Answer to Question 1
A, C
After giving care, the nurse needs to assess and record the nursing activities and the patient's responses. This is the final step in the implementation process. Documentation is a mode of communication among the members of the health team, so it needs to be done soon after finishing the procedure. It provides the information the nurse needs to evaluate the patient's health status and nursing care plan. The implementation phase ends when the nurse documents the nursing actions and evolves into evaluation as the nurse documents patient responses to the interventions. Teaching the patient and asking the patient to assist in wound care as a part of that teaching do not need to be done right away.
Answer to Question 2
A
Best practice is evidence-based practice; that is, it is developed through sound, scientific research. Research is currently being conducted, but many of the diagnoses are not research based. A perfect nursing diagnosis is impossible to write, so that is not an issue. Having standardized nursing diagnoses recognized in state practice acts or by other professions has nothing to do with the value of the NANDA-I taxonomy.
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