A nurse performs an assessment on a patient. Which assessment data will the nurse use as an etiology for Acute pain?
a. Discomfort while changing position
b. Reports pain as a 7 on a 0 to 10 scale
c. Disruption of tissue integrity
d. Dull headache
ANS: C
Disruption of tissue integrity is a possible cause or etiology of pain. A report of pain, headache, and discomfort are examples of things a patient might say (subjective data or defining characteristics) that may lead a nurse to select Acute pain as a nursing diagnosis.
You might also like to view...
Discussing sexuality and sexual function with an older person
a. Is unnecessary because of the loss of sexual function with aging b. Is the responsibility of the physician or registered nurse c. Is very embarrassing for the older adult, so the discussion should be avoided unless the patient specifically asks questions d. Is best approached by asking the older adult if he or she has any questions regarding sexuality or sexual function
After a spouse's death, a patient repeatedly says, "I should have recognized what was happening and been more helpful.". This individual is experiencing:
a. preoccupation with the image of the deceased. b. sensations of somatic distress. c. anger. d. guilt.
Stogdill's second study found
a. No significant differences in traits from 1948 to 1974 b. Situational factors could not be identified c. Emotional intelligence plays a significant role in leadership d. Both traits and situational factors are determinants of leadership
The paramedics are transporting to the emergency department a patient who is experiencing shock. What will the nurse prepare in anticipation of the patient's arrival?
1. Cardiac monitor 2. Pulse oximeter 3. Oxygen 4. Whole blood 5. Dextran 40