When focus charting, what does the nurse use as a basis for documentation?
a. Problem list
b. Nursing orders
c. Nursing diagnoses
d. Evaluation
C
In focus charting, instead of using the problem list, modified nursing diagnoses are used as an index for nursing documentation.
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A client who has degenerative arthritis of the knees and hips for which she takes nonsteroidal
antiinflammatory drugs tells the nurse "For the past month I have been having a lot of trouble sleeping. I cannot seem to fall asleep, and then when I finally do get to sleep, I find I wake up a number of times during the night.". Which information should the nurse seek initially? a. "Are you snoring a lot?" b. "Do you have pain at night?" c. "Do you sleep better with the radio on?" d. "Can you define ‘good sleep' for me?"
The nurse manager has implemented the process of progressive discipline with a nurse who has violated hospital policy. The nurse manager recognizes that two criteria for corrective actions to be effective are that the actions are:
a. consistent and impartial b. very assertive and pertinent c. pejorative and sound d. measurable and administered by HR
A patient diagnosed with obsessive-compulsive disorder (OCD) tells a nurse, "I'm such a stupid person for behaving this way.". The most therapeutic nursing response would be to:
a. change the subject. b. agree that the behavior is problematic. c. ask about the feelings experienced before using the behavior. d. support the insight by asking for immediate behavioral change.
Several clients are experiencing increased respiratory secretions and require intervention to assist in their removal. Chest percussion is indicated and appropriate for the client experiencing which one of the following?
a. Thrombocytopenia b. Cystic fibrosis c. Osteoporosis d. Spinal fracture