After an assessment, the nurse determines that the diagnosis of Constipation is appropriate for an older patient recovering from surgery. What would be a goal for this nursing diagnosis?
1. Decrease the frequency of pain medication.
2. Know the importance of hydration and activity in regard to constipation.
3. Drink at least 1,500 ml of noncaffeinated and nonalcoholic beverages each day.
4. Evacuate a formed bowel movement at least every 2 days with minimal distress.
4
Rationale: Pain control would be addressed under a separate nursing diagnosis, even though constipation may be improved by decreasing the pain medication.
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The client has broken ribs that penetrated through the skin as a result of a motor vehicle crash 3 days ago. The client now complains of increased pain, shortness of breath, and fever
Which assessment finding alerts the nurse to the possibility of a pleural effusion and empye-ma? A. Wheezing on exhalation on the side with the broken ribs B. Absence of fremitus at and below the site of injury C. Crepitus of the skin around the site of injury D. Absence of gastric motility
A client is taking a diuretic such as furosemide. When implementing client education, what information should be included?
A) Increased sodium levels B) Increased potassium levels C) Decreased potassium levels D) Decreased oxygen levels
A patient is scheduled for an MRI of the kidneys. Which question should the nurse avoid when preparing the patient for this test?
A. "Do you have any tattoos?" B. "Have you ever been treated for chest pain?" C. "When did you last have anything to eat or drink?" D. "Is there any possibility you could be pregnant?"
On examination of stool obtained during the rectal examination, the nurse suspects the client has an obstructive jaundice if the stool is:
a. Tan. b. Tarry. c. Black. d. Liquid.