The nurse is contributing to the care plan of a patient with aortic stenosis. Which of these outcomes would support a favorable response for the nursing diagnosis of activity intolerance?
a. Clear breath sounds, no edema or weight gain
b. Vital signs within normal limits during self-care
c. Verbalizes knowledge of disorder
d. States willingness to comply with therapeutic regimen
ANS: B
The desired outcome for activity intolerance would be for vital signs within normal limits during self-care.
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Which type of range of joint motion should a nurse implement for the client who has full range of joint motion and limited strength?
A. Passive ROM B. Active ROM C. Assisted ROM D. Resistive ROM
A client who is experiencing complications of anorexia nervosa has a nursing diagnosis of Fluid volume deficit related to inadequate intake of liquids, self-induced vomiting, laxative, and diuretic use
What is an appropriate nursing goal for this diagnosis? a. The client's intake and output will be ap-proximately equal by the 4th hospital day. b. The client will demonstrate increased con-sumption of nutrients as evidenced by daily weight gain. c. The client will verbalize feelings regarding the disease and coping strategies by the time of discharge. d. The client will verbalize plans for the future.
A nurse is teaching a group of parents about tracheoesophageal fistula. Which statement, made by the nurse, is accurate about tracheoesophageal fistula (TEF)?
a. This defect results from an embryonal failure of the foregut to differentiate into the trachea and esophagus. b. It is a fistula between the esophagus and stomach that results in the oral intake being refluxed and aspirated. c. An extra connection between the esophagus and trachea develops because of genetic abnormalities. d. The defect occurs in the second trimester of pregnancy.
A patient who is at risk for osteoporosis will begin taking the selective estrogen receptor modulator raloxifene (Evista). Which statement will the nurse include when teaching this patient about the medication?
a. Raloxifene reduces the risk of thromboembolism. b. The drug is associated with an increased risk of breast cancer. c. Use of this drug increases the risk of endometrial carcinoma. d. Vasomotor symptoms are a common side effect of this drug.