Nokea
One benefit of computerized charting is that:
- A. it increases cost
- B. it promotes individualization of the medical record
- C. it improves legibility
- D. it minimizes the number of forms to be completed
Correct Answer: C
Rationale: Computerized charting (C) improves legibility, reducing errors from illegible handwriting. A, B, and D are incorrect or less accurate benefits.
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Patient with a urinary tract infection
The patient with a urinary tract infection is being assessed using a critical pathway. When a projected outcome is not met by a predetermined date it is determined that a/an:
- A. omission exists
- B. failure exists
- C. variance exists
- D. error exists
Correct Answer: C
Rationale: A variance (C) occurs when outcomes deviate from the critical pathway's timeline, indicating a need for reassessment. A, B, and D are less precise terms.
Patient is admitted with a serious injury of the left hip after a fall at home. She is crying with severe pain in her left hip and leg
Your patient is admitted with a serious injury of the left hip after a fall at home. She is crying with severe pain in her left hip and leg. Which nursing diagnosis would apply to this patient's immediate needs?
- A. pain
- B. skin integrity
- C. fluid volume
- D. knowledge deficit
Correct Answer: A
Rationale: Pain (A) is the immediate need due to severe discomfort, requiring urgent management. Skin integrity (B), fluid volume (C), and knowledge deficit (D) are secondary.
Patient with dyspnea
The nurse is trying to decide what interventions will assist the patient with dyspnea to meet needs demonstrated by the patient. This phase of the nursing process is:
- A. implementation
- B. evaluation
- C. planning
- D. assessment
Correct Answer: C
Rationale: Planning (C) involves selecting interventions for patient needs, like dyspnea. A, B, and D represent other phases.
In which step of the nursing process do nurses look at outcomes?
- A. Evaluation
- B. Assessment
- C. Implementation
- D. Planning
Correct Answer: A
Rationale: Evaluation (A) is where nurses assess whether outcomes and goals were met. Assessment (B) collects data, Implementation (C) executes interventions, and Planning (D) sets goals.
Patient walks with a limp; Patient reports pain level as 3 on a scale of 1 to 10; Coughed up 5 mL yellow sputum; Headache in frontal area
The nurse is documenting patient data. Which of the following should the nurse document under objective data? (select all that apply)
- A. Assistive personnel reports the patient walks with a limp
- B. Patient reports pain level as 3 on a scale of 1 to 10
- C. Heart rate 72 beats per minute
- D. Respiratory rate 22 per minute with even unlabored respirations
- E. Coughed up 5 mL yellow sputum
- F. Headache in frontal area
Correct Answer: C,D,E
Rationale: C: Heart rate is measured, making it objective. D: Respiratory rate is observed and quantified, thus objective. E: Sputum volume and color are observable, hence objective. A is secondhand, B and F are subjective patient reports.