A client in the fourth stage of labor is crying out in pain. Which nursing diagnosis is the priority at this time?
A) Health-Seeking Behaviors
B) Fear
C) Anxiety
D) Acute Pain
Answer: D
In the fourth stage of labor, the diagnosis of Acute Pain, which could be related to perineal trauma, is the most appropriate for the client at this time. The diagnoses of Fear and Anxiety would be appropriate during the first stage of labor. The diagnosis of Health-Seeking Behaviors does not address the client experiencing pain during labor.
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In providing care to the client with dysphasia, which of these actions should the nurse take?
a. Continue to provide explanations before doing anything. b. Encourage a family member to stay with the client as often as possible. c. Plan care around rehabilitation activities to improve speech. d. Speak only when absolutely necessary, to avoid confusion for the client.
Which of these questions is essential to include during the nursing assessment of a client who has digestive system symptoms?
a. whether the client was breast-fed or bottle-fed as an infant b. whether the client consumes coffee or tea with meals c. client's knowledge of the food pyramid d. client's medication history, including over-the-counter drugs
An older person with a spinal cord injury wishes to be taken off of life support three months after his injury occurred. The physician will not allow this or sign the order for it. What two principles are in conflict in this situation?
a. autonomy versus paternalism b. autonomy versus justice c. nonmaleficence versus beneficence d. veracity versus fidelity
Following an intravenous pyelogram (IVP) the nurse encourages fluid intake, recognizing this is necessary to prevent which of the following renal complications?
A) glomerulonephritis B) acute renal failure C) chronic renal failure D) polycystic kidney disease