The nurse is developing a nursing care plan for a newly admitted patient. The first step in developing this care plan is a:
a. health history.
b. review of systems.
c. family history.
d. nursing assessment.
D
The nursing assessment is the critical step in forming the nursing care plan.
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The family development realm of assessment within family-focused care addresses family development as:
1. A functional process that is not influenced by contextual systems. 2. Family change and transformation occurring in a pattern over time. 3. A process that has a set end goal. 4. Predictable and accurate.
Six hours after delivery, an infant has a blood glucose level of 45 milligrams per deciliter. The nurse should
a. recognize this as a normal value b. observe for clinical signs of hyperglycemia c. substitute sterile water feedings instead of formula d. feed the infant glucose water or formula
The client with a massive pulmonary embolism is receiving alteplase (Activase). What is the priority nursing diagnosis or collaborative problem for this client?
A. Risk for Impaired Adjustment B. Ineffective Breathing Pattern C. Potential for Anaphylaxis D. Risk for Injury (Bleeding)
Which statement about growth and development is correct?
a. They involve a physical process. b. There is no over-lap. c. They do not depend on each other. d. They occur at the same time.