Which statement best defines the nursing process? Select one answer

Series of assessments that isolate a client’s health problem

Framework for the organization of individualized nursing care

Preset formula for the design of nursing care

Method to assure that the physician’s orders are carried out correctly

Answer and Explanation

The Correct Answer is B

Choice A reason: Series of assessments that isolate a client’s health problem is not the best definition of the nursing process. The nursing process is not only a series of assessments, but also a series of actions that include planning, implementing, and evaluating the nursing care. The nursing process does not isolate a client’s health problem, but rather identifies and addresses the client’s holistic needs and responses to health and illness. Therefore, this choice is incorrect.

Choice B reason: Framework for the organization of individualized nursing care is the best definition of the nursing process. The nursing process is a framework that guides the nurse’s decision making and actions in providing individualized nursing care to each client. It involves five steps: assessment, diagnosis, outcomes identification, planning, implementation, and evaluation. It is based on scientific principles, ethical standards, and evidence-based practice. Therefore, this choice is correct.

Choice C reason: Preset formula for the design of nursing care is not the best definition of the nursing process. The nursing process is not a preset formula, but rather a dynamic and ﬂexible method that adapts to the changing needs and situations of each client. It requires critical thinking, creativity, and clinical judgment from the nurse. It also involves collaboration and communication with the client and other members of the health care team. Therefore, this choice is incorrect.

Choice D reason: Method to assure that the physician’s orders are carried out correctly is not the best definition of the nursing process. The nursing process is not a method to assure that the physician’s orders are carried out correctly, but rather a method to provide independent and autonomous nursing care that complements or supplements the medical care. The nursing process reﬂects the nurse’s scope of practice, responsibility, and accountability for the client’s well-being. It also empowers the client to participate in their own care and achieve their health goals. Therefore, this choice is incorrect.

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Correct Answer is C

Explanation

Choice A reason: “Where do you hurt?” is not the best response to the PN’s observations. This response shows closed-ended questioning, which is a communication technique that involves asking questions that require a yes or no answer or a specific piece of information. It also shows confrontation, which is a communication technique that involves challenging or opposing the other person’s statements or behaviors. It may make the client feel defensive, pressured, or misunderstood, and may discourage further communication. Therefore, this choice is incorrect.

Choice B reason: "I am glad you are feeling beter and have no discomfort.” is not the best response to the PN’s observations. This response shows false reassurance, which is a communication technique that involves minimizing or dismissing the other person’s feelings or situation. It also shows inconsistency, which is a communication barrier that involves giving contradictory or conﬂicting messages. It may make the client feel confused, ignored, or invalidated, and may undermine the trust or rapport between the client and the PN. Therefore, this choice is incorrect.

Choice C reason: "What you are saying and what I am observing don’t seem to match.” is the best response to the PN’s observations. This response shows reﬂection, which is a communication technique that involves restating or paraphrasing what the client has said to show understanding and clarify meaning. It also shows congruence, which is a communication skill that involves using consistent verbal and nonverbal cues to reinforce the message and avoid confusion or misunderstanding. It helps the client to recognize and explore their own feelings or thoughts, and shows that the PN is atentive, respectful, and empathetic. Therefore, this choice is correct.

Choice D reason: "It makes me uncomfortable when you are not honest with me.” is not the best response to the PN’s observations. This response shows self-disclosure, which is a communication technique that involves sharing personal information or feelings with the other person. It also shows accusation, which is a communication barrier that involves blaming or criticizing the other person for their statements or behaviors. It may make the client feel

guilty, ashamed, or angry, and may damage the relationship or communication between the client and the PN. Therefore, this choice is incorrect.

A. An abduction pillow is placed between the client's legs when positioned. B. The client is told to keep both legs straight and together while turning. C. A turning sheet is used under the client for turning and repositioning. D. The UAPs keep their backs straight and knees bent when moving the client.

Correct Answer is B

Explanation

This is the observation that indicates that the UAPs need additional information about the turning procedure because it is incorrect and may cause complications for the client. The client who had a hip arthroplasty with prosthesis placement should not keep both legs straight and together while turning because this may cause dislocation of the prosthesis, nerve damage, or bleeding. The client should keep the aﬀected leg slightly abducted and supported with pillows or an abduction device.

A. An abduction pillow is placed between the client's legs when positioned is correct and does not indicate a need for additional information. This helps to maintain proper alignment and prevent dislocation of the prosthesis.

C. A turning sheet used under the client for turning and repositioning is correct and does not indicate a need for additional information. This helps to reduce friction and shear forces on the skin and prevent pressure ulcers.

D. The UAPs keep their backs straight and knees bent when moving the client is correct and does not indicate a need for additional information. This helps to protect their own musculoskeletal health and prevent injuries.

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Which statement best defines the nursing process? Select one answer

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Although the client denies pain, the Practical Nurse (PN) observes the client is breathing rapidly with clenched fists and is grimacing. The PN’s best response to his observations would be: * Select one answer

Correct Answer is C

Explanation

The practical nurse (PN) observes two unlicensed assistive personnel (UAP) turning an older client who had a hip arthroplasty with prosthesis placement four hours ago. Which observation by the PN indicates that the UAPs need additional information about the turning procedure?

Correct Answer is B

Explanation

Which of the following types of posture is best for the nurse to use when communicating with the patient? (Select all that apply)

The nurse preceptor is instructing the new nurse on appropriate communication techniques. The new nurse indicates a need for further teaching on using assertive communication, if she does which of the following when communicating with patients? Select one answer

Family members awaiting the outcome of a suicide atempt are tearful. Which response by the Practical Nurse (PN) is therapeutic to the family at this time? * Select one answer

Which statement best defines the nursing process? Select one answer

A nurse who is assigned to care for six clients is administering a tube feeding to a client when another client spills breakfast coﬀee on her chest and abdomen. What actions by the nurse are best? (Select all that apply)

A client is admited with the following vital signs: temperature 102oF (38.9oC); heart rate 144 beats/minute and irregular;, and respiratory rate 22 breaths/minute. Which nursing diagnosis takes highest priority when planning this client’s care? Select one answer

A client is to be discharged from an acute care facility after treatment for right leg thrombophlebitis. The nurse notes that the client’s leg is pain free, without redness or edema. The nurse’s actions reﬂect which phase of the nursing process? Select one answer

A Practical Nurse (PN) is planning on leaving the room of a patient with a tracheotomy. The PN ensures that the client has which of the following means of communication before leaving the room?