5. The nursing diagnosis for a client is immobility related to a stroke. Which classification system can be readily used with this diagnosis?
a. Omaha system of client problems
b. Clinical pathways
c. Nursing intervention classification
d. International classification of disease (ICD)
ANS: C
The nursing intervention classification organizes nursing interventions under domains. The Omaha classification system is used in health departments and home health agencies. Clinical pathways are standards of practice protocols. ICD describes medical practice.
You might also like to view...
The nursing home staff needs assistance to properly feed the residents who need assis-tance with feeding. Which should the nurse implement to ensure the residents are fed properly?
a. Instruct the feeding assistants to feed four people at a time. b. Draw on the availability of family members who are able to follow instructions. c. Ask some residents to self-feed for part of the mealtime. d. Assign a small group of nursing assistants to do the feeding.
In caring for an immediate postpartum patient, you note petechiae and oozing from her IV site. You would monitor her closely for the clotting disorder:
1. disseminated intravascular coagulation. 2. amniotic fluid embolism. 3. hemorrhage. 4. HELLP syndrome.
You are the nurse preparing the community health agency report on risk factors in the community. Based on your knowledge of risk factors and associated deaths in high-income countries, such as the United States,
what do you anticipate the leading risk factor will be? A) High cholesterol B) High blood pressure C) Physical inactivity D) Smoking
Which is the priority nursing intervention for an unconscious child after a fall?
a. Establish adequate airway. b. Perform neurologic assessment. c. Monitor intracranial pressure. d. Determine whether a neck injury is present.