Compare an actual nursing diagnosis with a risk for nursing diagnosis, recognizing that in the case of the actual nursing diagnosis
the patient is vulnerable to develop the problem
there is no evidence of defining characteristics
a condition is currently present
it is written as a two-part statement
The Correct Answer is C
A. The patient is vulnerable to develop the problem: This describes a risk diagnosis, where the patient has the potential to develop a condition but does not currently have it.
B. There is no evidence of defining characteristics: An actual nursing diagnosis must have defining characteristics (symptoms/signs).
C. A condition is currently present: An actual nursing diagnosis means the condition is already present, with observable signs and symptoms.
D. It is written as a two-part statement: Actual nursing diagnoses use a three-part statement:
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Problem (diagnosis)
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Etiology (cause)
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Signs and Symptoms (evidence)
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Use a Nursing Diagnosis from a source other than NANDA-I: NANDA-I provides standardized nursing diagnoses that ensure accurate problem identification and care planning.
B. Limit the number of interventions: Interventions should be appropriate and sufficient rather than arbitrarily limited.
C. Select interventions which will be easy to implement: Interventions should be effective and individualized, not just easy.
D. Involve the patient in the process: Patient involvement ensures better adherence, understanding, and personalized care.
Correct Answer is C
Explanation
A. The LPN should document the care that he/she provided and the care that was given by unlicensed assistive staff.: While the LPN is responsible for documenting their own care, they are not responsible for documenting care provided by unlicensed assistive personnel (UAP). Each staff member is responsible for documenting their own care.
B. The registered nurse must document all care provided by the nursing assistants because the RN is responsible for all patient care.: While RNs oversee patient care, UAPs and LPNs must document the care they perform themselves.
C. All staff members should document all of the care that they have provided.: Every healthcare provider is responsible for documenting their own interventions to maintain accurate and legal records.
D. All staff should document all care they provided, but the RN (as the only independent practitioner) must sign their notes.: While RNs may sign their own documentation, they do not need to sign documentation made by LPNs or UAPs unless verification is required.
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