Which of the following is the correct sequence of steps in making a nursing diagnosis?
1. Generate hypotheses about possible nursing diagnoses, check for defining characteristics, cluster assessment data into meaningful sets, choose the appropriate diagnostic label, and determine the etiology.
2. Compare cue clusters with assessment data, generate differential diagnoses, determine the etiology, make the diagnosis, plan interventions, and write the "related to" statement.
3. Review the assessment data, cluster the data into meaningful sets, compare clusters with defining characteristics of possible diagnoses, choose the appropriate nursing diagnosis, determine the etiology, and write the "related to" statement.
4. Cluster data into meaningful sets, choose the appropriate nursing diagnosis, compare diagnosis with assessment data, determine the etiology, plan interventions, and write the "related to" statement.
ANS: 3
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Family history reveals that the infant's two siblings are at the 50th percentile for height and at the 75th percentile for weight. Psychosocial history reveals that the parents are separated and are planning to divorce. Which of these nursing diagnoses takes priority? 1. Nutritional Intake: excessive secondary to maternal feeding patterns 2. Growth Pattern, Altered secondary to familial short stature 3. Growth Pattern, Altered related to parental anxiety 4. Constitutional Growth Delay, risk for related to decreased appetite
A p.r.n. order must indicate the minimum time between dosages such as q4h. _____
Indicate whether the statement is true or false.
Which statement is a likely response from someone who has survived a stay in the critical care unit?
a. "I don't remember much about being in the ICU, but if I had to be treated there again, it would be okay. I'm glad I can see my grandchildren again." b. "If I get that sick again, do not take me to the hospital. I would rather die than go through having a breathing tube put in again." c. "My family is thrilled that I am home. I know I need some extra attention, but my children have rearranged their schedules to help me out." d. "Since I have been transferred out of the ICU, I cannot get enough to eat. They didn't let me eat in the ICU, so I'm making up for it now."
The emergency room charge nurse calls the labor and birth charge nurse and reports the ambulance is en route with a seizing pregnant patient at 36 weeks' gestation
What medication will the charge nurse most likely direct the staff nurse to prepare to administer immediately on the patient's arrival to the labor and birth unit? a. Magnesium sulfate (magnesium) b. Hydralazine (Apresoline) c. Carbamazepine (Tegretol) d. Terbutaline (Brethine)