Nokea
What documentation reflects implementation?
- A. Patient selected low-sugar snacks independently.
- B. Patient was medicated with Tylenol 500 mg PO for pain.
- C. Patient was ambulated for 15 minutes after lunch.
- D. Patient participated in group therapy session without reminder.
Correct Answer: C
Rationale: Implementation is the nurse carrying out nursing orders to promote outcome achievement.
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NANDA International meets to reorganize diagnosis labels and language every 2 ____
Correct Answer: years
Rationale: NANDA International meets every two years to revise language, form, and diagnosis labels.
What is an appropriate outcome statement for a patient with a patient problem of ineffective airway clearance related to thick secretions?
- A. The patient will increase intake to 1000 mL daily to liquefy secretions.
- B. The patient will cough more frequently within 3 days.
- C. The patient will breathe better within 3 days.
- D. The patient will perform deep-breathing exercises four times daily.
Correct Answer: A
Rationale: The patient goal would be to improve airway clearance. Coughing more frequently within 3 days and performing deep-breathing exercises four times daily do not directly relate to the problem of thick secretions. Breathing better within 3 days is too vague.
The patient is confined to bed rest which contributes to immobility. What is bed rest considered in this situation?
- A. Contributing to the patient's recovery
- B. A risk factor
- C. Difficult to maintain
- D. A nursing responsibility
Correct Answer: B
Rationale: Risk factors are those that increase the susceptibility of a patient to a problem.
A systematic method by which nurses plan and provide care for patients is known as the nursing ____
Correct Answer: process
Rationale: The nursing process serves as the organizational framework for the practice of nursing. It is a systematic method by which nurses plan and provide care for patients.
When the nurse is prioritizing care during the planning phase of the nursing process what is the guiding framework?
- A. Primary
- B. Secondary
- C. Unreliable
- D. Biased
Correct Answer: B
Rationale: Secondary sources include family members.