The nurse is caring for a 5-year-old boy undergoing radiation treatment for a neuroblastoma. Which nursing diagnosis would be most applicable for this child?
A) Activity intolerance related to anemia and weakness from medications
B) Impaired skin integrity related to desquamation from cellular destruction
C) Impaired oral mucosa related to the presence of oral lesions from malnutrition
D) Imbalanced nutrition, less than body requirements related to nausea and vomiting
B
Feedback:
A nursing diagnosis for impaired skin integrity evidenced by desquamation of the radiation site would only be made for a child undergoing radiation therapy. Activity intolerance due to anemia and weakness, impaired oral mucosa evidenced by oral lesions, and malnutrition and anorexia due to nausea and vomiting are diagnoses that are common to both radiation and chemotherapy.
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A child is admitted with acute glomerulonephritis. What should the nurse expect the urinalysis during this acute phase to show?
a. Bacteriuria and hematuria b. Hematuria and proteinuria c. Bacteriuria and increased specific gravity d. Proteinuria and decreased specific gravity
Which of the following definitions best describes community-based nursing?
A) a focus on populations within the community B) a focus on older adults living in nursing homes C) care provided in the patient's home for chronic illnesses D) care centered on individual and family healthcare needs
Your 20-year-old client has had a miscarriage. She tells you that she no longer believes in God, because a just God would not make her suffer as she is. What nursing diagnosis would be most appropriate?
1. Ineffective coping 2. Readiness for enhanced spiritual well-being 3. Risk for spiritual distress 4. Spiritual distress
You are working with a client who is taking a neuroleptic medication that has recently been changed and increased. You notice that the client has a high fever (104 degrees Fahrenheit), is confused, and has extreme muscle rigidity
You would do which of the following? a. Suspect that the client has an infectious process, and call the health care provider, expecting an order for an antibiotic. b. Call an ambulance immediately, notify the health care provider, and prepare for seizure control and cardiopulmonary resuscitation (CPR). c. Suspect neuroleptic malignant syndrome, hold the neuroleptic medication, and call the health care provider. d. Give the neuroleptic on time as ordered, call the health care provider to report the symptoms, and see if additional medication is needed.