A nursing diagnosis that was written according to the PES format model would include:
1. Ineffective coping related to depression as evidenced by suicide attempt
2. Noncompliance (DASH diet) related to denial of having disease
3. Risk for infection related to recent surgery
4. Nutrition less than adequate related to anxiety as evidenced by weight loss of ten pounds
5. Ineffective Breathing Pattern as evidenced by cyanotic lips
Correct Answer: 1,4
Rationale 1: The basic three-part nursing diagnosis statement is called the PES format and includes the problem, etiology, and signs and symptoms.
Rationale 2: The basic three-part nursing diagnosis statement is called the PES format and includes the problem, etiology, and signs and symptoms; this diagnosis is lacking the signs and symptoms.
Rationale 3: The basic three-part nursing diagnosis statement is called the PES format and does not support the use of ‘risk for' diagnosis because the client does not have signs and symptoms of the diagnosis.
Rationale 4: The basic three-part nursing diagnosis statement is called the PES format and includes the problem, etiology, and signs and symptoms.
Rationale 5: The basic three-part nursing diagnosis statement is called the PES format and includes the problem, etiology, and signs and symptoms; this diagnosis is lacking the etiology.
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The nurse is providing care for a patient who was just diagnosed with diabetes mellitus. Which statements reflect this nurse's use of the values-based decision model in this situation?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "Tell me about what foods are important to your family celebrations." 2. "Let me help you select your lunch menu as I know you are not familiar with your diet yet." 3. "You can make the decision of when you want to take your daily oral medication dose." 4. "I have written down several websites that will provide accurate information about your disease." 5. "Is there anything you want me to talk to your physician about today?"
The nurse is preparing to assess the general appearance of the hospitalized client. Which of the following statements by the client are expected if the client is experiencing undernutrition? Standard Text: Select all that apply
1. "It seems like I get catch every bug that comes along. I can't seem to stay well.". 2. "This wound that I've had for the last 3 months on my leg won't heal.". 3. "I have gained 5 pounds over the last week and my ankles and feet are swollen.". 4. "My nails are so brittle.". 5. "I know my blood pressure has been up because I've been experiencing headaches in the morning, just like last time.".
A client has a slight shift to the left on the oxygen-hemoglobin dissociation curve. Which of the following assessment findings will support this curve configuration?
1. Arterial pH less than 7.35 2. Increased levels of 2,3-diphosphoglycerate 3. Hyperthermia 4. Hypothermia
The restraint should always be the correct ____________________ to fit the patient.
Fill in the blank(s) with the appropriate word(s).