Chapter 11: Implementing the Nursing Process: Standards of Practice and Professional Performance

Chapter 11: Implementing the Nursing Process: Standards of Practice and Professional Performance

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. A nurse teaching a patient about the effects and side effects of the prescribed medication bases the plan on the knowledge that learning is more effective when:

a.	patients are actively included in the process.
b.	topics are introduced only when the patient expresses an interest.
c.	nurses establish realistic goals for learning on behalf of the patient.
d.	patients have responsibility for directing the teaching-learning process.

 

 

ANS:  A

Learning is more effective when patients participate in the learning experience. By including patients as active participants, the nurse helps restore their sense of control over their life and over their responsibility for their own actions.

 

DIF:    Cognitive Level: Comprehension     REF:   Text Page: 152

TOP:   Nursing Process: Planning               MSC:  NCLEX: Health Promotion and Maintenance

 

2. A nurse interviewed a reluctant patient who answered questions with minimal responses and rarely made eye contact. When documenting baseline data collected in the interview, the nurse should include:

a.	interview content only.
b.	a description of the process of the interview.
c.	both the content and the process of the interview.
d.	both factual data about the patient and the nurse’s emotional reaction.

 

 

ANS:  C

It is important to document both baseline content and process. In addition to the verbal content of the interview, the patient’s nonverbal messages and the nurse’s reactions to the patient give important clues to the patient’s state.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 150

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Psychosocial Integrity

 

3. While gathering a baseline history about a patient, a nurse is told by a team social worker that the patient “acts weird and has bad hygiene.” The nurse’s responsibility is to:

a.	accept the data without question.
b.	form impressions based on data personally gathered.
c.	document the impression of the team social worker.
d.	discuss the social worker’s impression with the patient.

 

 

ANS:  B

In using information from secondary sources, nurses should not simply accept the assessment of another health care team member; instead, they should apply the information they obtain to their nursing framework for data collection and formulate their own impressions and diagnoses. This brings another perspective to the work of the health care team and promotes an unbiased receptivity to patients and their problems.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 152

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Psychosocial Integrity

 

4. To obtain the clearest clinical information about a patient, a nurse who used several secondary sources, including the patient’s spouse and the report of the admitting psychiatrist, will seek validation from:

a.	the patient.
b.	psychiatric nursing textbooks.
c.	the patient’s extended family.
d.	the use of psychiatric behavioral rating scales.

 

 

ANS:  A

Patients should be regarded as a source of validation.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 150

TOP:   Nursing Process: Assessment           MSC:  NCLEX: Psychosocial Integrity

 

5. If physicians wish to understand the nursing equivalent of the medical DSM-IV-TR, they should seek an understanding of the:

a.	nursing diagnoses.
b.	nursing process.
c.	behavioral rating scales.
d.	computerized medical records.

 

 

ANS:  A

A medical diagnosis is the health problem or disease state of the patient. Nursing diagnoses identify patterns of response to actual or potential psychiatric illnesses and mental health problems. Nursing diagnoses proceed from inductive and deductive reasoning, logical decision making, knowledge of normal parameters, and sociocultural sensitivity.

 

DIF:    Cognitive Level: Application           REF:   Text Page: 152

TOP:   Nursing Process: Analysis

MSC:  NCLEX: Safe, Effective Care Environment: Management of Care