task statement or verb- action
• conditions or modifiers

Question 19

What are the categories in Bloom’s taxonomy in writing an objective

Answer 19

• Remember
• understand
• apply
• analyze
• evaluate
• create

Question 20

_____________ is an action performed by the nurse that helps the client achieve the results specified by the goals and expected outcomes.

Answer 20

nursing intervention

Question 21

Nursing interventions are identified and written during ______ step of nursing process

Answer 21

Planning

Question 22

Types of nursing intervention

Answer 22

• independent
• dependent
• collaborative

Question 23

Nursing intervention that nurses are licensed to initiate on the basis of their knowledge & skills.

Includes: Physical care, ongoing assessment, emotional support, comfort, teaching, counseling, environmental management

Answer 23

Independent

Question 24

Nursing intervention that is carried out under the physician’s orders or supervision according to specified routines.

Includes: Providing medications, intravenous therapy, treatment, diet and activity, changing dressing, administering the medical orders, assess the need for explaining.

Answer 24

Dependent

Question 25

Nursing intervention that nurse carries out in collaboration with other health team members.

Answer 25

Collaborative

Question 26

Identify whether the nursing actions are independent, dependent or collaborative - Review & convey abnormal laboratory results to physician - Assisting the client with oral care - Giving oral medication to client - Referring client to dietician - Assessing pain level - Positioning client during mealtime - Supporting patient emotionally - Dextrose /Putting V - Diagnostic Test - Diet and Activity - Wound Dressing - Environmental Management

Answer 26

C I D C I I D D D D I

Question 27

Criteria for Selecting Nursing Interventions - Safe & appropriate for client's______,_______ &_______ - Achievable with the_______ available. - Congruent with client's_______,_______, and_______. - Congruent with other________ - Based on nursing knowledge & experience or rationale - Within established standards of care by laws, & policies set by the institution, organization or country.

Answer 27

- age, health, condition - resource - values, beliefs, culture - therapies

Question 28

- "Action phase" - Reassessing the client - Determining the nurse's need for assistance - Implementing the nursing interventions - Supervising the delegated care - Documenting nursing activities

Answer 28

IMPLEMENTATION PHASE

Question 29

• consists of doing and documenting the activities that are the specific nursing actions needed to carry out the interventions.

Answer 29

Implementing

Question 30

Skills involved in the implementation phase

Answer 30

- cognitive skill - interpersonal skill - technical skill

Question 31

intellectual skills include problem solving, decision making, critical thinking, clinical reasoning, and creativity.

Answer 31

Cognitive skills

Question 32

all of the activities, verbal and non-verbal, people use wher interacting directly with one another. - The effectiveness of a nursing action often depends largely on the nurse's ability to________ with others.

Answer 32

Interpersonal skills communicate

Question 33

are purposeful "hands-on" skills such as manipulating equipment, giving injections, bandaging, moving, lifting, and repositioning clients. also called tasks, procedures, or psychomotor skills.

Answer 33

Technical skills

Question 34

Process of Implementing 1._______ the client 2. Determining the nurse's_______ for assistance 3. Implementing the________ 4.__________ delegated care 5.__________ nursing activities

Answer 34

- reassessing - need - nursing intervention - supervising - documenting

Question 35

The evaluation phase has five components: -_________ related to the desired outcomes -__________ the data with desired outcomes -__________ nursing activities to outcomes - Drawing_________ about problem status -_________,_________, or__________ the nursing care plan

Answer 35

- collecting data - comparing - relating - conclusions - continuing, modifying, terminating

Question 36

end prodcut of planning phase is

Answer 36

nursing care plan

Question 37

stage of nursing process that use long term and short term goal

Answer 37

planning

Question 38

Does the the priorities change as tbe client responses, problesma nd therapies change?

Answer 38

yes

Question 39

is it assigned as a medium priority

Answer 39

health threatening problem

Question 40

what kind of problem impaired respiratory /cardiac function ineffective airway clearance deficient fluid volume

Answer 40

life threatening prob

Question 41

may result in delay deveopment or cause destructive physical or emotional change

Answer 41

heatlh threatening prob

Question 42

arises from “normal deveopment needs” requires MINIMAL nursing support

Answer 42

Low priority

Question 43

identify the priority Ineffective Airway Clearance Deficient fluid volume Anxiety related to difficulty breathing Risk for interrupted family processes Impaired nutrition Sleep pattern disturbance

Answer 43

HIGH- Ineffective Airway Clearance HIGH- Deficient fluid volume MEDIUM- Anxiety related to difficulty breathing LOW- Risk for interrupted family processes LOW- Impaired nutrition LOW- Sleep pattern disturbance

Question 44

goals serve as a criteria for evaluating client progress t or f

Answer 44

t

Question 45

goals help motivate client n nurse by providing a sense of achievement t or f

Answer 45

t

Question 46

2 kinds of outcomes

Answer 46

short term and long term outcome (planning

Question 47

statement written in objective format demonstrating an expectation to be achieved in resolution of the nursing diagnosis in a short period of time, usually in a **few hours or days.** - as students in hospitals

Answer 47

short term

Question 48

statement written in objective format demonstrating an expectation to be achieved in resolution of the nursing diagnosis over a long period of time, usually over weeks or months. Objective Formulation)

Answer 48

Long term

Question 49

easier to monitor progress and know when it is obtain or finished (smart)

Answer 49

MEASURABLE

Question 50

goals should be flexible yet still remains possible smart

Answer 50

attainable

Question 51

ESSENTIAL components of objectives cstc

Answer 51

criterion of desired performance subject task statement or verb action conditions or modifiers

Question 52

explain the “circumstances” under which behavior is to be perfome

Answer 52

conditions/modifier

Question 53

availability of “resources”

Answer 53

REALISTIC

Question 54

consists of doing and documenting the activities that are the specific nursing actions needed to carry out the interventions.

Answer 54

implementation

Question 55

takes place at the end of the learning process to ascertain if the objectives have been achieved and competencies developed

Answer 55

summative evaluation

Question 56

strives to assess the effectiveness of the nursing actions performed focuses more on the desired outcome

Answer 56

summative evaluation

Question 57

Goal met. Productive cough with moderate amount of thick, yellow sputum.

Answer 57

summative

Question 58

provides information about learning needs of clients and where additional instruction is needed. it is designed to monitor activities with the purpose of improving the care plan.

Answer 58

formative

Question 59

provides information about learning needs of clients and where additional instruction is needed. it is designed to monitor activities with the purpose of improving the care plan.

Answer 59

formative

Question 60

Continuing, modifying, or terminating the nursing care plan

Answer 60

evaluation phase