The nurse is having difficulty with developing appropriate nursing diagnoses for a client's care. Which of the following could explain why this nurse is having difficulty?
a. Diagnosing is for the physician to do. c. Other nurses think it is a waste of time.
b. The client has too many health issues. d. The nurse cannot find the diagnostic label appropriate for the client's needs.
ANS: D
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The nurse knows an appropriate goal for a patient with a stage III pressure ulcer with the nursing diagnosis Impaired physical mobility is:
a. the patient will remain free of wound infections during the hospitalization. b. the patient will report pain management strategies and reduce pain to a tolerable level. c. the patient will turn self in bed using over trapeze every two hours using assistance when needed. d. the patient will consume adequate nutrition to meet nutritional requirements within 1 week.
The nurse is performing a physical examination on Mrs. D. a 58-year-old client who comes to the clinic today complaining of lethargy, weight gain, and a mass under her throat. The best question the nurse can ask is:
1. "Do you include regular table salt in your diet?" 2. "Does anyone else in your family have this problem?" 3. "Have you had this mass since birth?" 4. "Do you have a history of thyroid cancer?"
A nurse in an outpatient surgical center is teaching a client about what will be necessary for discharge to home. What information should the nurse include about transportation?
A) The client is not allowed to drive a car home. B) If the client is not dizzy, driving a car is allowed. C) Only adults over the age of 25 may drive home. D) None; this is not necessary information.
To protect yourself and others from HIV, you must follow Standard Precautions and the Blood-borne Pathogen Standard:
a. When caring for persons at risk b. When caring for persons diagnosed with HIV or AIDS c. When caring for persons diagnosed with HIV d. At all times