Into to the Nursing Process

Question 1

5 key principles of the nursing process

Answer 1

1) Critical thinking
2) Patient centered care
3) Goal oriented tasks
4) Evidence-based practice
5) Nursing intuition

Question 2

The nursing process, as a __ __ model, demonstrated competency in the nursing practice and forms the foundation for clinical __ __

Answer 2

critical thinking

decision making

Question 3

5 sequential steps of the nursing process

Answer 3

1) Assessment
2) Analysis
3) Planning
4) Implementation
5) Evaluation

Question 4

Gather subjective and objective data

Answer 4

Assessment

Question 5

Analyze, validate, and cluster patient data to identify problems

Answer 5

Analysis

Question 6

Identifies goals that are realistic, measurable, patient focused, with specific outcomes

Answer 6

Planning

Question 7

Initiates nursing interventions designed to help patient establish goals

Answer 7

Implementation

Question 8

Determines if patient’s foals are met, examines effectiveness of interventions

Answer 8

Evaluation

Question 9

3 essential characteristics of nursing process

Answer 9

Organized
Outcome oriented
Collaborative

Question 10

3 more essential characteristics of nursing process

Answer 10

Dynamic, changing overtime
Requires knowledge application, analysis, critical thinking
Universally adaptable to all kinds of patients

Question 11

Systemic collection of patient Dara, 1st step in providing care

Answer 11

Assessment

Question 12

Assess state of patient’s physical, psychological, emotional, environmental, sociocultural, economic and spiritual health

Answer 12

Holistic assessment

Question 13

Data obtained directly from the patient

Answer 13

Primary data

Question 14

Data collected from family, caregivers, HCPs, medical record

Answer 14

Secondary data

Question 15

Information that is seen, measured, or tested

Answer 15

Objective data

Question 16

Information collected from the patient

Answer 16

Subjective data

Question 17

Second step in nursing process

Answer 17

Analysis

Question 18

Nurses’s clinical judgement based on data, a problem, or response to a problem

Answer 18

Nursing diagnosis

Question 19

An actual or potential problem or response treated by HCPs/team

Answer 19

Collaborative problem

Question 20

Who should be involved in determining nursing diagnoses if possible?

Answer 20

The patient

Question 21

naming systems aka

Answer 21

nomenclatures

Question 22

Standardized nursing language system used for point-of-care documentation

Answer 22

International Classification for Nursing Practice (ICNP)

Question 23

What can the ICNP be used to identify? (3)

Answer 23

Diagnoses, interventions, outcomes

Question 24

To determine if problems are improving, declining, or unchanged

Answer 24

Purpose of evaluation

Question 25

3 functions to effectively evaluate patient goals

Answer 25

Examine results Compare achieved effect with goals and outcomes Recognize errors

Question 26

Last step of the nursing process

Answer 26

Evaluation

Question 27

5 steps to prepare for implementation

Answer 27

1) Reassess patient 2) Review/revise POC 3) Organize resources and care delivery 4) Anticipate and prevent complications 5) Implement nursing interventions

Question 28

Performed on behalf of patient

Answer 28

indirect care

Question 29

Performed on or with patients

Answer 29

direct care

Question 30

Example of indirect care

Answer 30

Provider prescribes a special diet

Question 31

Example of direct care

Answer 31

ambulating a patient

Question 32

Fourth step of the nursing process

Answer 32

Implementation

Question 33

Collaborative interventions

Answer 33

Requires combined knowledge of multiple HCPs

Question 34

Needs order from the HCP

Answer 34

HCP initiated intervention

Question 35

Nurse-initiated interventions

Answer 35

Does not require HCP, nurse can do alone

Question 36

3 types of nursing interventions

Answer 36

nurse-initiated HCP-initiated collaborative interventions

Question 37

Measurable changes

Answer 37

outcomes

Question 38

Goals may extend over weeks or months

Answer 38

long-term goals

Question 39

Goals may be achieved in 1 week or less

Answer 39

short-term goals

Question 40

SMART stands for...

Answer 40

``` Specific Measurable Attainable Realistic Timed ```

Question 41

Goals and outcomes should be written according to the

Answer 41

SMART acronym

Question 42

Often focused on long term patient needs can affect future well being if not addressed

Answer 42

Low importance priority

Question 43

Intermediate importance priority

Answer 43

Non emergent, but important to address to prevent complications

Question 44

High important priority

Answer 44

If not addressed, can results in patient harm or harm to others

Question 45

Priority setting is

Answer 45

Organization of a vision for a desired patient outcomes, NOT a list of tasks

Question 46

Third step in the nursing process

Answer 46

Planning

Question 47

The nursing diagnoses reflects clinical judgements about...

Answer 47

Patient problems health promotion Vulnerability/risk for problems