The nurse is assigned to a child in a spica cast for a fractured femur suffered in an automobile accident. The child's teenage brother was driving the car, which was totaled
The nurse learns that the father lost his job three weeks ago and the mother has just accepted a temporary waitress job. Which nursing diagnosis will the nurse use when planning care for this child and family?
1. Compromised Family Coping Related to the Effects of Multiple Simultaneous Stressors
2. Impaired Social Interaction (Parent and Child) Related to the Lack of Family or Respite Support
3. Interrupted Family Processes Related to Child with Significant Disability Requiring Alteration in Family Functioning
4. Risk for Caregiver Role Strain Related to Child with a Newly Acquired Disability and the Associated Financial Burden
Correct Answer: 1
Rationale: Compromised Family Coping Related to the Effects of Multiple Simultaneous Stressors best fits the multiple crises to which this family is responding. The spica cast may require alteration in family functioning; however, fractures are generally not considered a significant long-term disability. Lack of family members and lack of respite support was not mentioned in the scenario.
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The nursing unit staff has used evidence-based practice to implement a practice change. What is the next step in the process the nursing staff should implement?
a. Review literature. b. Engage companies. c. Measure outcomes. d. Ask a clinical question.
An elderly client is in the emergency department after suffering a fracture. The daughter is distraught and says "This will never heal in my mother; she's so old!" The most appropriate response by the nurse is
a. "Actually fractures in infants take the longest to heal." b. "Do you think your mother has a bone disease, like osteoporosis?" c. "Unless there are other problems, elderly bones heal as quickly as in adults." d. "You're right; fractures take longer to heal in the elderly."
A client with a serum potassium level of 6.6 mEq/L would have a characteristic ECG configuration of
a. increased PR interval. b. inverted QRS complex. c. no change. d. tall T wave.
The telemetry unit nurse is reviewing laboratory results for a client who is scheduled for an operative procedure later in the day
The nurse notes on the laboratory report that the client has a serum potassium level of 6.5 mEq/L, indicative of hyperkalemia. The nurse informs the physician of this laboratory result because the nurse recognizes hyperkalemia increases the client's operative risk for which of the following? A) Cardiac problems B) Infection C) Bleeding and anemia D) Fluid imbalances