The nurse has completed the admission assessment for a client admitted to the hospital's sub-acute care unit. Of the following nursing diagnoses identified by the nurse, the one that takes the highest priority is:
1. Social isolation
2. Risk for injury
3. Risk-prone health behavior
4. Impaired verbal communication
ANS: 2
Safety is always a top priority.
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During a routine visit, a parent of a school-age child states to the nurse, "I don't think my child wants me to help with anything anymore." The best response from the nurse should be:
1. "Continue to do what you have been doing for your child." 2. "Your child's ability to solve problems and assume more responsibility for herself is important." 3. "Just let your child know you are the parent, and that what you are doing is the right thing." 4. "Let your child know that she should inform you when she needs to have something done."
When must the nurse remember to use an electric razor when shaving a patient?
a. When a bleeding tendency is present b. When there is a risk for suicide c. When the facial hair is fine d. When speed is essential
A woman aged 48 years comes to the clinic because she has discovered a lump in her breast. The diagnosis is positive for breast cancer. The woman asks you when her teenage daughters should begin mammography. What is your best advice?
A) Age 28 years B) Age 35years C) Age 38 years D) Age 40 years
When caring for a client with Raynaud's disease, the nurse provides the following instructions:
A) Restrict your fluid intake to <1,500 mL of liquids daily. B) Wear gloves and warm socks during cold weather. C) Engage in high activity and stressful situations to promote circulation. D) Drink red wine because it is a vasodilator and would be helpful.