Practice questions

1. A nurse educator is teaching a group of nurses about assessing critically ill clients for multiple
organ dysfunction syndrome (MODS). The nurse educator evaluates understanding by asking the nurses
to identify which client would be at highest risk for MODS. It would be the client who is experiencing
septic shock and is

a) An older adult man with end-stage renal disease and an infected dialysis access site

b) An 8-year-old boy who underwent an appendectomy and then incurred an iatrogenic infection

c) A young female adolescent who developed shock from tampon use during menses

d) A middle-aged woman with metastatic breast cancer and a BMI of 26

2. A patient is admitted to the emergency department after sustaining abdominal injuries and a
broken femur from a motor vehicle accident. The patient is pale, diaphoretic, and is not talking
coherently. Vital signs upon admission are temperature 98 F (36 C), heart rate 130 beats/minute,
respiratory rate 34 breaths/minute, blood pressure 50/40 mmHg. The healthcare provider suspects
which type of shock?

a.) Hypovolemic

b.) Cardiogenic

c.) Neurogenic

d.) Distributive

3. When caring for a patient in acute septic shock, what should the nurse anticipate?

A. Infusing large amounts of IV fluids

B. Administering osmotic and/or loop diuretics

C. Administering IV diphenhydramine (Benadryl)

D. Assisting with insertion of a ventricular assist device (VAD)

4. A massive gastrointestinal bleed has resulted in hypovolemic shock in an older patient. What is a
priority nursing diagnosis?

A. Acute pain
B. Impaired tissue integrity

C. Decreased cardiac output

D. Ineffective tissue perfusion

5. What laboratory finding fits with a medical diagnosis of cardiogenic shock?

A. Decreased liver enzymes

B. Increased white blood cells

C. Decreased red blood cells, hemoglobin, and hematocrit

D. Increased blood urea nitrogen (BUN) and serum creatinine levels

6. A patient's localized infection has progressed to the point where septic shock is now suspected.
What medication is an appropriate treatment modality for this patient?

A. Insulin infusion

B. IV administration of epinephrine

C. Aggressive IV crystalloid fluid resuscitation

D. Administration of nitrates and β-adrenergic blockers

7. The nurse would recognize which clinical manifestation as suggestive of sepsis?

A. Sudden diuresis unrelated to drug therapy

B. Hyperglycemia in the absence of diabetes

C. Respiratory rate of seven breaths per minute

D. Bradycardia with sudden increase in blood pressure

8. The nurse is caring for a 72-year-old man in cardiogenic shock after an acute myocardial
infarction. Which clinical manifestations would be of most concern to the nurse?

A. Restlessness, heart rate of 124 beats/minute, and hypoactive bowel sounds

B. Mean arterial pressure of 54 mm Hg, increased jaundice, and cold, clammy skin

C. PaO2 of 38 mm Hg, serum lactate level of 46.5 mcg/dL, and bleeding from puncture sites

D. Agitation, respiratory rate of 32 breaths/minute, and serum creatinine level of 2.6 mg/dL

9. A patient has a spinal cord injury at T4. Vital signs include falling blood pressure and
bradycardia. The nurse recognizes that the patient is experiencing

a. a relative hypervolemia

b. an absolute hypovolemia

c. neurogenic shock from low blood flow

d. neurogenic shock from massive vasodilation

10. A patient who has pericarditis related to radiation therapy, becomes dyspneic, and has a rapid,
weak pulse. Heart sounds are muffled, and a 12 mmHg drop in blood pressure is noted on inspiration.
The healthcare provider's interventions are aimed at preventing which type of shock?

a.) Distributive

b.) Neurogenic

c.) Obstructive

d.) Cardiogenic

11. The healthcare provider is caring for a patient who has septic shock. Which of these should the
healthcare provider administer to the patient first?

a.) Antibiotics to treat the underlying infection.

b.) Corticosteroids to reduce inflammation.

c.) IV fluids to increase intravascular volume.

d.) Vasopressors to increase blood pressure.

12. 4.5 kg infant is admitted to the pediatric intensive care unit after 33 days of watery diarrhea.
The infant is diagnosed with severe dehydration. The infant's skin is mottled and turgor is poor. Capillary
refill is delayed, and there is an absence of tears with crying. Which intervention should be the priority
action by the healthcare provider?

a.) Calculate the mean arterial pressure

b.) Draw blood for a complete blood count

c.) Establish vascular access

d.) Take a complete set of vital signs

13. Which of the following assessment findings is an early indication of hypovolemic shock?

a.) Diminished bowel sounds

b.) Increased urinary output

c.) Tachycardia

d.) Hypertension

14. When compensatory mechanisms for hypovolemic shock are activated, the nurse would expect
which two patient findings to normalize?

a.) Intensity of peripheral pulses and body temperature.

b.) Peripheral pulses and heart rate (HR).

c.) Metabolic alkalosis and oxygen saturation.

d.) Cardiac output (CO) and blood pressure (BP).

15. Which type of fluid is most appropriate for volume replacement for a patient with non-
hemorrhagic hypovolemic shock?

a.) Lactated Ringers (LR)

b.) 10% Dextrose in Water (D 10 W)

c.) One-half Normal Saline (1/2% NS)

d.) Packed Red Blood Cells (PRBC)

16. A 78 year old man has confusion and temperature of 104. He is a diabetic with purulent drainage
from his right heel. After an infusion of 3 L of normal saline solution, his assessment findings are BP
84/40, HR 110, RR 42 and shallow, CO 8L/min, and PAWP 4 mm Hg. This patient's symptoms are most
likely indicative o

a. sepsis

b. septic shock

c. multiple organ dysfunction syndrome

d. systemic inflammatory response syndrome

17. ppropriate treatment modalities for the management of cardiogenic shock include (Select all that
apply)

a. dobutamine to increase myocardial contractility

b. vasopressors to increase systemic vascular resistance

c. circulatory assist devices such as an intraaortic balloon pump

d. corticosteroids to stabilize the cell wall in the infarcted myocardium

e. trendelenburg positioning to facilitate venous return and increase preload

18. Appropriate treatment modalities for the management of cardiogenic shock include (select all that
apply):

a. dobutamine to increase myocardial contractility.

b. vasopressors to increase systemic vascular resistance.

c. circulatory assist devices such as an intraaortic balloon pump.

d. corticosteroids to stabilize the cell wall in the infarcted

myocardium.

e. Trendelenburg positioning to facilitate venous return and

increase preload.

19. A massive gastrointestinal bleed has resulted in hypovolemic shock in an older patient. What is a
priority nursing diagnosis?

a-Acute pain

b-Impaired tissue integrity

c-Decreased cardiac output

d-Ineffective tissue perfusion

20. What laboratory finding fits with a medical diagnosis of cardiogenic shock?

a-Decreased liver enzymes

b-Increased white blood cells

c-Decreased red blood cells, hemoglobin, and hematocrit

d-Increased blood urea nitrogen (BUN) and serum creatinine levels

21. What will the nurse identify as symptoms of hypovolemic shock in a patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

a. Temperature of 97.6°F (36.4°C)

b. Restlessness

c. Decrease in blood pressure of 20 mm Hg when the patient sits up

d. Capillary refill time greater than 3 seconds

e. Sinus bradycardia of 55 beats per minute

22. Which laboratory finding should cause the nurse to suspect that a patient is developing hypovolemic
shock?

a. Serum sodium of 130 mEq/L (130 mmol/L)

b. Metabolic acidosis validated by arterial blood gases

c. Serum lactate of 3 mmol/L

d. SvO2 greater than 80%

23. The nurse recognizes that which patient would be most likely to develop hypovolemic shock? A
patient with:

a. Decreased cardiac output

b. Severe constipation, causing watery diarrhea

c. Ascites

d. Syndrome of inappropriate ADH (SIADH)

24. Which finding indicates that a patient is experiencing increased peripheral resistance and
vasoconstriction?

a. Strong bounding pulse with deep red coloring

b. Pale, cool extremities with decreased pulses

c. Increased venous engorgement with strong pulses

d. Faster than normal capillary refill time

25. Which solution would be the most appropriate initial volume replacement for a patient with severe
GI bleeding?

a. 200 mL of normal saline (NS) per hour for 5 hours

b. A liter of Ringer's lactate (RL) over 15 minutes

c. Two liters of D5W over half an hour

d. 500 mL of 0.45% normal saline (1/2 NS) over half an hour

26. Which life-threatening complications would the nurse anticipate developing in the patient being
treated for hypovolemic shock?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

a. Fluid volume overload

b. Renal insufficiency

c. Cerebral ischemia

d. Gastric stress ulcer

e. Pulmonary edema

27. The nurse, caring for a patient in hypovolemic shock, will not utilize a hypotonic solution for fluid
resuscitation because hypotonic solutions:

a. Move quickly into the interstitial spaces and can cause third spacing

b. Stay longer to expand the intravascular space but deplete intracellular fluid levels

c. Do not stay in the intravascular space long enough to expand the circulating blood volume

d. Need a smaller bore needle to run at a slower rate to keep the intravascular space low

28. The nurse should warm intravenous fluids when a rapid infuser is being utilized to prevent which
complication?

a. Hemorrhagic shock

b. Hypothermia

c. Sepsis

d. Cardiogenic shock

29. A patient is treated in the emergency department (ED) for shock of unknown etiology. The first
action by the nurse should be to

a. check the blood pressure.

b. obtain an oxygen saturation.

c. attach a cardiac monitor.

d. check level of consciousness.

30. A diabetic patient who has had vomiting and diarrhea for the past 3 days is admitted to the hospital
with a blood glucose of 748 mg/ml (41.5 mmol/L) and a urinary output of 120 ml in the first hour. The
vital signs are blood pressure (BP) 72/62; pulse 128, irregular and thready; respirations 38; and
temperature 97° F (36.1° C). The patient is disoriented and lethargic with cold, clammy skin and cyanosis
in the hands and feet. The nurse recognizes that the patient is experiencing the

a. progressive stage of septic shock.

b. compensatory stage of diabetic shock.

c. refractory stage of cardiogenic shock.

d. progressive stage of hypovolemic shock.

31. A patient with hypovolemic shock has a urinary output of 15 ml/hr. The nurse understands that the
compensatory physiologic mechanism that leads to altered urinary output is

a. activation of the sympathetic nervous system (SNS), causing vasodilation of the renal arteries.

b. stimulation of cardiac -adrenergic receptors, leading to increased cardiac output.

c. release of aldosterone and antidiuretic hormone (ADH), which cause sodium and water retention.

d. movement of interstitial fluid to the intravascular space, increasing renal blood flow.

32. While caring for a seriously ill patient, the nurse determines that the patient may be in the
compensatory stage of shock on finding

a. cold, mottled extremities.

b. restlessness and apprehension.

c. a heart rate of 120 and cool, clammy skin.

d. systolic BP less than 90 mm Hg.

33. When assessing the hemodynamic information for a newly admitted patient in shock of unknown
etiology, the nurse will anticipate administration of large volumes of crystalloids when the
a. cardiac output is increased and the central venous pressure (CVP) is low.

b. pulmonary artery wedge pressure (PAWP) is increased, and the urine output is low.

c. heart rate is decreased, and the systemic vascular resistance is low.

d. cardiac output is decreased and the PAWP is high.

34. . A patient who has been involved in a motor-vehicle crash is admitted to the ED with cool, clammy
skin, tachycardia, and hypotension. All of these orders are written. Which one will the nurse act on first?

a. Insert two 14-gauge IV catheters.

b. Administer oxygen at 100% per non-rebreather mask.

c. Place the patient on continuous cardiac monitor.

d. Draw blood to type and crossmatch for transfusions.

35. A patient with massive trauma and possible spinal cord injury is admitted to the ED. The nurse
suspects that the patient may be experiencing neurogenic shock in addition to hypovolemic shock,
based on the finding of

a. cool, clammy skin.

b. shortness of breath.

c. heart rate of 48 beats/min

d. BP of 82/40 mm Hg.

36. The nurse caring for a patient in shock notifies the health care provider of the patient's deteriorating
status when the patient's ABG results include

a. pH 7.48, PaCO2 33 mm Hg.

b. pH 7.33, PaCO2 30 mm Hg.

c. pH 7.41, PaCO2 50 mm Hg.

d. pH 7.38, PaCO2 45 mm Hg.

Answers

1. Answer A: An older adult man with end-stage renal disease and an infected dialysis access site

Explanation:

MODS may develop when a client experiences septic shock. Those at increased risk for MODS are

• older clients,

• clients who are malnourished, and

• clients with coexisting disease.

2. Answer A. Hypovolaemic

3. A. Infusing large amounts of IV fluids

Septic shock is characterized by a decreased circulating blood volume. Volume expansion with the
administration of IV fluids is the cornerstone of therapy. The administration of diuretics is inappropriate.
VADs are useful for cardiogenic shock not septic shock. Diphenhydramine (Benadryl) may be used for
anaphylactic shock but would not be helpful with septic shock.

4. D. Ineffective tissue perfusion

The many deleterious effects of shock are all related to inadequate perfusion and oxygenation of every
body system. This nursing diagnosis supersedes the other diagnoses.

5. D. Increased blood urea nitrogen (BUN) and serum creatinine levels

The renal hypoperfusion that accompanies cardiogenic shock results in increased BUN and creatinine
levels. Impaired perfusion of the liver results in increased liver enzymes, while white blood cell levels do
not typically increase in cardiogenic shock. Red blood cell indices are typically normal because of relative
hypovolemia.

6. C. Aggressive IV crystalloid fluid resuscitation

Patients in septic shock require large amounts of crystalloid fluid replacement. Nitrates and β-adrenergic
blockers are most often used in the treatment of patients in cardiogenic shock. Epinephrine is indicated
in anaphylactic shock, and insulin infusion is not normally necessary in the treatment of septic shock
(but can be).

7. B- Hyperglycemia in patients with no history of diabetes is a diagnostic criterion for sepsis.

Oliguria, not diuresis, typically accompanies sepsis along with tachypnea and tachycardia

8. C. PaO2 of 38 mm Hg, serum lactate level of 46.5 mcg/dL, and bleeding from puncture sites

Severe hypoxemia, lactic acidosis, and bleeding are clinical manifestations of the irreversible state of
shock. Recovery from this stage is not likely because of multiple organ system failure. Restlessness,
tachycardia, and hypoactive bowel sounds are clinical manifestations that occur during the
compensatory stage of shock. Decreased mean arterial pressure, jaundice, cold/ clammy skin, agitation,
tachypnea, and increased serum creatinine are clinical manifestations of the progressive stage of shock.

9. D

10. c.) Obstructive

Rationale:

Obstructive shock can be caused by anything that impedes the heart's ability to contract and pump
blood around the body, as with cardiac tamponade.

11. c.) IV fluids to increase intravascular volume.

Rationale:

Circulation and perfusion are addressed first so IV fluids will be started immediately. After blood cultures
are obtained, broad-spectrum antibiotics should be administered without delay. Vasopressors are
administered if the patient is not responding to the fluid challenge. Corticosteroids may be considered
to address the inflammatory-induced vasodilation and capillary leakage.

12. c.) Establish vascular access

Rationale:
Vascular access should be established quickly in order to replace lost volume before shock progresses.

13. c.) Tachycardia

Rationale:

Tachycardia is an early symptom as the body compensates for a declining blood pressure the heart rate
increases to circulate the blood faster to prevent tissue hypoxia.

14. d.) Cardiac output (CO) and blood pressure (BP).

[1/26, 12:45] Dr Augustine Ndaimani: But here we are saying, in shock. Pulse rate is already high, and BP
low. Compensation releases catecholamines (adrenaline etc). this increases heart rate (further) and may
improve BP (increased vasoconstriction increases BP)

[1/26, 12:45] Dr Augustine Ndaimani: So Pulse worsens but BP normalises

18. A. Dobutamine to increase myocardial contractility and Circulatory assist devices such as an
intraaortic balloon pump.

Rationale: Dobutamine (Dobutrex) is used in patients in cardiogenic shock with severe systolic
dysfunction. Dobutamine increases myocardial contractility, decreases ventricular filling pressures,
decreases systemic vascular resistance and pulmonary artery wedge pressure, and increases cardiac
output, stroke volume, and central venous pressure. Dobutamine may increase or decrease the heart
rate. The workload of the heart in cardiogenic shock may be reduced with the use of circulatory assist
devices such as an intraaortic balloon pump or ventricular assist device.

[1/26, 12:54] Dr Augustine Ndaimani: Answer should be A, C. The SPECIFIC treatment for cardiogenic
shock. D is tru but not specific to any one shock type

19. Answer D: Ineffective tissue perfusion

Rationale: The many deleterious effects of shock are all related to inadequate perfusion and
oxygenation of every body system. This nursing diagnosis supersedes the other diagnoses.

20. Answer D. Increased blood urea nitrogen (BUN) and serum creatinine levels
Rationale: The renal hypoperfusion that accompanies cardiogenic shock results in increased BUN and
creatinine levels. Impaired perfusion of the liver results in increased liver enzymes, while white blood
cell levels do not typically increase in cardiogenic shock. Red blood cell indices are typically normal
because of relative hypovolemia.

21. Correct Answer: b,c,d

Rationale a: Fever will increase oxygen demands but is unrelated to hypovolemic shock unless prolonged
fever has caused severe dehydration, reducing the circulating blood volume. Hypovolemic shock reduces
temperatures by peripheral shunting of blood away from the extremities and reducing the core
metabolic rate.

Rationale b: Due to decreased blood flow to the brain and peripheral areas when blood is shunted to
maintain the vital organs, cerebral hypoxia occurs, leading to a change in mental status.

Rationale c: Orthostatic hypotension is a manifestation of hypovolemic shock.

Rationale d: Due to decreased blood flow to the brain and peripheral areas when blood is shunted to
maintain the vital organs, capillary refill time will be reduced.

Rationale e: Bradycardia is not present. The compensatory response is to increase the heart rate to
circulate the blood faster to make up for the fluids that are not present in hypovolemic shock.

22. Correct Answer: b

Rationale a: The sodium level in hypovolemic shock is elevated above the normal values of 135 to 145
mEq/L, not reduced.

Rationale b: Metabolic acidosis is present due to an accumulation of carbonic acid, leaving a bicarbonate
deficit from decreased tissue perfusion.

Rationale c: Serum lactate is greater than 4 mmol/L as a result of tissue ischemia, hypoxia, and
breakdown from decreased blood flow with hypovolemic shock.

Rationale d: SvO2 (mixed venous oxygen saturation) would be less than 60% due to decreased
circulating blood volume or decrease in cells to carry the oxygen. Therefore, O2 is carried less efficiently
and decreased, not increased.

23. Correct Answer: c

Rationale a: Although ECG changes reflect the effectiveness of the heart's pumping when circulating the
blood, it is not a risk factor for hypovolemic shock, which reflects a decreased circulating volume from
either blood or fluid losses within the intravascular system.

Rationale b: Severe constipation does not affect the circulating blood volume.

Rationale c: Third spacing shifts move the fluids from the intravascular space into the interstitial space,
causing a drop in the circulating blood volume. Therefore, third spacing is a risk factor for the
development of hypovolemic shock.

Rationale d: Overhydration does not lead to hypovolemic shock. It leads to fluid overload, which might
cause cardiogenic shock, congestive heart failure, and pulmonary edema.

24. Correct Answer: b

Rationale a: An increased blood supply would increase color and bounding pulses as seen with
vasodilation (blood engorgement) and is not present with increased peripheral resistance and
vasoconstriction.

Rationale b: Increased peripheral resistance causes the blood supply to decrease and results in
decreased blood to the tissues, which causes pallor and decreased skin temperatures. The pulses would
decrease in intensity with a decreased blood supply.

Rationale c: Venous engorgement would not result from vasoconstriction of the arteries. Strong pulses
would not be present with vasoconstriction from increased peripheral resistance.

Rationale d: Capillary refill times are delayed or slowed due to decreased blood flow through the vessels
caused by the vasoconstriction from increased peripheral resistance.

[1/26, 13:00] Dr Augustine Ndaimani: Its should be given i shock and many other conditions. its like
morphine which is for pain but can be used to improve preload or afterload

[1/26, 13:01] Dr Augustine Ndaimani: or having a drink during supper. The drink may be needed but its
not supper

25. Correct Answer: B

Rationale A: This is not an adequate amount of fluid replacement.

Rationale B: The patient requires immediate infusion of an adequate amount of fluid. Fluid resuscitation
begins with 500 to 1,000 mL of an isotonic solution.

Rationale C: This is a hypotonic solution and would not help with fluid resuscitation.
Rationale D: This is a hypotonic solution and would not help with fluid resuscitation.

26. Correct Answer: b,c

Rationale a: Fluid volume overload is not an identified complication of hypovolemic shock.

Rationale b: Renal insufficiency is a serious complication because of the prerenal etiology of

hypovolemia.

Rationale c: Early identification and correction of the fluid volume deficit in hypovolemic shock is
necessary to prevent cerebral ischemia.

Rationale d: Although physiologic stress can increase the risk for the development of stress ulcers, it is
not considered one of the common or life-threatening complications of hypovolemic shock.

Rationale e: Pulmonary edema is not an identified complication of hypovolemic shock.

27. Correct Answer: C

Rationale A: Hypotonic solutions do not cause third spacing.

Rationale B: Hypotonic solutions do not stay in the intravascular space long enough to expand the
circulating blood volume.

Rationale C: Hypotonic solutions do not stay in the intravascular space long enough to expand the
circulating blood volume.

Rationale D: The bore size of the needle does not affect the displacement or shifting of fluids.

28. Correct Answer: B

Rationale A: Hemorrhagic shock is caused by a loss of cells or blood volume and is not a result of infusing
fluids too quickly.

Rationale B: Hypothermia can result when providing room temperature fluids at a faster pace than the
body can warm them.

Rationale C: Bacterial contamination can be avoided by sterile technique, and sepsis is not caused by the
rate or temperature of the fluid being administered.

Rationale D: Cardiogenic shock results from poor ventricular functioning, not from the temperature of
the intravenous fluids being administered too rapidly.
29. Correct Answer: B

Rationale: The initial actions of the nurse are focused on the ABCs, and assessing the airway and
ventilation is necessary. The other assessments should be accomplished as rapidly as possible after the
oxygen saturation is determined and addressed.

30. Correct Answer: D

Rationale: The patient's history of hyperglycemia (and the associated polyuria), vomiting, and diarrhea is
consistent with hypovolemia, and the symptoms are most consistent with the progressive stage of
shock. The patient's temperature of 97° F is inconsistent with septic shock. The history is inconsistent
with a diagnosis of cardiogenic shock, and the patient's neurologic status is not consistent with
refractory shock.

31. Correct Answer: C

Rationale: The release of aldosterone and ADH lead to the decrease in urine output by increasing the
reabsorption of sodium and water in the renal tubules. SNS stimulation leads to renal artery
vasoconstriction. -Receptor stimulation does increase cardiac output, but this would improve urine
output. During shock, fluid leaks from the intravascular space into the interstitial space.

32. Correct Answer: B

Rationale: Restlessness and apprehension are typical during the compensatory stage of shock. Cold,
mottled extremities, cool and clammy skin, and a systolic BP less than 90 are associated with the
progressive and refractory stages.

33. Correct Answer: A

Rationale: A high cardiac output and low CVP suggest septic shock, and massive fluid replacement is
indicated. Increased PAWP indicates that the patient has excessive fluid volume (and suggests
cardiogenic shock), and diuresis is indicated. Bradycardia and a low systemic vascular resistance (SVR)
suggest neurogenic shock, and fluids should be infused cautiously.

34. Correct Answer: B

Rationale: The first priority in the initial management of shock is maintenance of the airway and
ventilation. Cardiac monitoring, insertion of IV catheters, and obtaining blood for transfusions should
also be rapidly accomplished, but only after actions to maximize oxygen delivery have been
implemented.

35. Correct Answer: C

Rationale: The normal sympathetic response to shock/hypotension is an increase in heart rate. The
presence of bradycardia suggests unopposed parasympathetic function, as occurs in neurogenic shock.
The other symptoms are consistent with hypovolemic shock.

36. Correct Answer: B

Rationale: The patient's low pH in spite of a respiratory alkalosis indicates that the patient has severe
metabolic acidosis and is experiencing the progressive stage of shock; rapid changes in therapy are
needed. The values in the answer beginning "pH 7.48" suggest a mild respiratory alkalosis (consistent
with compensated shock). The values in the answer beginning "pH 7.41" suggest compensated
respiratory acidosis. The values in the answer beginning "pH 7.38" are normal.
Pulmonary artery wedge pressure. Normally 4-12mmHG. an estimate of left ventricular end-diastolic
pressure.

Homework

Can you draw a detailed nursing care plan, using all the provided nursing diagnoses. A nursing care plan
has the following columns: Nursing diagnoses, Client-centred goal, Nursing Interventions, Evaluation
criteria.

In wards we do evaluation. In theory we use evaluation criteria since we will not be dealing with actual
patients.