Nursing Diagnosis

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Nursing Today
The Health Care Delivery System
Community-Based Nursing Practice
Theoretical Foundations of Nursing Practice
Evidence-Based Practice
Health and Wellness
Caring in Nursing Practice
Caring for the Cancer Survivor
Cultural Awareness
Caring for Families
Developmental Theories
Conception Through Adolescence
Young and Middle Adults
Older Adult
Critical Thinking in Nursing Practice
Nursing Assessment
Nursing Diagnosis
Planning Nursing Care
Implementing Nursing Care
Evaluation
Managing Patient Care
Ethics and Values
Legal Implications in Nursing Practice
Communication
Patient Education
Documentation and Informatics
Patient Safety and Quality
Immobility
Infection Prevention and Control
Vital Signs
Health Assessment and Physical Examination
Medication Administration
Complementary and Alternative Therapies
Self-Concept
Sexuality
Spiritual Health
The Experience of Loss, Death, and Grief
Stress and Coping
Activity and Exercise
Hygiene
Oxygenation
Fluid, Electrolyte, and Acid-Base Balance
Sleep
Pain Management
Nutrition
Urinary Elimination
Bowel Elimination
Skin Integrity and Wound Care
Sensory Alterations
Care of Surgical Patients

All Questions

Question 1

Free

Multiple Choice

After assessing a patient, a nurse develops a standard formal nursing diagnosis. What is the rationale for the nurse's actions?

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To form a language that can be encoded only by nurses

To distinguish the nurse's role from the physician's role

To develop clinical judgment based on other's intuition

To help nurses focus on the scope of medical practice

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Question 2

Free

Multiple Choice

Which diagnosis will the nurse document in a patient's care plan that is NANDA-I approved?

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Sore throat

Acute pain

Sleep apnea

Heart failure

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Question 3

Free

Multiple Choice

A nurse develops a nursing diagnostic statement for a patient with a medical diagnosis of pneumonia with chest x-ray results of lower lobe infiltrates. Which nursing diagnosis did the nurse write?

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Ineffective breathing pattern related to pneumonia

Risk for infection related to chest x-ray procedure

Risk for deficient fluid volume related to dehydration

Impaired gas exchange related to alveolar-capillary membrane changes

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Question 4

Free

Multiple Choice

The nurse is reviewing a patient's plan of care, which includes the nursing diagnostic statement, Impaired physical mobility related to tibial fracture as evidenced by patient's inability to ambulate. Which part of the diagnostic statement does the nurse need to revise?

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Etiology

Nursing diagnosis

Collaborative problem

Defining characteristic

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Question 5

Free

Multiple Choice

A nurse is using assessment data gathered about a patient and combining critical thinking to develop a nursing diagnosis. What is the nurse doing?

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Assigning clinical cues

Defining characteristics

Diagnostic reasoning

Diagnostic labeling

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Question 6

Multiple Choice

A patient presents to the emergency department following a motor vehicle crash and suffers a right femur fracture. The leg is stabilized in a full leg cast. Otherwise, the patient has no other major injuries, is in good health, and reports only moderate discomfort. Which is the most pertinent nursing diagnosis the nurse will include in the plan of care?

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Posttrauma syndrome

Constipation

Acute pain

Anxiety

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Question 7

Multiple Choice

The nurse is reviewing a patient's database for significant changes and discovers that the patient has not voided in over 8 hours. The patient's kidney function lab results are abnormal, and the patient's oral intake has significantly decreased since previous shifts. Which step of the nursing process should the nurse proceed to after this review?

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Diagnosis

Planning

Implementation

Evaluation

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Question 8

Multiple Choice

A patient with a spinal cord injury is seeking to enhance urinary elimination abilities by learning self-catheterization versus assisted catheterization by home health nurses and family members. The nurse adds Readiness for enhanced urinary elimination in the care plan. Which type of diagnosis did the nurse write?

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Risk

Problem focused

Health promotion

Collaborative problem

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Question 9

Multiple Choice

A nurse administers an antihypertensive medication to a patient at the scheduled time of 0900. The nursing assistive personnel (NAP) then reports to the nurse that the patient's blood pressure was low when it was taken at 0830. The NAP states that was busy and had not had a chance to tell the nurse yet. The patient begins to complain of feeling dizzy and light-headed. The blood pressure is rechecked and it has dropped even lower. In which phase of the nursing process did the nurse first make an error?

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Assessment

Diagnosis

Implementation

Evaluation

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Question 10

Multiple Choice

A nurse adds the following diagnosis to a patient's care plan: Constipation related to decreased gastrointestinal motility secondary to pain medication administration as evidenced by the patient reporting no bowel movement in seven days, abdominal distention, and abdominal pain. Which element did the nurse write as the defining characteristic?

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Decreased gastrointestinal motility

Pain medication

Abdominal distention

Constipation

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Question 11

Multiple Choice

The patient database reveals that a patient has decreased oral intake, decreased oxygen saturation when ambulating, reports of shortness of breath when getting out of bed, and a productive cough. Which elements will the nurse identify as defining characteristics for the diagnostic label of Activity intolerance?

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Decreased oral intake and decreased oxygen saturation when ambulating

Decreased oxygen saturation when ambulating and reports of shortness of breath when getting out of bed

Reports of shortness of breath when getting out of bed and a productive cough

Productive cough and decreased oral intake

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Question 12

Multiple Choice

A nurse performs an assessment on a patient. Which assessment data will the nurse use as an etiology for Acute pain?

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Discomfort while changing position

Reports pain as a 7 on a 0 to 10 scale

Disruption of tissue integrity

Dull headache

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Question 13

Multiple Choice

A new nurse writes the following nursing diagnoses on a patient's care plan. Which nursing diagnosis will cause the nurse manager to intervene?

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Wandering

Hemorrhage

Urinary retention

Impaired swallowing

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Question 14

Multiple Choice

A patient has a bacterial infection in left lower leg. Which nursing diagnosis will the nurse add to the patient's care plan?

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Infection

Risk for infection

Impaired skin integrity

Staphylococcal leg infection

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Question 15

Multiple Choice

A nurse adds a nursing diagnosis to a patient's care plan. Which information did the nurse document?

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Decreased cardiac output related to altered myocardial contractility.

Patient needs a low-fat diet related to inadequate heart perfusion.

Offer a low-fat diet because of heart problems.

Acute heart pain related to discomfort.

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Question 16

Multiple Choice

A charge nurse is evaluating a new nurse's plan of care. Which finding will cause the charge nurse to follow up?

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Assigning a documented nursing diagnosis of Risk for infection for a patient on intravenous (IV) antibiotics

Completing an interview and physical examination before adding a nursing diagnosis

Developing nursing diagnoses before completing the database

Including cultural and religious preferences in the database

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Question 17

Multiple Choice

A patient exhibits the following symptoms: tachycardia, increased thirst, headache, decreased urine output, and increased body temperature. The nurse analyzes the data. Which nursing diagnosis will the nurse assign to the patient?

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Adult failure to thrive

Hypothermia

Deficient fluid volume

Nausea

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Question 18

Multiple Choice

Which question would be most appropriate for a nurse to ask a patient to assist in establishing a nursing diagnosis of Diarrhea?

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"What types of foods do you think caused your upset stomach?"

"How many bowel movements a day have you had?"

"Are you able to get to the bathroom in time?"

"What medications are you currently taking?"

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Question 19

Multiple Choice

A nurse assesses that a patient has not voided in 6 hours. Which question should the nurse ask to assist in establishing a nursing diagnosis of Urinary retention?

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"Do you feel like you need to go to the bathroom?"

"Are you able to walk to the bathroom by yourself?"

"When was the last time you took your medicine?"

"Do you have a safety rail in your bathroom at home?"

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Question 20

Multiple Choice

A nurse is developing nursing diagnoses for a group of patients. Which nursing diagnoses will the nurse use? (Select all that apply.)

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Anxiety related to barium enema

Impaired gas exchange related to asthma

Impaired physical mobility related to incisional pain

Nausea related to adverse effect of cancer medication

Risk for falls related to nursing assistive personnel leaving bedrail down

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