the nursing process assignment

What is the Nursing Process?

Characteristics of the nursing process, history of the nursing process.

Understanding the nursing process is key to providing quality care to your patients. The nursing process is a cyclical process used to assess, diagnose, and care for patients as a nurse. It includes 5 progressive steps often referred to with the acronym:

Planning/outcomes
Implementation

In this article, we’ll discuss each step of the nursing process in detail and include some examples of how this process might look in your practice.

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The nursing process is a patient-centered, systematic, evidence-based approach to delivering high-quality nursing care. It consists of five steps: assessment , diagnosis , outcomes/planning, implementation, and evaluation.

The Nursing Process (ADPIE)

	Identify patients' health needs and collect about their condition.
	Identify any real or potential health problems that the patient is experiencing or may possibly experience.
	Develop a nursing plan of care, which outlines the actions that will be taken to meet the needs identified to achieve the desired patient outcomes.
	Carry out the plan of care and monitor patients' progress.
	Evaluate whether the plan of care was successful. If necessary, the process is then repeated until the patient is discharged or until they reach all their health care goals.

1. Assessment

To begin the nursing process, assessment involves collecting information about the patient and their health. This information is used to identify any problems, or potential problems, that may need to be addressed while you’re caring for a patient.

Example: If you’re admitting an older patient who is falling and getting injured at home, you’ll want to do a thorough physical and mental health assessment, including a medical history to try and determine why this is happening.

Some important things you’ll want to find out are:

What medications and over-the-counter products is the patient taking
History of alcohol and recreational drug use
Where the person lives and the layout of their home, including scatter rugs they may be tripping over: clutter, pets, stairs, slippery tubs they’re climbing into or out of, fluid or food spills on floors, lighting, mobility aids they use, etc.

2. Diagnosis

The Nursing Diagnosis is the second step in the nursing process and involves identifying real or potential health problems for a patient based on the information you gathered during the assessment.

Example: Using the falls patient example above, you may identify from your assessment that the patient is falling because they’re tripping on things in their environment that they don’t see, like their pet cat lying on the floor and loose scatter rugs.

Based on this, you might form a diagnosis such as “Falls related to poor vision, cluttered environment, unsteady gait, Lt. hip pain due to previous fall.”

3. Outcomes/Planning

Planning or Outcomes is the third step in the nursing process. This step involves developing a nursing care plan that includes goals and strategies to address the problems identified during the assessment and diagnosis steps.

Example: Continuing with the example above, you will likely recommend that the patient keep their environment,

Free of scatter rugs
Check to ensure the cat is not underfoot before they mobilize
Suggest the patient use a walker for support when mobilizing
Recommending that the patient schedule an eye exam to get their vision checked if they have not had one in the last year or two would also be a good idea or if they’ve noticed any changes in their vision lately.

4. Implementation

As the fourth step of the nursing process, implementation involves putting the plan of care into action.

Example In the above example, this would include:

Making sure the patient’s environment is free of clutter and tripping hazards while in the hospital or a skilled nursing facility.
Teaching the patient to wear proper footwear before mobilizing.
Assisting the patient with mobility as needed, including putting proper footwear on the patient if needed.
Speaking to the patient and family about removing scatter rugs from the patient’s home, scheduling an eye exam, and ensuring proper footwear is worn for mobilizing at home.
Discussing with the patient and family about getting the patient a walker to assist with mobility on discharge and providing one while the patient is admitted.

5. Evaluation

The last step of the nursing process is evaluation , which involves determining whether or not the goals of care have been met.

Example Here you would look back at the patient’s medical record to see if the patient has had any further falls since implementing the preventative actions above.

If so, you would repeat the nursing process over and reassess why this is still happening and plan new actions to prevent future falls.

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The nursing process is also characterized by the following elements.

1. Dynamic and Cyclic

The nursing process is an evolving process that continues throughout a patient’s admission or illness and ends when the problems identified by the nurse are no longer an issue.

2. Patient-Centered and Goal-Directed

The entire nursing process is sensitive to and responsive to the patient's needs, preferences, and values. As nurses, we need to act as patient advocates and protect the patient’s right to make informed decisions while involving the patient in goal setting and attainment.

3. Collaborative and Interpersonal

This describes the level of interaction that may be required between nurses, patients, families and supports, and the interprofessional healthcare team. These aspects of the nursing process require mutual respect, cooperation, clear communication, and decision-making that is shared between all parties involved.

4. Universally Applicable

As a widely and globally accepted standard in nursing practice, the nursing process follows the same steps, regardless of where a nurse works.

5. Systematic and Scientific

The nursing process is also an objective and predictable process for planning, conducting, and evaluating patient care that is based on a large body of scientific evidence found in peer-reviewed nursing research.

6. Requires Critical Thinking

Most importantly, it’s essential that nurses use critical thinking when planning patient care using the nursing process. This means as nurses, we must use a combination of our knowledge and past experiences with the information we have about a current patient to make the best decisions we can about nursing care.

The nursing process was introduced in 1958 by Ida Jean Orlando. Today, it continues to be the most widely-accepted method of prioritizing, organizing, and providing patient care in the nursing profession.

It’s characterized by the key elements of:

Critical thinking
Client-centered methods for treatment
Goal-oriented activities
Evidence-based nursing research and findings

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The nursing process helps nurses to provide quality patient care by taking a holistic view of each patient they plan care for.
The nursing process is an evidence-based approach to caring for patients that helps nurses provide quality care and improve patient outcomes.
Ida Jean Orlando introduced the nursing process in 1958.
The primary focus of the nursing process is the patient or client. The process is designed to meet the real and potential healthcare needs of the patient/client and to prevent possible illness or injury.

Leona Werezak BSN, MN, RN is the Director of Business Development at NCLEX Education. She began her nursing career in a small rural hospital in northern Canada where she worked as a new staff nurse doing everything from helping deliver babies to medevacing critically ill patients. Learning much from her patients and colleagues at the bedside for 15 years, she also taught in baccalaureate nursing programs for almost 20 years as a nursing adjunct faculty member (yes! Some of those years she did both!). As a freelance writer online, she writes content for nursing schools and colleges, healthcare and medical businesses, as well as various nursing sites.

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The Nursing Process: Everything Next-Gen NCLEX-RN Test-Takers Need to Know

This section of allnurses' Next-Gen NCLEX-RN Study Guide focuses on The Nursing Process. Resources

Next Gen Nclex
Table of Contents:
Phase 1: Assessment & Analysis

Phase 2: Diagnosis

Phase 3: planning.

Phase 4: Implementaion

Phase 5: Evaluation

Thinking Critically

Since the Next-Gen NCLEX-RN is a test that challenges nursing concepts rather than focusing solely on nursing content, you must understand how to use The Nursing Process.

The Nursing Process is a systematic approach nurses use to provide effective, safe patient care. It comprises five phases: Assessment & Analysis, Diagnosis, Planning, Implementation, and Evaluation. Each phase plays a crucial role in delivering quality nursing care, and understanding these phases is essential for success on the NCLEX exam.

This article is part of a more extensive study guide for the Next-Gen NCLEX-RN:

Best Free Online Next-Gen NCLEX-RN Study Guide
Next-Gen NCLEX-RN Question Leveling: Recognition, Comprehension, Application, and Analysis
Next-Gen NCLEX-RN Identifying Prioritization, Delegation, and Scope of Practice Questions
Next-Gen NCLEX-RN Expert Test-Taking Strategies

Phase 1: Assessment & Analysis

The first step of The Nursing Process, assessment, is a nurse's most important skill to grow and nurture. Assessment allows nurses to identify actual or potential alterations in health, safety, and overall well-being for their patients, families, and communities. Assessment can include:

Interviewing the patient
Physically assessing the well-being of the patient
Reviewing medical records
Observing behaviors and interactions
Collaboration with other healthcare members
Identify actual or potential health alterations.

On the NCLEX, many questions challenge candidates to understand the importance of assessment. Sometimes, the question is written to challenge the candidates' understanding of the importance of further assessment when there isn't enough information to make a sound judgment. Other times, the questions may challenge the candidates' ability to recognize the limitations of their scope of practice. Despite the structure of the questions, knowing the key points surrounding the concept of assessment will help in selecting correct answers.

Key points for assessment include:

Always assess first, then implement
When in doubt, assess further
RNs must complete all initial assessments, such as new patients and changes in status.
The PN must report all changes of status to the RN so they can validate the findings.
The PN is perfectly capable of assessing clients when the assessment is ongoing.
The words observe, inspect, monitor, examine, and determine are all indicators that assessment is required.

Once the assessment phase of The Nursing Process is completed, the nurse must take the time to review all of the information collected, which leads to analysis.

During the analysis phase of The Nursing Process, the nurse takes the time to put all the pieces together. Over time, this practice becomes second nature, but for new graduate nurses, this requires some conscious effort. When you take the time to make sense of all of the information collected from a patient or an NCLEX test question, the focus or problem becomes much clearer. This step allows for easier identification of actual or potential issues and enables the nurse to move more confidently into the next phase of The Nursing Process.

On the NCLEX, the concept of analysis is often challenged. In fact, analysis-level questions are the most complex questions on the exam and therefore require sharp analysis skills. Since this is a skill that nursing students do not get very much practice with during their programs, this is often the most difficult skill for new grads to master before sitting for their exams. To help you improve your analysis skills, we've put together a few key points to remember.

Some key points for analysis include:

To effectively analyze data, candidates must know the nursing content.
During the analysis phase, nurses are looking for data significance & meaning.
Analysis requires questions to be asked and answered systematically.
Analysis helps nurses to conclude the status of their patients.
Sound nursing judgment comes from strong analysis skills.
The analysis phase should always end with the question: Does this make sense?

Once all of the data has been analyzed, the nurse can easily identify actual and potential alterations to health, thus leading to the next phase of The Nursing Process.

During the diagnosis phase of The Nursing Process, nurses create a list of all the actual and potential alterations to health that their patients present with. Nursing diagnoses stem from the direct observations of the nurse and are health issues that the nurse is licensed to manage. On the NCLEX, questions written about the diagnosis phase of The Nursing Process challenges candidates to understand the why .

We all learned that nursing diagnoses cannot include medical diagnoses . The typical reason given for this is nurses are not doctors. Although this is true, it does not explain the difference between a nursing diagnosis and a medical diagnosis. Therefore, here are the key differences so test-takers can better understand their role in creating and managing nursing diagnoses.

Nursing Diagnosis:

Stem from direct observations through assessment skills
Nurses can identify and validate findings that support the diagnosis
Nurses do not need the assistance of diagnostics or labs to identify and validate nursing diagnoses

Examples of nursing diagnoses include acute pain, altered nutrition, decreased cardiac output, ineffective coping mechanisms, knowledge deficit, risk for injury, etc.

Medical Diagnosis:

Stem from the interpretation of diagnostic studies and labs
Only a PA, NP, or physician can order, interpret, and validate the findings of diagnostic studies and lab reports
Medical practitioners require the assistance of diagnostics or labs to identify and validate medical diagnoses

Examples of medical diagnoses include asthma, bowel obstruction, congestive heart failure, diabetes, fibromyalgia, hyperlipidemia, etc.

Once a nurse has identified all the actual and potential nursing diagnoses for the patient, they can move into planning.

During the planning phase of The Nursing Process, the nurse focuses on assigning priorities to all of the actual and potential health alterations, as well as begins to consider all of the ways that the nurse can meet the patient's needs. The nurse will establish goals that are patient-specific, measurable, and have an established time frame. To meet the goals that have been established, the nurse must also identify all nursing interventions that will assist the nurse in meeting the needs of the patient.

On the NCLEX, questions written about the planning phase of The Nursing Process make up the majority of the exam. Planning questions typically involve many nursing concepts that fall within the NCLEX test plan categories of Management of Care (NCLEX- RN) and Coordination of Care (NCLEX-PN). These questions often require the test-taker to make careful decisions regarding what action is best or which intervention will meet the client's needs based on their clinical presentation.

Since the planning phase of The Nursing Process involves many nursing concepts and considerations, we've created a list of key terms that can help you to find the nursing concept the question is challenging, so you can focus on selecting the correct answer.

Concept: Establishing Priorities

Key Terms: Best, first, initial, most, next

Concept: Therapeutic Communication

Key Terms: Appropriate response, addressing behaviors, concerns and emotions, communication and responding to others (patient, family, staff)

Concept: Delegation

Key Terms: Creating an assignment, Asking others to complete tasks, Giving instructions to other members of the nursing team (RN, LPN, UAP)

Concept: Teach & Learning Principle

Key Terms: Patient understands, Nurse evaluates the effectiveness of discharge instructions, Nurse expects the client to return demonstrate, patient needs further explanation

Understanding that the nursing concept of safety can be incorporated and challenged on every question type is important. There aren't any specific terms or statements that can alert the test-taker that the question is focusing on safety. Since the NCLEX aims to determine if candidates are demonstrating safe decision-making skills, it is vital to consider safety at all times.

Once the planning phase is completed, the nurse can implement the plan.

Phase 4: Implementation

The implementation phase of The Nursing Process includes all activities and interventions that help the nurse meet the patient's needs. These activities include but are not limited to assisting patients with activities of daily living (ADLs), teaching others, performing patient care skills, giving medications, putting safety measures in place, documenting, and supervising the care that other healthcare team members provide.

On the NCLEX, questions about The Nursing Process's implementation phase are also very common. Candidates often have to decide which action or intervention will best meet the patient's needs or resolve the problem presented in the question. Implementation questions can come from all of the other NCLEX test plan categories.

Since implementation focuses on the action or interventions of nursing practice, these questions can embody all of the test plan categories. To make it easier to understand, we've created a list of actions and interventions you may see from each category on the NCLEX test plan.

Category: Safe and Effective Care Environment

Actions and Interventions: Effectively communicate, verify orders, advocate for patient rights, supervise care provided by others, report client findings and observations, provide care within scope of practice, document care, perform ongoing safety checks

Category: Health Promotion and Maintenance

Actions and Interventions: Provide education, teaching and instructions to others, complete comprehensive health assessments, plan the care of outpatient and members of the community

Category: Psychosocial Integrity

Actions and Interventions: Respond to behavioral changes, assist patients with coping strategies, provide end-of-life care, use therapeutic communication techniques, promote a safe and therapeutic environment

Category: Physiological Integrity

Actions and Interventions: Assist patients with activities of daily living, provide comfort measures, monitor physical health status, perform post-mortem care

The final phase of The Nursing Process is evaluation. After completing the actions, interventions, nursing skills, teaching, etc., it's time to determine if we've met the patient's needs. This step is just as essential as the assessment.

On the NCLEX, questions that focus on the evaluation phase of The Nursing Process challenge candidates to understand the intricacies of expected and unexpected outcomes. Did the nitroglycerin tablet have the intended effect on the patient? Is the patient having an adverse reaction to the medication? Is the absence of chest pain the goal for administering nitroglycerin?

These are all examples of evaluating the effectiveness of treatment. Whether the interventions performed are independent, dependent, or interdependent, the nurse is responsible for evaluating whether or not it is meeting the client's needs and whether the task was done correctly and safely. To help you identify if the question is about evaluation, we've created a list of key terms to signal that you're working within the evaluation phase of The Nursing Process.

Here is a list of key terms that will let you know you should be focusing on the concept of evaluation:

Accountability
Correctness
Effectiveness
Patient Response to Treatment
Standards of Care

The current care plan will be continued if the nurse identifies that the actions and interventions meet the patient's needs. Suppose the nurse identifies that the actions or interventions are not meeting the patient's needs or are not resulting in expected outcomes. In that case, the nurse will return to the assessment phase of The Nursing Process and collect more information to create and initiate a new care plan.

Critical Thinking

Many nursing students have a hard time speaking to the concept of critical thinking.

What does critical thinking mean?
What are the steps in critical thinking?
How does one learn to think critically?

Critical thinking is one of the hardest concepts to teach nursing students. The nursing professors more or less facilitate it. However, the student must take the initiative and effectively demonstrate critical thinking through disciplined and systematic practice. Fortunately, we've identified a simplified yet effective process for mastering critical thinking, which helps significantly in improving a test-taker's accuracy when answering practice questions.

To be able to think critically, one must be able to:

Have good observational skills
Scrutinize information to determine its significance
Identify issues that need to be resolved
Prepare to address the issues
Engage in activities that work towards solving the issues
Measure the success of resolving the issues

What do the above steps sound like? Let's take a closer look:

Observation = Assessment
Scrutinize = Analysis
Identify Issues = Diagnosis
Prepare to Address Issues = Planning
Activities to Solve the Issues = Implementation
Measuring Success = Evaluation

Critical thinking is the same thing as using The Nursing Process. Many nursing students leave their programs not fully understanding that The Nursing Process was designed as a systematic approach to critical thinking so that nurses remain objective, safe, and always work within their scope of practice.

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Damion Jenkins has 14 years experience as a MSN, RN and specializes in NCLEX Prep Expert - 100% Pass Rate!.

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The Nursing Process

The common thread uniting different types of nurses who work in varied areas is the nursing process—the essential core of practice for the registered nurse to deliver holistic, patient-focused care. Assessment An RN uses a systematic, dynamic way to collect and analyze data about a client, the first step in delivering nursing care. Assessment includes not only physiological data, but also psychological, sociocultural, spiritual, economic, and life-style factors as well. For example, a nurse’s assessment of a hospitalized patient in pain includes not only the physical causes and manifestations of pain, but the patient’s response—an inability to get out of bed, refusal to eat, withdrawal from family members, anger directed at hospital staff, fear, or request for more pain mediation.

Diagnosis The nursing diagnosis is the nurse’s clinical judgment about the client’s response to actual or potential health conditions or needs. The diagnosis reflects not only that the patient is in pain, but that the pain has caused other problems such as anxiety, poor nutrition, and conflict within the family, or has the potential to cause complications—for example, respiratory infection is a potential hazard to an immobilized patient. The diagnosis is the basis for the nurse’s care plan.

Outcomes / Planning Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and long-range goals for this patient that might include moving from bed to chair at least three times per day; maintaining adequate nutrition by eating smaller, more frequent meals; resolving conflict through counseling, or managing pain through adequate medication. Assessment data, diagnosis, and goals are written in the patient’s care plan so that nurses as well as other health professionals caring for the patient have access to it.

Implementation Nursing care is implemented according to the care plan, so continuity of care for the patient during hospitalization and in preparation for discharge needs to be assured. Care is documented in the patient’s record.

Evaluation Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed.

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The nursing process is something often discussed in nursing theory. Most nurses use the nursing process without realizing it is a part of their careers. That is, it comes as second nature to them rather than thinking out each step as they take it. If you’re just beginning to learn about nursing and nursing theory , understanding the nursing process can help you gain a deeper appreciation for how nurses care for their patients, as well as better prepare you to implement the process into your own nursing process.

What is the nursing process?

The nursing process is a set of steps followed by nurses in order to care for patients. How a particular nurse uses the nursing process varies based on the nurse, the patient, and the situation, but the process generally follows the same steps: assessment, diagnosis, plan, implementation, evaluation.

The first step, assessment, is used to get the patient’s history, as well as a list of symptoms or complaints. Using the information gathered in the assessment, the nurse and other health care professionals can form a diagnosis. The diagnosis is the determination of what’s wrong with the patient, if anything. The assessment and diagnosis allow the nurse to develop a nursing care plan, which is a plan of action for how to care for the patient. This step includes goals set by both the nurse and patient, and determining how best to meet those goals. The implementation sets the nursing care plan in motion in order to meet the patient’s goals.

Finally, the patient is evaluated by the nurse to show whether or not goals were met. Evaluation may be done during the implementation phase in order to make changes to the nursing care plan as needed. For example, if the patient gets worse, he or she may need to be reassessed to come up with a different diagnosis and plan of action. The nurse may also be evaluated at this point to determine how he or she cared for the patient.

Why is the nursing process used?

The nursing process is used to regulate patient care and how nurses interact with patients. By following a particular set of steps in the nursing process, a nurse knows exactly what to do to care for a patient and what comes next.

The nursing process also allows nurses to keep better track of patient care in terms of record-keeping. As a nurse is writing up notes about a patient, he or she can mentally go through the nursing process and make notes about each step. This will help ensure that the nurse does not forget a step or notes about an aspect of patient care, and the rest of a patient’s health care team will be able to follow the process the nurse used, as well.

How are nursing theories applied to the nursing process?

Some nursing models deal directly with the nursing process. That is, these theories guide nurses in how to treat patients from assessment through evaluation. Other nursing theories give a modified version of the nursing process, adapting them to fit the model of nursing. However, there are also nursing theories that don’t apply to the nursing process. These theories may only apply to a specific aspect of nursing, such as assessment, rather than the nursing process as a whole.

An Example of the Nursing Process

The nursing process can be a confusing concept for nursing students to grasp. Below is an example of the process from start to finish in a story like fashion:

Implementation

Prioritization, Delegation, and Assignment in Nursing NCLEX Practice Questions (100 Items)

Prioritization, Delegation, and Assignment Nursing Test Banks for NCLEX RN

In this NCLEX guide , we’ll help you review and prepare for prioritization, delegation, and assignment in your nursing exams. For this nursing test bank , improve your prioritization, delegation , and patient assignment skills by exercising with these practice questions. We will also be teaching you test-taking tips and strategies so you can tackle these questions in the NCLEX with ease. The goal of these practice quizzes and reviewers is to help student nurses establish a foundation of knowledge and skills on prioritization, delegation, and assignment.

Quiz Guidelines

Before you start, here are some examination guidelines and reminders you must read:

Practice Exams : Engage with our Practice Exams to hone your skills in a supportive, low-pressure environment. These exams provide immediate feedback and explanations, helping you grasp core concepts, identify improvement areas, and build confidence in your knowledge and abilities.
You’re given 2 minutes per item.
For Challenge Exams, click on the “Start Quiz” button to start the quiz.
Complete the quiz : Ensure that you answer the entire quiz. Only after you’ve answered every item will the score and rationales be shown.
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Prioritization, Delegation, and Assignment Practice Quiz

This section contains the practice questions to exercise your knowledge on nursing prioritization, delegation, and assignment. As with other quizzes, be sure to read and understand the question carefully. For prioritization, delegation, and assignment questions, read each choice carefully before deciding on your answer. Good luck and answer these questions at your own pace. You are here to learn.

Quizzes included in this guide are:

Quiz No.	Quiz Title	Questions

1		25
2		25
3		25
4		25

Nursing Prioritization, Delegation and Assignment Reviewer for Nurses

This is your guide to help you answer NCLEX priority, delegation, and assignment style questions.

NCLEX Tips for Nursing Prioritization, Delegation, and Assignment questions:

Here are six tips and strategies to help you ace NCLEX questions about delegation, assignment, and prioritization.

1. Do not make decisions based on resolutions

Do not make decisions concerning the management of care issues based on resolutions you may have witnessed during your clinical experience in the hospital or clinic setting. As a student nurse , you are constantly reminded that NCLEX questions are to be solved and responded to in the context of “Ivory Tower Nursing.” That is, if you only had one patient at a time, loads of assistive personnel, countless supplies, and equipment. This is what people mean when they refer to “ textbook nursing .” But when you’re in the real world without the time and resources, you adjust. Your clinical rotation in management may have been less than ideal but remember that in NCLEX, the answers to the questions are seen in nursing textbooks or journals. Always bear in mind, “Is this textbook nursing care?”

2. Never delegate the functions of assessment, evaluation and nursing judgment.

Throughout your nursing education , you learned that assessments, nursing diagnosis , establishing expected outcomes, evaluating care and any other tasks and aspects of care including but not limited to those that entail sterile technique, critical thinking, professional judgment, and professional knowledge are the responsibilities of the registered professional nurse. You cannot give these responsibilities to nonprofessional, unlicensed assistive nursing personnel, such as nursing assistants, patient care technicians, and personal care aides.

3. Identify tasks for delegation based on the client’s needs.

Delegate activities for stable patients because some of these needs are relatively predictable and more frequently encountered. These are somewhat routinized and without the need for high levels of professional judgment and skill. But if the patient is unstable, the needs are acute and become unpredictable, ever-changing, and rarely encountered based on the patient’s changing status. These needs should not be delegated.

4. Ensure the appropriate education, skills, and experience of personnel performing delegated tasks.

Delegate activities that involve standard, consistent, and unchanged systems and procedures. The care of a patient with chest tubes and chest drainage can be delegated to either another RN or a licensed practical nurse. Therefore, the authorizing RN must ensure that the nurse is qualified, skilled, and competent to perform this intricate task, observe the patient’s response to this treatment, and ensure that the equipment is operating suitably and accurately.

The care of a stable chronically ill patient who is comparatively stable and more anticipated than a seriously ill and unstable acute patient can be assigned to the licensed practical nurse, and assistance with the activities of daily living and basic hygiene and comfort care can be assigned and delegated to an unlicensed assistive staff member like a nursing assistant or a patient care technician. Activities that frequently occur in daily patient care can be delegated. Bathing, feeding , dressing , and transferring patients are examples.

Procedures that are complex or complicated should not be delegated, especially if the patient is highly unstable.

5. Remember priorities!

Recall and understand Maslow’s Hierarchy of Needs , the ABCs (Airway, Breathing, Circulation ), and stable versus unstable. It is necessary to know and understand the priorities when deciding which patient the RN should attend to first. Remember that you can see only one patient or perform one activity when answering questions that require you to establish priorities.

Always keep in mind that improper and inappropriate assignments can lead to inadequate quality of care, unexpected care outcomes, the jeopardization of client safety, and even legal consequences. Right assignment of care to others, including nursing assistants, licensed practical nurses, and other registered nurses, is certainly one of the most significant daily decisions nurses make.

6. Additional Test Taking Tips and Strategies

Questions using keywords such as “ best ,” “ essential ,” “ highest priority ,” “ primary ,” “ immediate ,” “ first ,” or “ initial response ” are asking for your prioritizing skills.
Know the patient’s purpose of care, current clinical condition, and outcome of care in order to determine and plan priorities.
Identify the priority patient based on the following: patient’s age, day of admission/ surgery , or the number of body systems involved.
Unlicensed assistive personnel (UAP) such as nurses’ aides, certified nursing assistants, attendants, health aides are not allowed to delegate. Only a registered nurse can delegate tasks.
In some states, Licensed Practical Nurses ( LPN ) may delegate to a UAP depending on the state nursing practice .
Ensure the appropriate knowledge, skills, and experience of personnel performing the delegated tasks.
Do not delegate teaching, assessment , planning , evaluating, and nursing judgment to an unlicensed nurse.
A client with an unstable and unpredictable condition cannot be delegated to a UAP’s or LPNs.
Delegate tasks that involve standard, simple procedures such as bathing , dressing , feeding , and transferring patients.
Student nurses, float nurses, personal assistants, and other personnel may require levels of guidance and supervision.

Nursing Prioritization

Prioritization is deciding which needs or problems require immediate action and which ones could be delayed until later because they are not urgent. In the NCLEX, you will encounter questions that require you to use the skill of prioritizing nursing actions. These nursing prioritization questions are often presented using the multiple-choice format or via ordered-response format. For a review, in an ordered-response question format , you’ll be asked to use the computer mouse to drag and drop your nursing actions in order or priority. Based on the information presented, determine what you’ll do first, second, third, and so forth. Directions are provided with the question. To help you answer nursing prioritization questions, remember the three principles commonly used:

1. Remember ABC’s (airway, breathing, and circulation).

Patients with obvious respiratory problems or interventions to provide airway management are given priority.

2. Maslow’s Hierarchy of Needs

Use Maslow’s hierarchy of needs as a guide to prioritize by determining the order of priority by addressing the physiological needs first.

There are five different levels of Maslow’s hierarchy of needs:

Physiological Needs. The basic physiological needs have the highest priority and must be met first. Some examples of physiological needs include oxygen, food, fluid, nutrition , shelter, sleep , clothing, and reproduction.
Safety Needs. Safety can be divided into physical and physiological. These include health, property, employment, security of the environment, and resources.
Social Needs. These include love, family, friendship, and intimacy.
Esteem. These include confidence, self-esteem , respect, and achievement.
Self-actualization. These include creativity, morality, and problem-solving.

3. Using the Nursing Process

The nursing process is a systematic approach to assess and give care to patients. Assessment should always be done first before planning or providing interventions.

Delegation in Nursing

Delegation is the transference of responsibility and authority for an activity to other health care members who are competent to do so. The “delegate” assumes responsibility for the actual performance of the task and procedure. The nurse (delegator) maintains accountability for the decision to delegate and for the appropriateness of nursing care rendered to the patient. The role of a registered nurse also includes delegating care, assigning tasks, organizing and managing care, supervising care delivered by other health care providers while effectively managing time! The NCLEX includes questions related to this unique nursing role of delegation.

5 Rights of Delegation in Nursing

The following are the five rights of delegation in nursing:

Right Person. The licensed nurse and the employer and the delegatee are responsible for ensuring that the delegatee possesses the appropriate skills and knowledge to perform the activity.
Right Tasks. The activity falls within the delegatees’ job description or is included as part of the nursing practice settings established written policies and procedures. The facility needs to ensure the policies and procedures describe the expectations and limits of the activity and provide any necessary competency training.
Each delegation situation should be specific to the patient, the licensed nurse, and the delegatee.
The licensed nurse is expected to communicate specific instructions for the delegated activity to the delegatee; the delegatee should ask any clarifying questions as part of two-way communication . This communication includes any data that needs to be collected, the method for collecting the data, the time frame for reporting the results to the licensed nurse, and additional information pertinent to the situation.
The delegatee must understand the terms of the delegation and must agree to accept the delegated activity.
The licensed nurse should ensure that the delegatee understands that she or he cannot make any decisions or modifications in carrying out the activity without first consulting the licensed nurse.
Right Circumstances. The health condition of the patient must be stable. If the patient’s condition changes, the delegatee must communicate this to the licensed nurse, and the licensed nurse must reassess the situation and the appropriateness of the delegation.
The licensed nurse is responsible for monitoring the delegated activity, following up with the delegatee at the completion of the activity, and evaluating patient outcomes . The delegatee is responsible for communicating patient information to the licensed nurse during the delegation situation. The licensed nurse should be ready and available to intervene as necessary.
The licensed nurse should ensure appropriate documentation of the activity is completed.

Recommended Resources

Recommended books and resources for your NCLEX success:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

Saunders Comprehensive Review for the NCLEX-RN Saunders Comprehensive Review for the NCLEX-RN Examination is often referred to as the best nursing exam review book ever. More than 5,700 practice questions are available in the text. Detailed test-taking strategies are provided for each question, with hints for analyzing and uncovering the correct answer option.

Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items Next Generation NCLEX®-style practice questions of all types are illustrated through stand-alone case studies and unfolding case studies. NCSBN Clinical Judgment Measurement Model (NCJMM) is included throughout with case scenarios that integrate the six clinical judgment cognitive skills.

Saunders Q & A Review for the NCLEX-RN® Examination This edition contains over 6,000 practice questions with each question containing a test-taking strategy and justifications for correct and incorrect answers to enhance review. Questions are organized according to the most recent NCLEX-RN test blueprint Client Needs and Integrated Processes. Questions are written at higher cognitive levels (applying, analyzing, synthesizing, evaluating, and creating) than those on the test itself.

NCLEX-RN Prep Plus by Kaplan The NCLEX-RN Prep Plus from Kaplan employs expert critical thinking techniques and targeted sample questions. This edition identifies seven types of NGN questions and explains in detail how to approach and answer each type. In addition, it provides 10 critical thinking pathways for analyzing exam questions.

Illustrated Study Guide for the NCLEX-RN® Exam The 10th edition of the Illustrated Study Guide for the NCLEX-RN Exam, 10th Edition. This study guide gives you a robust, visual, less-intimidating way to remember key facts. 2,500 review questions are now included on the Evolve companion website. 25 additional illustrations and mnemonics make the book more appealing than ever.

NCLEX RN Examination Prep Flashcards (2023 Edition) NCLEX RN Exam Review FlashCards Study Guide with Practice Test Questions [Full-Color Cards] from Test Prep Books. These flashcards are ready for use, allowing you to begin studying immediately. Each flash card is color-coded for easy subject identification.

11 thoughts on “Prioritization, Delegation, and Assignment in Nursing NCLEX Practice Questions (100 Items)”

Very helpful. A LPN graduate who has taken the nclex four times. It gives me a quick overview. Thanks

Love it!!! These made me think. They up there with ReMar and uWorld.

Very helpful thanks

In which order will the nurse perform the following actions as she prepares to leave the room of a client with airborne precautions after performing oral suctioning?

please your order for this question is wrong

I have learned a lot from the NursesLabs. Love it!

Nurse Pietro receives an 11-month old child with a fracture of the left femur on the pediatric unit. Which action is important for the nurse to take FIRST? First- Speak with parents as to how injury occurred??? Yes, this is going to take place but this the first thing to do? Perhaps the wording needs to change as I have been “textbook” taught, treat first, then question in cases of suspected abuse.

good questions which test your analyzing and critical thinking skils

Thank you for making this free. It is my additional resources. This has been very helpful. I really appreciate that you are helping all future nurses to be at their best .

I’m really grateful for this excercise which aids in preparing for the NCLEX. Thanks

This has help me pass my nclex !! Thanks

I am interested to join nurseslab daily question

StatPearls [Internet].

Nursing admission assessment and examination.

Tammy J. Toney-Butler ; Wendy J. Unison-Pace .

Last Update: August 28, 2023 .

Definition/Introduction

The initial nursing assessment, the first step in the five steps of the nursing process, involves the systematic and continuous collection of data; sorting, analyzing, and organizing that data; and the documentation and communication of the data collected. Critical thinking skills applied during the nursing process provide a decision-making framework to develop and guide a plan of care for the patient incorporating evidence-based practice concepts. This concept of precision education to tailor care based on an individual's unique cultural, spiritual, and physical needs, rather than a trial by error, one size fits all approach results in a more favorable outcome. [1] [2] [3]

The nursing assessment includes gathering information concerning the patient's individual physiological, psychological, sociological, and spiritual needs. It is the first step in the successful evaluation of a patient. Subjective and objective data collection are an integral part of this process. Part of the assessment includes data collection by obtaining vital signs such as temperature, respiratory rate, heart rate, blood pressure, and pain level using an age or condition appropriate pain scale. The assessment identifies current and future care needs of the patient by allowing the formation of a nursing diagnosis. The nurse recognizes normal and abnormal patient physiology and helps prioritize interventions and care. [4] [5]

Nursing Process

Assessment (gather subjective and objective data, family history, surgical history, medical history, medication history, psychosocial history)
Analysis or diagnosis (formulate a nursing diagnosis by using clinical judgment; what is wrong with the patient)
Planning (develop a care plan which incorporates goals, potential outcomes, interventions)
Implementation (perform the task or intervention)
Evaluation (was the intervention successful or unsuccessful)
Issues of Concern

The function of the initial nursing assessment is to identify the assessment parameters and responsibilities needed to plan and deliver appropriate, individualized care to the patient. [6] [7] [8] [9]

This includes documenting:

Appropriate level of care to meet the client's or patient’s needs in a linguistically appropriate, culturally competent manner
Evaluating response to care
Community support
Assessment and reassessment once admitted
Safe plan of discharge

The nurse should strive to complete:

Admission history and physical assessment as soon as the patient arrives at the unit or status is changed to an inpatient
Data collected should be entered on the Nursing Admission Assessment Sheet and may vary slightly depending on the facility
Additional data collected should be added
Documentation and signature either written or electronic by the nurse performing the assessment

Summary Nursing Admission Assessment

Documentation: Name, medical record number, age, date, time, probable medical diagnosis, chief complaint, the source of information (two patient identifiers)
Past medical history: Prior hospitalizations and major illnesses and surgeries
Assess pain: Location, severity, and use of a pain scale
Allergies: Medications, foods, and environmental; nature of the reaction and seriousness; intolerances to medications; apply allergy band and confirm all prepopulated allergies in the electronic medical record (EMR) with the patient or caregiver
Medications: Confirm accuracy of the list, names, and dosages of medications by reconciling all medications promptly using electronic data confirmation, if available, from local pharmacies; include supplements and over-the-counter medications
Valuables: Record and send to appropriate safe storage or send home with family following any institutional policies on the secure management of patient belongings; provide and label denture cups
Rights: Orient patient, caregivers, and family to location, rights, and responsibilities; goal of admission and discharge goal
Activities: Check daily activity limits and need for mobility aids
Falls: Assess Morse Fall Risk and initiate fall precautions as dictated by institutional policy
Psychosocial: Evaluate need for a sitter or video monitoring, any signs of agitation, restlessness, hallucinations, depression, suicidal ideations, or substance abuse
Nutritional: Appetite, changes in body weight, need for nutritional consultation based on body mass index (BMI) calculated from measured height and weight on admission
Vital signs: Temperature recorded in Celsius, heart rate, respiratory rate, blood pressure, pain level on admission, oxygen saturation
Any handoff information from other departments

Physical Exam

Cardiovascular: Heart sounds; pulse irregular, regular, weak, thready, bounding, absent; extremity coolness; capillary refill delayed or brisk; presence of swelling, edema, or cyanosis
Respiratory: Breath sounds, breathing pattern, cough, character of sputum, shallow or labored respirations, agonal breathing, gasps, retractions present, shallow, asymmetrical chest rise, dyspnea on exertion
Gastrointestinal: Bowel sounds, abdominal tenderness, any masses, scars, character of bowel movements, color, consistency, appetite poor or good, weight loss, weight gain, nausea, vomiting, abdominal pain, presence of feeding tube
Genitourinary: Character of voiding, discharge, vaginal bleeding (pad count), last menstrual period or date of menopause or hysterectomy, rashes, itching, burning, painful intercourse, urinary frequency, hesitancy, presence of catheter
Neuromuscular: Level of consciousness using AVPU (alert, voice, pain, unresponsive); Glasgow coma scale (GCS); speech clear, slurred, or difficult; pupil reactivity and appearance; extremity movement equal or unequal; steady gait; trouble swallowing
Integument: Turgor, integrity, color, and temperature, Braden Risk Assessment, diaphoresis, cold, warm, flushed, mottled, jaundiced, cyanotic, pale, ruddy, any signs of skin breakdown, chronic wounds

Initial Assessment [10] [11] [12]

Steps in Evaluating a New Patient

Record chief complaint and history
Perform physical examination
Complete an initial psychological evaluation; screen for intimate partner violence; CAGE questionnaire and CIWA (Clinical Institute Withdrawal Assessment for Alcohol) scoring if indicated; suicide risk assessment
Provide a certified translator if a language barrier exists; ensure culturally competent care and privacy
Ensure the healthcare provider has ordered the appropriate tests for the suspected diagnosis, and initiate any predetermined protocols according to the hospital or institutional policy

Which provides the diagnosis most often: history, physical, or diagnostic tests?

History: 70%
Physical: 15% to 20%
Diagnostic tests: 10% to 15%

History Taking Techniques

Record chief complaint

History of the present illness, presence of pain

P-Q-R-S-T Tool to Evaluate Pain

P: What provokes symptoms? What improves or exacerbates the condition? What were you doing when it started? Does position or activity make it worse?
Q: Quality and Quantity of symptoms: Is it dull, sharp, constant, intermittent, throbbing, pulsating, aching, tearing or stabbing?
R: Radiation or Region of symptoms: Does the pain travel, or is it only in one location? Has it always been in the same area, or did it start somewhere else?
S: Severity of symptoms or rating on a pain scale. Does it affect activities of daily living such as walking, sitting, eating, or sleeping?
T: Time or how long have they had the symptoms. Is it worse after eating, changes in weather, or time of day?

S-A-M-P-L-E

S: Signs and symptoms
A: Allergies
M: Medications
P: Past medical history
L: Last meal or oral intake
E: Events before the acute situation

Pain Assessment

Pain, or the fifth vital sign, is a crucial component in providing the appropriate care to the patient. Pain assessment may be subjective and difficult to measure. Pain is anything the patient or client states that it is to them. As nurses, you should be aware of the many factors that can influence the patient's pain. Systematic pain assessment, measurement, and reassessment enhance the ability to keep the patient comfortable. Pain scales that are age appropriate assist in the concise measurement and communication of pain among providers. Improvement of communication regarding pain assessment and reassessment during admission and discharge processes facilitate pain management, thus enhancing overall function and quality of life in a trickle-down fashion.

According to one performance and improvement outpatient project in 2017, areas for improvement in pain reassessment policies and procedures were identified in a clinic setting. The study concluded compliance rates for the 30-minute time requirement outlined in the clinic policy for pain reassessment were found to be low. Heavy patient load, staff memory rather than documentation, and a lack of standardized procedures in the electronic health record (EHR) design played a role in low compliance with the reassessment of pain. Barriers to pain assessment and reassessment are important benchmarks in quality improvement projects. Key performance indicators (KPIs) to improve pain management goals and overall patient satisfaction, balanced with the challenges of an opioid crisis and oversedation risks, all play a role in future research studies and quality of care projects. Recognition of indicators of pain and comprehensive knowledge in pain assessment will guide care and pain management protocols.

Indicators of Pain

Restlessness or pacing
Groaning or moaning
Gasping or grunting
Nausea or vomiting
Diaphoresis
Clenching of the teeth and facial expressions
Tachycardia or blood pressure changes
Panting or increased respiratory rate
Clutching or protecting a part of the body
Unable to speak or open eyes
Decreased interest in activities, social gatherings, or old routines

Psychosocial Assessment

The primary consideration is the health and emotional needs of the patient. Assessment of cognitive function, checking for hallucinations and delusions, evaluating concentration levels, and inquiring into interests and level of activity constitute a mental or emotional health assessment. Asking about how the client feels and their response to those feelings is part of a psychological assessment. Are they agitated, irritable, speaking in loud vocal tones, demanding, depressed, suicidal, unable to talk, have a flat affect, crying, overwhelmed, or are there any signs of substance abuse? The psychological examination may include perceptions, whether justifiable or not, on the part of the patient or client. Religion and cultural beliefs are critical areas to consider. Screening for delirium is essential because symptoms are often subtle and easily overlooked, or explained away as fatigue or depression.

Safety Assessment

Ambulatory aids
Environmental concerns, home safety
Domestic and family violence risk, human trafficking risks, elder or child abuse risk
Suicidal ideation (initiate suicide precautions as directed by institutional policy)

Therapeutic Communication Techniques Used to Take a Good History

Multiple strategies are employed that will include:

Active, attentive listening
Reflection, sharing observations
Share hope
Share humor
Therapeutic silence
Provide information
Clarification
Paraphrasing
Asking relevant questions
Summarizing
Self-disclosure
Confrontation

What are examples?

Active, attentive listening: Attention to the details of what the patient is saying either in a verbal or nonverbal manner
Reflection, share observations: Repeat the patient’s words to encourage discussion, state observations that will not make the patient angry or embarrassed; i.e., " You seem tired today, sad...," " You have hardly eaten anything this morning."
Empathy: Demonstrate that you understand and feel for the patient, recognition of their current situation and perceived feelings, and communicating in a nonjudgmental, unbiased way of acceptance
Share hope: Ensure in the patient a sense of power, hope in an often hopeless environment, and the possibility of a positive outcome
Share humor: Fosters a relationship of emotional support, establishes rapport, acts as a positive diversion technique, and promotes physical and mental well being. Cultural considerations play a role in humor
Touch: Touch may be a source of comfort or discomfort for a patient, wanted or unwanted; observe verbal and nonverbal cues with touch; holding a hand, conducting a physical assessment, performing a procedure
Therapeutic silence: Fosters an environment of patience, thought and reflection on difficult decisions, and allows time to observe any nonverbal signs of discomfort (the patient typically breaks the silence first)
Provide information: During an assessment and care, inform the patient as to what is about to happen, explain findings and the need for further testing or observation to promote trust and decrease anxiety
Clarification: Ask questions to clear up ambiguous statements, ask the client or patient to rephrase or restate confusing remarks so wrong assumptions are clarifiable and a missed opportunity for valuable information forgone
Focusing: Brings the focus of the conversation to an essential area of concern, eliminating vague or rambling dialogue, centers the assessment on the source of discomfort and pertinent details in the history
Paraphrasing: Invites patient participation and understanding in a conversation
Asking relevant questions: Questions are general at first then become more specific; asked in a logical, consecutive order; open-ended, close-ended, and focused questions may be useful during an assessment
Summarizing: Provides a review of assessment findings, offers clarification opportunities, informs the next step in the admission and hospitalization process
Self-disclosure: Promotes a trusting relationship, the feeling that the patient is not in this alone, or unique in their current circumstances; provides a framework for hope, support, and respect
Confrontation: You may have to confront the patient after a trustful rapport has been established, discussing any inconsistencies in the history, thought processes, or inappropriate behavior

Cultural Assessment

The cultural competency assessment will identify factors that may impede the implementation of nursing diagnosis and care. Information obtained should include:

Ethnic origin, languages spoken, and need for an interpreter
Primary language preferred for written and verbal instructions
Support system, decision makers
Living arrangements
Religious practices
Emotional responses
Special food requirements, dietary considerations
Cultural customs or taboos such as unwanted touching or eye contact

Physical Examination Techniques

Initial evaluation or the general survey may include:

Overall health status
Body habitus
Personal hygiene, grooming
Skin condition such as signs of breakdown or chronic wounds
Breath and body odor
Overall mood and psychological state
Initial vital sign measurements: temperature recorded in Celsius in most institutions, respiratory rate, pulse rate, blood pressure with appropriate sized cuff, pulse oximetry reading and note if on room air or oxygen; accurately measured weight in kilograms with the proper scale and height measurement, so body mass index (BMI) is calculable for dosing weights and nutritional guidelines

Secondary Assessment

Cardiovascular
Gastrointestinal
Musculoskeletal
Neurological
Genitourinary/Pelvic
Integumentary
Mental status and behavioral
Look at all areas of the skin, including those under clothing or gowns
Ensure patient is undressed, allowing for privacy, uncover one body part at a time if possible
Lighting should be bright
Be alert for any malodors from the body including the oral cavity; fecal odor, fruity-smell, odor of alcohol or tobacco on the breath
Compare one side to the other, and ask the patient about any asymmetrical areas
Observe for color, rashes, skin breakdown, tubes and drains, scars, bruising, burns
Grade any edema present
Document pertinent normal and abnormal findings
Consistency
Tenderness
Temperature and moisture (warm, moist or cool, and dry)
Tactile fremitus
Good hand and finger technique
Good striking and listening technique
Especially important in the pulmonary and gastrointestinal systems
Dull, flat, resonance, hyper-resonance, or tympany sounds
Percussion is an advanced technique requiring a specific skill set to perform. Therefore, it is a skill practiced by advanced practice nurses as opposed to a bedside nurse on a routine basis

Auscultation

Listening to body sounds such as bowel sounds, breath sounds, and heart sounds
Important in examination of the heart, blood pressure, and gastrointestinal system
Listen for bruits, murmurs, friction rubs, and irregularities in pulse

What are important things to remember about the physical exam?

Physical exam length can vary depending on complexity
Physical exam extends from passive observation to hands-on
Be systematic and thorough
Ensure privacy and comfort
Warm hands for patient comfort
Avoid long fingernails to prevent patient injury during the exam
Palpate areas that are tender or painful last
Be alert for any signs of maltreatment or abuse, and follow mandatory reporting guidelines
Abdominal assessment follows the techniques in this sequence: inspection, auscultation, percussion, and palpation
Auscultate bowel sounds for at least 15 seconds in each quadrant using the diaphragm of the stethoscope, starting with the lower right-hand quadrant and moving clockwise
If a fistula is present for hemodialysis, assess for a thrill or bruit, document presence or absence. Notify managing healthcare provider immediately if absent
Steps in a comprehensive lung exam include PIPPA; Positioning of the patient, Inspection, Palpation, Percussion, Auscultation

Diagnostic Studies

Driven by findings on the history and physical examination; options include:

Blood tests (CBC, chemistry, bedside glucose, pregnancy test, urinalysis, cardiac enzymes, coagulation studies)
Imaging studies (X-rays, CT, MRI, ultrasound)
Other diagnostic studies (ECG, EEG, lumbar puncture, etc.,)

Discharge Planning

Document mode of transport
Who is accompanying the patient?
Transfer forms/EMTALA considerations
Functional status
Financial considerations
Discharge medications and instructions
Follow up information, referrals, hotline numbers, shelter information
Barriers to learning
Document verbalization that discharge instructions were understood by caregiver or surrogate
Provide translators and language appropriate discharge instructions or paperwork
Clinical Significance

Often the initial history and physical examination lead to the identification of life- or limb-threatening conditions that can be stabilized promptly, ensuring better patient outcomes. The sooner the patient is correctly assessed, the more likely a life-altering condition is recognizable, nursing diagnosis formulated, appropriate intervention or treatment initiated, and stabilizing care rendered. Physiological abnormalities manifested by changes in vital signs and level of consciousness often provide early warning signs that patient condition is deteriorating; thus, requiring prompt intervention to forego an adverse outcome, decreasing morbidity and mortality risk. In the fast-paced, resource-challenged healthcare environment today, thorough assessment can pose a challenge for the healthcare provider but is essential to safe, quality care. The importance of a head-to-toe assessment, critical thinking skills guided by research, and therapeutic communication are the mainstays of safe practice. [13] [14] [15]

Assessment findings that include current vital signs, lab values, changes in condition such as decreased urine output, cardiac rhythm, pain level, and mental status, as well as pertinent medical history with recommendations for care, are communicated to the provider by the nurse. Communicating in a concise, efficient manner in rapidly changing situations and deteriorating patient conditions can promote quick solutions during difficult circumstances. Healthcare providers communicate and share in the decision-making process. The SBAR model facilitates this communication between members of the healthcare team and bridges the gap between a narrative, descriptive approach and one armed with exact details.

Communication using the SBAR Model

Recommendation

Assessment Tools

Activities of daily living scale
Cough assessment
Health questionnaires such as those that address recent travel and exposure risks
Waterlow or Braden scale for assessing pressure ulcer risk
Glasgow coma scale/AVPU for assessment of consciousness
Pain scales such as the Faces Pain Scale (FPS), Numeric Rating System (NRS), Visual Analogue Scales (VAS), Wong-Baker Faces Pain Rating Scale (WBS), and the (MPQ) McGill Pain Questionnaire
CAGE assessment/CIWA scoring
Morse Fall Risk
Standard vital sign flow charts for different age groups
NIH Stroke Scale (NIHSS)
Dysphagia Screen
4AT Assessment for Delirium
The nurse should be familiar with the otoscope, penlight, stethoscope (bell and diaphragm), thermometer, bladder scanner, speculum, eye charts, cardiac and blood pressure monitors, fetal doppler and extremity doppler, and sphygmomanometer
Stretcher or bed for proper positioning during a physical exam
Hand hygiene products, personal protective equipment if required
Alcohol swabs, sanitizer, or soapy water to clean equipment after use, such as with stethoscopes, to decrease the likelihood of cross-contamination of pathogens from inanimate objects (follow any manufacturer guidelines or institutional policies)
Computer or paper chart to document findings
Calculation devices for BMI, conversion from pounds to kilograms, kilograms to pounds, Celsius to Farenheight
Review Questions
Access free multiple choice questions on this topic.
Comment on this article.

Disclosure: Tammy Toney-Butler declares no relevant financial relationships with ineligible companies.

Disclosure: Wendy Unison-Pace declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Cite this Page Toney-Butler TJ, Unison-Pace WJ. Nursing Admission Assessment and Examination. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Getting Ready for the Next-Generation NCLEX® (NGN): How to Shift from the Nursing Process to Clinical Judgment in Nursing

Authored by.

Donna D. Ignatavicius , MS, RN, CNE, CNEcl, ANEF, FAADN

Linda Silvestri , PhD, RN, FAAN

What is the Nursing Process?

The nursing process has been used for over 50 years as the systematic, stepwise method for problem solving to make safe, client-centered clinical decisions. Originally, there were four nursing process steps, published in the late 1960s. These were:

Implementation

In the early 1970s, the North American Nursing Diagnosis Association (NANDA, currently called NANDA-I) was formed to develop a common language to identify standardized nursing diagnoses based on a nurse’s interpretation of assessment data. As a nurse educator, you likely include this additional step of Diagnosis as part of the nursing process, referred to as ADPIE:

Using a problem-solving approach as a basis for nursing practice requires the use of critical thinking and decision-making. Some experts have referred to that thinking more recently as clinical reasoning. The 2020 NCLEX-RN® Test Plan identifies the nursing process as one of five integrated processes which is defined as “a scientific, clinical reasoning approach to client care that includes assessment, analysis, planning, implementation, and evaluation” (NCSBN, 2019, p.5). Note that this definition does not include Diagnosis; rather the second step of the nursing process is labeled as Analysis.

The NCLEX-RN® and NCLEX-PN® do not measure the nursing graduate’s knowledge of nursing diagnoses (NDs) because NDs are not universally used as originally intended as a standardized language, even in the United States where the NANDA nursing diagnosis list began. Yet many faculty continue to teach the nursing process as a five-step ADPIE approach.

Comparing the Nursing Process and Clinical Judgment

While the nursing process has been taught in prelicensure programs for many years, nurses continue to make serious errors in practice, including failure-to-rescue clinical situations that sometimes result in sentinel events. Based on these errors and employer dissatisfaction with the clinical-decision ability of new graduates, the National Council of State Boards of Nursing (NCSBN) developed a model of clinical judgment that is built on and expands the nursing process. Officially entitled the NCSBN Clinical Judgment Measurement Model (NCJMM), this evidence-based model identifies six cognitive skills needed to make appropriate clinical judgments. These skills include:

Recognize Cues
Analyze Cues
Prioritize Hypotheses
Generate Solutions
Take Action
Evaluate Outcomes

The NCJMM will be the basis for the Next-Generation NCLEX-RN and NCLEX-PN (NGN) new test items that will be presented most often in an unfolding case format . These cases will present clinical situations in which the test candidate will need to use clinical judgment skills to answer questions about how to manage the presented client’s care.

If you are teaching in a state, province, or territory in which the nursing process is required as a regulation for prelicensure nursing education, follow these guidelines to help transition from the nursing process to clinical judgment:

Use the term clinical judgment as part of your program’s definition of professional nursing and end-of-program student learning outcomes (also called program learning outcomes).
Introduce the nursing process in your first basic nursing course as the foundation for clinical decision-making.
Minimize emphasis on the NANDA nursing diagnosis list and ensure that students understand that the diagnostic labels and taxonomy are not universally used in health care today. Instead, assist students in learning the signs, symptoms, and behaviors that nurses and other interprofessional health care team members utilize and understand. For example, fever is a more commonly used term in nursing and health care than hyperthermia. A nurse can take a client’s body temperature and determine that he or she has a fever if the thermometer reads 103 o F (39.4 o C).
Introduce the NCSBN definition of clinical judgment and the six cognitive skills of the NCJMM early in your nursing program.
Have students practice using the six cognitive skills in a variety of learning activities, including unfolding case studies in place of excessive lecture throughout your program.

Building on the Nursing Process to Transition to Clinical Judgment

As you and your students transition from the nursing process to clinical judgment, remember that clinical judgment is more closely aligned with how nurses in practice actually think to make the best possible decisions about client care. Also recall that clinical judgment in nursing is not a new concept. For example, Tanner, the National League for Nursing, and others have posited for almost 15 years that clinical judgment is a better problem-solving approach than the nursing process.

The NCJMM cognitive skills can be aligned with the nursing process steps and phases of Tanner’s clinical judgment model as illustrated below:

Comparison of the Nursing Process with Tanner’s Clinical Judgment Model and the NCSBN Clinical Judgment Measurement Model (NCJMM)


Assessment	Noticing	Recognize Cues
Diagnosis/Analysis	Interpreting	Analyze Cues
Diagnosis/Analysis	Interpreting	Prioritize Hypotheses
Planning	Responding	Generate Solutions
Implementation	Responding	Take Action
Evaluation	Reflecting	Evaluate Outcomes

While these models may look very similar, the thinking processes differ. For example, in the Assessment step of the nursing process, the nurse collects subjective and objective client data using a systematic approach. By contrast, the Recognize Cues cognitive skill of clinical judgement requires the nurse to collect client data and then decide “What matters most?”—which client data (findings) are relevant in a specific contextual clinical situation and which data are not relevant? Two other examples comparing the nursing process steps and the cognitive skills of the NCJMM are described below:


: The nurse identifies the actual and potential client problem(s) based on review and interpretation of the client data.	: The nurse reviews the client data and determines what they mean. For example, the nurse may identify certain data that are consistent with common diseases or disorders. Or, the nurse may identify potential complications for which the client is at risk based on the assessment data.
The nurse performs appropriate interventions to meet the desired client outcomes. For example, if the client reports acute postoperative ORIF pain of 8/10, the nurse might administer an analgesic.	: The nurse performs an action which could be an intervention or an assessment. For example, if a client reports acute postoperative ORIF pain of 8/10, the nurse might perform a neurovascular assessment of the extremity to determine if the pain is due to decreased peripheral perfusion or the surgical incision. While that action is an assessment, it is also an action or intervention.

As you begin or continue making the transition of building on the nursing process to emphasize clinical judgment in your program, remember that clinical judgment will be the focus of the new test item types for the NGN by no sooner than 2023. You still have time to begin the transition journey, but we suggest that you start it soon! More NGN resources are available on www.ncsbn.org and the Elsevier Evolve Faculty Resources webpage.

Reference :

National Council of State Boards of Nursing (NCSBN). (2018). NCLEX-RN® Examination: Test plan for the National Council Licensure Examination for Registered Nurses. Chicago, IL: Author.

The Ultimate Guide to Nursing Assignments: 7 Tips and Strategies

Nursing assignments are a critical component of every nursing student’s academic journey. They serve as opportunities to test your knowledge, apply theoretical concepts to real-world scenarios, and develop essential skills necessary for your future nursing career. However, tackling nursing assignments can often be overwhelming, particularly when you’re juggling multiple responsibilities. In this comprehensive guide, we provide valuable tips, strategies, and expert assignment help services to help you excel in your nursing assignments. Whether you’re struggling with research, structuring your assignment, or proofreading, we’re here to support you every step of the way.

Understanding the Nursing Assignments

To excel in nursing assignments , it’s crucial to start by thoroughly understanding the requirements. Take the time to carefully read the assignment prompt, paying close attention to the topic, word count, formatting guidelines, and any specific instructions provided by your instructor. Understanding these key components will ensure that you meet all the necessary criteria.

Conducting Thorough Research

Once you have a clear understanding of the assignment, it’s time to conduct thorough research. Solid research forms the foundation of any successful nursing assignment. Begin by gathering relevant and credible sources, such as nursing textbooks, scholarly articles, reputable websites , and academic databases specific to nursing. These resources will provide you with evidence-based information to support your arguments and demonstrate your understanding of the topic.

Creating a Well-Structured Outline

A well-structured outline is essential for organizing your thoughts and ensuring a logical flow in your nursing assignment. An effective outline acts as a roadmap, guiding you through the writing process and ensuring that you cover all the necessary points.

At [Your Service Name], our expert writers can assist you in creating a comprehensive outline tailored to your specific assignment. By collaborating with us, you can receive personalized guidance in organizing your ideas effectively and structuring your assignment in a logical manner. Our writers understand the nuances of nursing assignments and can help you identify the most important concepts and supporting evidence to include.

Using a Professional Tone

Maintaining a professional tone throughout your nursing assignment is crucial. As aspiring healthcare professionals, it’s essential to communicate your ideas with clarity, conciseness, and professionalism. Use clear and concise language, avoiding jargon or slang that may hinder the reader’s understanding. Present your arguments and supporting evidence in a logical and coherent manner, demonstrating your ability to think critically and apply nursing principles.

Our expert writers have extensive experience in academic writing within the field of nursing. They possess a deep understanding of the professional tone required for nursing assignments and can ensure that your assignment is written to the highest standards. By collaborating with us, you can receive guidance in maintaining a professional tone and effectively conveying your ideas.

Incorporating Practical Examples

In addition to a professional tone, incorporating practical examples into your nursing assignment can greatly enhance its quality. Practical examples bring theoretical concepts to life, illustrating their application in real-life scenarios. They demonstrate your understanding of nursing principles and showcase your ability to bridge the gap between theory and practice.

Our team consists of experienced nursing professionals who can assist you in incorporating relevant practical examples into your assignment. Drawing from their extensive knowledge and expertise, they can provide you with real-life scenarios or case studies that strengthen the impact and credibility of your work. By collaborating with us, you can elevate the quality of your assignment by demonstrating your ability to apply nursing concepts in practical settings.

Proofreading and Editing

Proofreading and editing are essential steps in the assignment writing process. They ensure that your nursing assignment is polished, error-free, and effectively communicates your ideas. After completing the initial draft, it’s crucial to take a break and return to your work with fresh eyes. During the proofreading stage, carefully review your assignment for grammar, spelling, punctuation, and sentence structure. Correct any errors and inconsistencies that may affect the clarity and professionalism of your writing.

At nursingresearchhelp.com , we have a dedicated team of proofreaders and editors who specialize in nursing assignments. They meticulously review your work, ensuring that it adheres to formatting guidelines and meets the highest standards of academic writing. Our proofreaders and editors will help you refine your assignment, ensuring that it is polished and error-free. By collaborating with us, you can rest assured that your assignment will be thoroughly reviewed and refined before submission.

Seeking Help When Needed

In addition to proofreading and editing, it’s important to seek help when needed. Nursing assignments can be challenging, and it’s perfectly normal to require assistance. Whether you’re facing difficulties in understanding the assignment prompt, need guidance in specific areas, or simply want a fresh perspective on your work, don’t hesitate to reach out for support.

Our friendly and knowledgeable support team is always available to address any questions or concerns you may have. We understand the unique challenges faced by nursing students and can provide you with the guidance and clarification you need. By seeking help when needed, you can overcome obstacles and ensure the successful completion of your nursing assignments.

Mastering nursing assignments is within your reach with the right tips, strategies, and expert assignment help services. At nursingresearchhelp.com we are committed to supporting nursing students in excelling in their academic pursuits. Our experienced writers, proofreaders, and editors can provide personalized assistance throughout the assignment writing process, ensuring that your assignments meet the highest standards of quality and professionalism.

With our help, you can confidently tackle your nursing assignments and overcome any challenges you may face. Visit our website nursingresearchhelp.com to learn more about our services and how we can support you in achieving academic excellence. Whether you need guidance in understanding the assignment, conducting thorough research, creating a well-structured outline, using a professional tone, incorporating practical examples, or ensuring a polished final product, we are here to assist you. Trust us for reliable and professional assignment help tailored to your needs.

Don’t let the challenges of nursing assignments hold you back—reach out to us for reliable and professional assignment help tailored to your needs.

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Chapter 4 Nursing Process
The nursing process becomes a road map for the actions and interventions that nurses implement to optimize their patients' well-being and health. This chapter will explain how to use the nursing process as standards of professional nursing practice to provide safe, patient-centered care. ... The assignment of the performance of activities or ...
The Nursing Process: A Comprehensive Guide
The nursing process is defined as a systematic, rational method of planning that guides all nursing actions in delivering holistic and patient-focused care. The nursing process is a form of scientific reasoning and requires the nurse's critical thinking to provide the best care possible to the client.
The 5 Nursing Process Steps
The nursing process is a dynamic process as it is constantly affected by the patient's needs, circumstances impacting their needs, and the environment in which care is applied. It encompasses emotional, physical, social, and medical aspects. ... Delegation involves the assignment of specific tasks or activities related to patient care to ...
What is the Nursing Process? ADPIE
The nursing process is a patient-centered, systematic, evidence-based approach to delivering high-quality nursing care. It consists of five steps: assessment, diagnosis, outcomes/planning, implementation, and evaluation. The Nursing Process (ADPIE) Assessment. Identify patients' health needs and collect subjective and objective nursing data ...
The Nursing Process: Everything Next-Gen NCLEX-RN Test ...
Phase 1: Assessment & Analysis. The first step of The Nursing Process, assessment, is a nurse's most important skill to grow and nurture. Assessment allows nurses to identify actual or potential alterations in health, safety, and overall well-being for their patients, families, and communities. Assessment can include:
5 Core Areas of the Nursing Process Explained
Care is documented in the patient's record. Evaluation. Both the patient's status and the effectiveness of the nursing care must be continuously evaluated, and the care plan modified as needed. Learn more about the nursing process, including its five core areas (assessment, diagnosis, outcomes/planning, implementation, and evaluation).
4.1: Nursing Process Introduction
Nurses do this activity every shift. They know how to find pertinent information and use the nursing process as a critical thinking model to guide patient care. The nursing process becomes a road map for the actions and interventions that nurses implement to optimize their patients' well-being and health. This chapter will explain how to use ...
Mastering the Nursing Process: A Guide for Aspiring Nurses
The nursing process provides nurses with a rational and systematic way of evaluating their patients and delivering holistic care in a patient-first paradigm. ... SimpleNursing makes it easy to prepare for your upcoming exams and assignments on the nursing process, with a wealth of content that includes fun videos, comprehensive study guides ...
Nursing Process
The nursing process functions as a systematic guide to client-centered care with 5 sequential steps. These are assessment, diagnosis, planning, implementation, and evaluation. Assessment. Assessment is the first step and involves critical thinking skills and data collection; subjective and objective. Subjective data involves verbal statements ...
The Nursing Process
The Nursing Process. The Nursing Process is a formalized way for nurses to apply critical thinking to the "work of nursing." The nursing process encompasses all significant actions taken by registered nurses and forms the foundation of the nurse's decision making (ANA, 2015). Technically, the nursing process is a systematic method that directs the nurse, with the patient's ...
Nursing Fundamentals- Nursing Process Practice Questions
Study with Quizlet and memorize flashcards containing terms like A client comes to the walk-in clinic with reports of abdominal pain and diarrhea. While taking the client's vital signs, the nurse is implementing which phase of the nursing process? A. Assessment B. Diagnosis C. Planning D. Implementation, The nurse is measuring the client's urine output and straining the urine to assess for stones.
The Nursing Process
The nursing process is a set of steps followed by nurses in order to care for patients. How a particular nurse uses the nursing process varies based on the nurse, the patient, and the situation, but the process generally follows the same steps: assessment, diagnosis, plan, implementation, evaluation. The first step, assessment, is used to get ...
Nursing Process Example
The nursing process can be a confusing concept for nursing students to grasp. Below is an example of the process from start to finish in a story like fashion: Assessment John visits his general physician on Monday because he was feeling sick over the weekend. When he is called back from the waiting room, the nurse on staff takes his temperature ...
Nursing fundamentals: the nursing process (ati) Flashcards
1. establish priorities and outcomes that can be measured and evaluated. 2. these priorities and outcomes are what directs selection of interventions. 3. three types of planning. 4. develop plan of care based on assessment. 5. planning is continuous; obtain new info and evaluate responses to care; modify plan of care if necessary.
Nursing Process Assignment
Nursing process nr226 fundamentals: patient care nr226 nursing process practice patient name: instructions complete the following after reading (and. ... Nursing Process Assignment. Course: Transition To The Nursing Profession (NR-103) 342 Documents. Students shared 342 documents in this course.
PDF 8 steps for making effective nurse-patient assignments
Decide on the process. Now that you've gathered the information you need, you're ready to develop your plan for assigning nurses. This step usually combines the unit layout with your patient flow. Nurses typically use one of three processes—area, direct, or group—to make assignments. (See Choose your process.)
Prioritization, Delegation, and Assignment in Nursing NCLEX Practice
Directions are provided with the question. To help you answer nursing prioritization questions, remember the three principles commonly used: 1. Remember ABC's (airway, breathing, and circulation). Patients with obvious respiratory problems or interventions to provide airway management are given priority. 2.
Nursing Admission Assessment and Examination
The initial nursing assessment, the first step in the five steps of the nursing process, involves the systematic and continuous collection of data; sorting, analyzing, and organizing that data; and the documentation and communication of the data collected. Critical thinking skills applied during the nursing process provide a decision-making framework to develop and guide a plan of care for the ...
From Nursing Process to Clinical Judgment
The nursing process has been used for over 50 years as the systematic, stepwise method for problem solving to make safe, client-centered clinical decisions. Originally, there were four nursing process steps, published in the late 1960s. These were: In the early 1970s, the North American Nursing Diagnosis Association (NANDA, currently called ...
Ultimate Guide to Nursing Assignments: 7 Tips and Strategies
Proofreading and Editing. Proofreading and editing are essential steps in the assignment writing process. They ensure that your nursing assignment is polished, error-free, and effectively communicates your ideas. After completing the initial draft, it's crucial to take a break and return to your work with fresh eyes.
NURSING PROCESS ASSIGNMENT (NPA)
NURSING PROCESS ASSIGNMENT (NPA) PURPOSES: To apply the nursing process to an adult patient care situation. To establish priorities and demonstrate clinical decision making. PREPARATION: Review Lewis, pp. 9-16. Prepare Part 1 prior to experience. REQUIREMENTS: Submits a complete assignment according to the criteria, in ink, two weeks following ...

What is the Nursing Process?

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1. Assessment

2. Diagnosis

3. Outcomes/Planning

4. Implementation

5. Evaluation

1. Dynamic and Cyclic

2. Patient-Centered and Goal-Directed

3. Collaborative and Interpersonal

4. Universally Applicable

5. Systematic and Scientific

6. Requires Critical Thinking

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The Nursing Process: Everything Next-Gen NCLEX-RN Test-Takers Need to Know

Phase 2: Diagnosis

Phase 5: Evaluation

Phase 1: Assessment & Analysis

Phase 4: Implementation

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Prioritization, Delegation, and Assignment in Nursing NCLEX Practice Questions (100 Items)

Prioritization, Delegation, and Assignment Practice Quiz

Nursing Prioritization, Delegation and Assignment Reviewer for Nurses

NCLEX Tips for Nursing Prioritization, Delegation, and Assignment questions:

1. Do not make decisions based on resolutions

2. Never delegate the functions of assessment, evaluation and nursing judgment.

3. Identify tasks for delegation based on the client’s needs.

4. Ensure the appropriate education, skills, and experience of personnel performing delegated tasks.

5. Remember priorities!

6. Additional Test Taking Tips and Strategies

Nursing Prioritization

1. Remember ABC’s (airway, breathing, and circulation).

2. Maslow’s Hierarchy of Needs

3. Using the Nursing Process

Delegation in Nursing

5 Rights of Delegation in Nursing

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Getting Ready for the Next-Generation NCLEX® (NGN): How to Shift from the Nursing Process to Clinical Judgment in Nursing

What is the Nursing Process?

Comparing the Nursing Process and Clinical Judgment

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The Ultimate Guide to Nursing Assignments: 7 Tips and Strategies

Understanding the Nursing Assignments

Conducting Thorough Research

Creating a Well-Structured Outline

Using a Professional Tone

Incorporating Practical Examples

Proofreading and Editing

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