NATIONAL AND STATE NURSING EXAM- MCQ _MG_00 157
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1. The patient will remain free from pain throughout hospitalization. This statement is an example of a (an):
a. Short term goal
b. Nursing diagnosis
c. Long term goal
d. Expected outcome.
Answer: a. Short term goal
Description:In the context of healthcare, expected outcomes are specific, measurable statements that describe the anticipated results of nursing interventions and the overall treatment plan. They are often formulated based on nursing diagnoses and guide the care provided to the patient. In this case, the expected outcome is that the patient will not experience pain during their time in the hospital.
2. First step of nursing process is:
a. Assessment
b. Implementation
c. Diagnosis
d. Planning
Answer: a. Assessment
Description:Assessment involves gathering information about the patient's health status, medical history, current condition, and any other relevant data. This step forms the foundation for the rest of the nursing process, as it helps nurses identify the patient's needs, problems, and areas requiring intervention.
3. Collection of subjective data from patient is carried out in:
a. Assessment phase
b. Planning phase
c. Implementation phase
d. Nursing diagnosis phase
Answer: a. Assessment phase
Description:Assessment involves gathering both subjective (patient's feelings, perceptions, and experiences) and objective (observable and measurable) data to comprehensively understand the patient's health status and needs. The subjective data collected during the assessment phase provide valuable insights into the patient's perspective, which is essential for developing an accurate picture of their condition and planning appropriate care.
4. Which of the following is an example of nursing diagnosis?
a. Hyperglycemia
b. Pain
c. Hypertension
d. Shock
Answer: b. Pain
Description:Nursing diagnoses are statements that describe a patient's actual or potential health problems that nurses can address through nursing interventions. "Pain" is an example of a nursing diagnosis because it describes a patient's health problem that requires nursing assessment and intervention. The other options (a. Hypertension, c. Shock, d. Hyperglycemia) are medical diagnoses that describe specific conditions or states of health rather than nursing diagnoses.
5. The interpretation of the information collected about the patient represents the:
a. Plan of care
b. Nursing interventions implemented for the patient
c. Health problems of the patient
d. Assessment of the patient
Answer: c. Health problems of the patient
Description:Assessment involves not only collecting data but also analyzing and interpreting that data to form a comprehensive understanding of the patient's health status and needs. This interpretation is a crucial step in the nursing process as it guides the subsequent development of the plan of care, identification of health problems, and selection of appropriate nursing interventions.
6. Action phase of nursing process includes:
a. Evaluation
b. Planning
c. Implementation
d. Subjective assessment
Answer: c. Implementation
Description:Implementation involves carrying out the planned nursing interventions and actions to address the patient's health needs and achieve the desired outcomes. This phase is where the nurse puts the care plan into action by providing the necessary treatments, medications, education, and other interventions to promote the patient's well-being.
7. Priorates of planning in nursing process is done based on:
a. Erik Erikson’s theory
b. Maslow’s hierarchy of human needs
c. Health – illness continuum model
d. Information processing model
Answer: b. Maslow’s hierarchy of human needs
Description:Maslow's hierarchy of needs is a widely recognized framework in nursing and healthcare that categorizes human needs into a hierarchy, ranging from basic physiological needs to higher-level psychological and self-fulfillment needs. In the nursing process, prioritizing care based on this hierarchy helps ensure that the most critical and immediate needs of the patient are addressed first, leading to better patient outcomes.
8. Patient-oriented outcomes should be derived from:
a. Nursing diagnosis
b. Planned intervention.
c. Assessment
d. Evaluation
Answer: c. Assessment
Description:Patient-oriented outcomes are specific goals or changes in a patient's condition that are directly related to the patient's health status and well-being. These outcomes should be based on the assessment data collected about the patient's current condition, needs, and preferences. While nursing diagnoses inform the identification of the patient's health problems, the assessment data is used to develop patient-oriented outcomes that are relevant and tailored to the individual patient.
9. Which of the following takes priority in planning nursing care for a client?
a. Hospital policy
b. Physician order
c. Client condition
d. Nurse’s condition
Answer: c. Client condition
Description:When planning nursing care for a client, the client's condition and needs take priority. Nursing care is centered around the individual patient and their specific health situation. While physician orders, nurse's judgment, and hospital policies are important considerations, they should all be aligned with and tailored to the client's condition. The client's well-being and best interests should guide the planning and implementation of nursing care.
10. The client manifestation that are objective are:
a. Signs
b. Disease
c. Symptoms
d. Syndrome
Answer: a. Signs
Description:Signs are objective, observable, and measurable indicators of a patient's condition. They can be detected by a healthcare provider and are often used to make a diagnosis or assess the progress of a condition. Symptoms, on the other hand, are subjective experiences reported by the patient, such as pain, nausea, or fatigue.
11. The nurse compares the characteristics of acute renal failure with those of chronic renal failure and at the end selects acute renal failure. This process is called:
a. Data lustering
b. Data interpretation
c. Data comparing
d. Data collection
Answer: b. Data interpretation
Description:Data interpretation involves analyzing and making sense of the collected information to reach conclusions or make decisions. In this case, the nurse is comparing the characteristics of acute renal failure and chronic renal failure to determine which condition best matches the patient's situation. This process is crucial for accurate diagnosis and effective decision-making in healthcare.
12. Total number of steps in nursing process are:
a. Three
b. Four
c. Five
d. Six
Answer: c. Five
Description:The nursing process consists of five steps, which are: Assessment Diagnosis Planning Implementation Evaluation These steps provide a systematic framework for nurses to provide effective and individualized care to patients.
13. The primary source of data for evaluation is:
a. Nurse
b. Doctor
c. Client
d. Family
Answer: c. Client
Description:The primary source of data for evaluation in the context of healthcare is the client (patient). Evaluating the effectiveness of nursing interventions and the progress of the client's condition requires gathering information directly from the client. This information helps determine whether the desired outcomes have been achieved and if any adjustments to the care plan are necessary. While input from doctors, nurses, and family members can be valuable, the client's own perspective and experiences are essential for accurate evaluation.
14. Which of the following is subjective data of nursing assessment?
a. Pale skin and moist hands
b. Vomiting, pulse 82/min.
c. Nausea and abdominal pain
d. Respirations 22/min, blood pressure 120/70 mm Hg.
Answer: c. Nausea and abdominal pain
Description:Subjective data in nursing assessment refers to information that the patient provides based on their personal feelings, experiences, and perceptions. "Nausea and abdominal pain" are examples of subjective data because they are symptoms that the patient reports and are not directly observable or measurable by a healthcare provider. The other options (a, b, and d) involve objective data that can be measured or observed externally.
15. Conditions that increase vulnerability to a disease known as:
a. Etiology
b. Precipitating factor
c. Risk factors
d. Pathophysiology
Answer: c. Risk factors
Description:A risk factor of predisposing factor in any attribute, characteristic or exposure of an individual that increase the likelihood of developing a disease or injury.
16. Data that include all the measurable and observable pieces of information are called:
a. Subjective data
b. Documented data
c. Objective data
d. Hearsay data
Answer: c. Objective data
Description:Objective data in healthcare and nursing refer to information that can be measured or observed directly. These are concrete and factual details that can be documented and shared among healthcare professionals. Examples include vital signs, laboratory results, physical examination findings, and other measurable aspects of a patient's condition. This data is not influenced by personal opinions or interpretations, making it more objective in nature.
17. When considering a client’s symptoms, how should the nurse categorize a client’s complaint of tinnitus?
a. Functional
b. Subjective
c. Prodromal
d. Objective
Answer: b. Subjective
Description:Tinnitus, a sensation of ringing or noise in the ears, is a symptom that the client experiences based on their personal perception. Since it is based on the client's own feelings and observations, it falls under the category of subjective data in nursing assessment. Subjective data are information provided by the patient about their experiences, sensations, and perceptions, which cannot be directly observed or measured by others.
18. A method of data interpretation among the following is:
a. Observation
b. Interview
c. Prioritization
d. Listening
Answer: c. Prioritization
Description:Interview, observation and listening are the methods of data collection not data interpretation whereas prioritizations is an action (interpretation) that can be done after collection of data.
19. Nurse uses the nursing process as a method of:
a. Planning, organizing and delivering patient care.
b. Meeting public expectations of nurse
c. Communicating with patients and families
d. Meeting public expectations of nurse
Answer: a. Planning, organizing and delivering patient care.
Description:The purpose of nursing process is primarily to organize and deliver care to the patient. Communicating with patients, meeting legal requirements and standards , meeting public expectations are duties and responsibilities that are part of nursing process.
20. The type of assessment that includes data related to clients biological, cultural, spiritual and social need is called:
a. Focused assessment
b. Behavioral assessment
c. Comprehensive assessment
d. Screening assessment
Answer: c. Comprehensive assessment
Description:Comprehensive assessment involves gathering in-depth information about a patient's overall health status, including not only their physical health but also their biological, cultural, spiritual, and social needs. This type of assessment aims to provide a thorough and holistic understanding of the patient's condition and factors that may influence their health and well-being. It goes beyond specific issues or concerns and takes into account a wide range of aspects that contribute to the patient's health.
21. Purpose of assessment is to:
a. To provide intervention
b. To collect basic data regarding client’s health status
c. For giving health education
d. Make nursing diagnosis
Answer: b. To collect basic data regarding client’s health status
Description:The primary purpose of assessment in nursing is to collect comprehensive and accurate data about a client's health status. This data forms the foundation for making informed clinical decisions, developing nursing diagnoses, creating care plans, and providing appropriate interventions. Assessment involves gathering information related to the client's physical, emotional, psychological, social, and environmental aspects to gain a holistic understanding of their health needs.
22. Your patient says that he “urinates at night†and it is affecting his daytime alertness. You would document this as:
a. Polyuria
b. Nocturia
c. Oliguria
d. Dysuria
Answer: b. Nocturia
Description:Nocturia and nocturnal polyuria is defined as the need to wake (one or more tiles) and pass urine at night. It should be distinguished from enuresis, where urine is passed unintentionally during sleep.
23. A post-operative patient is brought to the postsurgical ward. The receiving nurse assessed the patient for patient airway and stable vital signs. Which of the following should performed next?
a. Pain assessment on a scale of 1 to 10.
b. Complete the admission file work
c. Assess dressing for bleeding.
d. Log roll the patient to evaluate cleanliness of bed linens
Answer: c. Assess dressing for bleeding.
Description:After assessing the patient's airway and stable vital signs, the next priority for a post-operative patient should be to assess the surgical site and dressing for bleeding or any signs of complications. Monitoring the surgical wound and ensuring that there is no excessive bleeding or signs of infection is crucial for the patient's recovery and well-being. Once this immediate assessment is done, other tasks like completing admission paperwork or pain assessment can follow.
24. Time limit for registering birth is within:
a. 21 days
b. 14 days
c. 10 days
d. 7 days
Answer: a. 21 days
Description:The registration of births and deaths act passed in 1969, for the regulation of registration of births and deaths and for matter connected therewith. The normal period of 21 days (from the date of occurrence) has been prescribed for reporting the birth, death and still birth events.
25. The disadvantages of electronic health record are the following; EXCEPT:
a. Expensive
b. Downtime process
c. Lack of integration
d. Increased medicals errors
Answer: d. Increased medicals errors
Description:Electronic health records (EHRs) are designed to reduce medical errors by providing accurate and accessible patient information to healthcare providers. While there can be challenges and disadvantages associated with EHR implementation, including those listed in options (a), (b), and (c), the goal of EHRs is to enhance patient safety and decrease medical errors by improving communication, information sharing, and clinical decision-making.
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