Identify the two primary methods used to collect data:

interview and physical examination

review of the doctor's orders and the Kardex

written report by patient and family

review of the chart and the nurse's notes

Answer and Explanation

The Correct Answer is A

A. Interview and physical examination: The two primary methods of data collection in nursing are:

Interview (subjective data: patient history, symptoms, concerns)
Physical examination (objective data: vital signs, assessment findings)

B. Review of the doctor's orders and the Kardex: This provides supplementary data but does not directly collect patient information.

C. Written report by patient and family: This may provide valuable subjective data but is not a primary method of data collection.

D. Review of the chart and the nurse’s notes: This is reviewing existing documentation, not actively collecting data.

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Correct Answer is D

Explanation

A. Unacceptable because it is vague subjective data without supportive data: The documentation includes objective data (BP, pulse), a physician notification, an intervention (analgesic), and an outcome.

B. Good because it shows immediate response to the problem: While the response to the problem is immediate, this choice is incomplete as it does not acknowledge that the documentation reflects all aspects of assessment, intervention, and evaluation.

C. Inadequate because the time of physician notification is not listed: While including the exact time of physician notification is best practice, the record still meets documentation standards.

D. Acceptable because it includes assessment, intervention, and evaluation: The note follows the nursing process (assessment, intervention, and response/evaluation), making it acceptable documentation.

A. CNA B. Technician C. RN D. LPN/LVN

Correct Answer is C

Explanation

A. CNA (Certified Nursing Assistant): CNAs assist with basic patient care (e.g., hygiene, vital signs) but do not perform assessments or make nursing diagnoses.

B. Technician: Technicians perform specific tasks (e.g., drawing blood, ECGs) but do not analyze patient data for diagnosis.

C. RN (Registered Nurse): The RN is responsible for analyzing and interpreting data, identifying nursing diagnoses, and developing the care plan.

D. LPN/LVN (Licensed Practical/Vocational Nurse): LPNs/LVNs can collect data but cannot make a nursing diagnosis, which is the RN’s role.

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Identify the two primary methods used to collect data:

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Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

Identify the person responsible for analyzing and interpreting data to arrive at a nursing diagnosis:

Correct Answer is C

Explanation

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