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National Council Licensure Examination(NCLEX-PN) Questions 516–520 (page: 105)

Updated On: 9-Feb-2026

During which phase of the nursing process does data get collected and validated with the patient and/or family members by the nurse?

  1. The implementation phase.
  2. The assessment phase.
  3. The evaluation phase.
  4. The planning phase.

Answer(s): B

Explanation:

Subjective, objective, primary and secondary data is collected and validated with the patient and/or family members by the nurse during the assessment phase of the nursing process.
The implementation phase is the actual care of the patient; the evaluation phase includes the comparison of current data to expected outcomes to determine if the patient has achieved the pre-established goals and the planning phase consists of priority setting and care planning.



What is a major difference between a problem oriented medical record and a source oriented medical record?

  1. The problem oriented medical system has a centralized part of the chart for interdisciplinary progress notes and the source oriented medical record has separate areas for each profession’s progress notes.
  2. The problem oriented medical system consists of narrative progress notes and the source oriented medical record uses SOAP.
  3. The source oriented medical system uses charting by exception and the source oriented medical record system does not.
  4. The source oriented medical system has a centralized part of the chart for interdisciplinary progress notes and the problem oriented medical record has separate areas for each profession’s progress notes.

Answer(s): A

Explanation:

The problem oriented medical system has a centralized part of the chart for interdisciplinary SOAP progress notes and the source oriented medical record has separate areas for each profession’s progress notes.
Although source oriented medical records can use SOAP, this is not a defining characteristic and most of these notes are free formed narrative notes.
Charting by exception is a distinctly different medical system than source or problem oriented medical systems.



Which of the following are necessary elements of malpractice? (Choose all that apply.)

  1. A breach of duty
  2. An intentional act
  3. A nonintentional act
  4. Foreseeability
  5. Patient harm
  6. Causation

Answer(s): A,D,E,F

Explanation:

The necessary elements of malpractice are a duty to the patient, a breach of duty, foreseeability, causation, and patient harm.
The breach of duty can be intentional or nonintentional.



Select the following fire emergency interventions in correct sequential order.

  1. C, B, A, D
  2. A, C, B, D
  3. C, A, B, D
  4. C, A, D, B

Answer(s): C

Explanation:

The RACE acronym is used to prioritize and sequence the steps that must be followed when a fire occurs. R stands for rescue patients;
A is pulling the fire alarm;
C is to contain the fire by closing doors, etc.; and
E is extinguishing the fire with a fire extinguisher when possible.



You are preparing a sterile field for an operating room surgical procedure. When should you stop the preparation of this sterile field?

  1. When you have placed a sterile item only 1 inch and not 2 inches from the edge of the sterile field.
  2. When you have completely finished the field. You cannot stop the set up until it is all done.
  3. When you have accidentally poured a sterile liquid into a container that was on the sterile field.
  4. When you turn your upper body only away from the field because the surgeon calls your name.

Answer(s): D

Explanation:

You must stop the preparation of the sterile field and begin all over again when you have turned your upper body away from the field because sterile technique has been violated and the sterility of the field has been broken even when on turns away from the sterile field even for a second.
Sterile items must be placed within one inch, not two inches from the edge of the sterile field.
Lastly, sterile solutions can be poured into sterile containers on the sterile field without breaking the techniques required according to surgical asepsis.



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