Test Generator Questions, Chapter 7, Nursing Diagnosis

Format: Multiple Choice

Chapter: 7

Client Needs: Safe and Effective Care Environment: Management of Care

Cognitive Level: Understand

Integrated Process: Nursing Process

Learning Objective: 3

Page and Header: Introduction, p. 97.

1. What is the nurse accountable for, according to state nurse practice acts?

A) Managing the care team effectively

B) Making nursing diagnoses

C) Prescribing PRN (as needed) medications

D) Mentoring other nurses

2. The nursing diagnosis taxonomy provides nursing with:

A) legal information.

B) common language.

C) discharge planning.

D) evaluative care.

3. Which of the following is classified as a nursing diagnosis?

A) Esophageal cancer

B) Cholecystitis

C) Grieving

D) Pneumonia

4. Nursing diagnoses that require physician-prescribed and nurse-prescribed actions would be what type of problems?

A) Independent health problems

B) Collaborative health problems

C) Physician-developed problems

D) Interdisciplinary health problems

5. In the development of a nursing diagnosis for a client who has cachexia and decreased weight, what would be an appropriate nursing diagnosis?

A) Anorexia nervosa and bulimia

B) Lack of adequate nutrition related to decreased calories

C) Weight loss related to abdominal discomfort

D) Imbalanced nutrition: less than body requirements

6. What does the nursing diagnosis represent?

A) Symptoms

B) Signs

C) Cues

D) Maladaptation

7. What gives additional meaning to a nursing diagnosis?

A) Composition

B) Descriptors

C) Dysfunction

D) Qualifications

8. What is meant by impaired state of equilibrium?

A) It describes the client’s condition.

B) It is common terminology.

C) It is a nursing diagnosis.

D) It assists in planning care.

9. What information provides the nurse with accuracy when developing a nursing diagnosis?

A) A set of lab values

B) Abnormal diagnostic tests

C) A set of clinical cues

D) Specific nursing interventions

10. One major requirement of a nursing diagnosis is that it focuses on a problem that is:

A) established by the physician.

B) based on the client’s pathophysiology.

C) legally treatable by registered nurses.

D) included within the diagnosis-related group.

11. A client is experiencing shortness of breath, lethargy, and cyanosis. These three cues provide organization, or:

A) categorizing.

B) diagnosing.

C) grouping.

D) clustering.

12. The act of analyzing and synthesizing cues requires:

A) critical thinking.

B) certification.

C) advanced practice.

D) attendance at NANDA.

13. A nurse sees the client grimace and documents that the client is in pain, without interviewing the client to obtain further cues. The nurse has:

A) impaired cluster interpretation.

B) a lack of cues, or premature closure.

C) ineffective database.

D) inaccurate evaluation.

14. Which statement appropriately identifies a nursing diagnosis reflecting vulnerability of a woman 78 years of age who is confined to bed?

A) Ineffective airway clearance related to bed rest

B) Immobility related to confinement to bed

C) Potential for pneumonia related to inactivity

D) Risk for impaired skin integrity related to bed rest

15. Why is coding important when writing a nursing diagnosis?

A) Enhances the professionalism of the nursing process

B) Allows for direct reimbursement for nurses

C) Evaluates the diagnostic statement for accuracy

D) Provides legal characteristics for licensure

16. What is the purpose of establishing a nursing diagnosis?

A) To describe a functional health problem

B) To collaborate with the physician

C) To identify medical problems

D) To meet accreditation criteria

17. A nurse had identified several nursing diagnoses for a client. Which diagnosis best reflects health promotion?

A) Constipation related to inadequate intake of fiber

B) Impaired skin integrity related to prolonged immobility

C) Readiness for enhanced family coping

D) Right hip fracture secondary to fall

18. Which assessment finding would support the nursing diagnosis of acute pain? Select all that apply.

A) The client had an abdominal hysterectomy 1 day ago.

B) The client is crying in pain about 20 minutes before his or her pain medicine is due.

C) The client has a history of osteoarthritis.

D) The client had back surgery 2 years ago and expresses the need for ibuprofen on most days.

E) The client is a heavy cigarette smoker.

19. The following nursing diagnosis appears on a clients plan of care: Impaired Physical Mobility related to postoperative pain as evidenced by difficulty ambulating. The nurse identifies the descriptor in this nursing diagnosis as:

A) impaired.

B) physical mobility.

C) postoperative pain.

D) difficulty ambulating.

20. A nurse is developing a plan of care for a client with a chronic respiratory problem. When developing appropriate nursing diagnoses for this client, the nurse needs to keep in mind that:

A) the interventions planned must be within the nurse’s scope of practice.

B) the problem’s existence requires validation by the physician.

C) the main focus is on monitoring the body’s pathophysiologic response.

D) The signs and symptoms of the disease are part of the information conveyed.

21. Assessment of a client with difficulty breathing reveals thick, tenacious secretions in the trachea and bronchi and excessive sputum with coughing. The respiratory rate is slightly increased. When developing this client’s plan of care, which nursing diagnostic label would be most appropriate?

A) Risk for activity intolerance

B) Disturbed sleep pattern

C) Ineffective airway clearance

D) Impaired spontaneous ventilation

22. A nurse is preparing to write a nursing diagnosis for a client. Which activity would the nurse need to do first?

A) Identify the significant data

B) Cluster the cues

C) Synthesize cue clusters

D) Validate the diagnosis

23. A nurse has identified a risk nursing diagnosis for a client. When writing this diagnosis, the nurse would write a statement consisting of how many parts?

A) One

B) Two

C) Three

D) Four

24. A client has significant problems related to breathing for which the nurse identifies several nursing diagnostic labels, including ineffective breathing pattern and impaired gas exchange. The nurse understands that these diagnostic labels are based on which organizing framework?

A) Functional health patterns

B) Body system affected

C) Maslow’s hierarchy

D) Reimbursement codes

25. A nurse is developing the plan of care for a client and establishes several nursing diagnoses based on assessment data. The nurse demonstrates an understanding of nursing diagnoses by focusing on which area?

A) Actions to be initiated for treatment

B) Human responses to actual or potential health problems

C) Pathophysiologic responses occurring in body systems

D) Problem validation through physician collaboration