A patient has had an appendectomy. He has an incision at the right lower quadrant of the abdomen. Nurse has written: Alteration in skin integrity related to incision at right lower quadrant of the abdomen. This is
A) A planned outcome
B) Subjective data
C) A nursing intervention
D) An actual nursing diagnosis
Ans: D
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The nurse is assessing a client from another country for a personality disorder. Even though the client makes statements that the nurse interprets as symptoms of personality disorders, the nurse should plan to:
1. investigate the statements with a cultural expert. 2. assume the client has a disorder. 3. ask the family about past diagnoses. 4. report the symptoms to the physician.
Which statement is priority teaching at the time of discharge for the client who receives imipramine (Tofranil)?
1. "You will need to maintain a low-fat diet while on this medication." 2. "You must maintain a normal intake of salt while on this medication." 3. "Please notify your health care provider of any changes in urine quantity or quality." 4. "You can stop the medication when you are no longer feeling depressed."
An appropriate nursing diagnosis for the family of a client dying of cancer whose members have expressed sorrow over the forthcoming loss would be
A) Anticipatory grieving related to loss of family member as evidenced by sorrow B) Dysfunctional grieving related to the loss of family member as manifested by behaviors indicating anxiety C) Potential for grieving related to loss of family member and sorrow D) Dysfunctional grieving related to future loss of family member manifested by family's developmental regression
Which of the following is an example of nonverbal communication?
A. Spoken words B. A written report C. Smiling D. Screaming