The nurse observes that the urinary meatus is located on the under surface of the penis. How does the nurse document this finding?
a. Balanitis
b. Phimosis
c. Epispadias
d. Hypospadias
ANS: D
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During an inspection of a patient's face, the nurse notices that the facial features are symmetric. This finding indicates which cranial nerve is intact?
a. VII b. IX c. XI d. XII
Several nurses are concerned that agency policies related to restraint and seclusion practices are inadequate
Which understanding about the relationship of substandard institutional policies and individual nursing practice should guide nursing practice? a. The policies do not absolve an individual nurse of the responsibility to practice according to professional standards of nursing care. b. Agency policies are considered the legal standard by which a professional nurse must act and therefore override other standards of care. c. In an institution with substandard policies, the nurse has a responsibility to inform the supervisor and leave the premises without delay. d. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.
For a client with dissociative identity disorder, the nursing diagnosis of disturbed personal identity
most likely has an etiology statement of "related to a. poor impulse control." b. chronic low self-esteem." c. unresolved childhood abuse issues." d. high risk for self-directed violence."
Which portion of the interview determines how well the client can perform activities of daily living (ADLs)?
A) Cultural history B) Functional assessment C) Chief complaint D) Psychosocial history