An adolescent client who is diagnosed with Duchenne muscular dystrophy is seen in the clinic for a routine health visit. Which nursing diagnosis is the priority for this client?

1. Risk for Impaired Mobility Related to Hypertrophy of Muscles
2. Risk for Infection Related to Altered Immune System
3. Risk for Impaired Skin Integrity Related to Paresthesia
4. Risk for Altered Comfort Related to Effects of the Illness


Correct Answer: 1
Rationale: Nursing care for muscular dystrophy (MD) focuses on promoting independence and mobility for this progressive, incapacitating disease. Risk for Infection, Risk for Impaired Skin Integrity, and Risk for Altered Comfort are not as high a priority as Risk for Impaired Mobility.

Nursing

You might also like to view...

The ages and stages developmental theories are based on which premise?

a. Development occurs in response to specific life events and transitions that require adaptive, coping behavior and involve changes in one's life patterns. b. People experience much the same sequential physical, cognitive, socioemotional, and moral changes during the same age periods or developmental states. c. Human behavior is motivated by internal psychodynamic forces and external factors such as cultural orientation, socioeconomic status, and the number and intensity of life events. d. Development occurs as a result of stress associated with life events or transitions that serve as an impetus for growth.

Nursing

The nurse is reviewing a client's urinalysis and notes a positive glucose. Which action by the nurse is best?

a. Document the finding and call the health care provider. b. Collect and send another urinalysis sample to the laboratory. c. Review the client's recent dietary selec-tions. d. Perform a finger stick blood glucose on the client.

Nursing

The client with active tuberculosis has started therapy with isoniazid and rifampin. He reports that his urine now has an orange color. What is the nurse's best action?

A. Document the report as the only action. B. Obtain a specimen for culture. C. Test the urine for occult blood. D. Notify the physician.

Nursing

The nurse is preparing to assist in examining a Hispanic-American child who was brought to the clinic by the mother. During assessment of the child, the nurse would avoid which of the follow-ing?

1. Admiring the child 2. Taking the child's temperature 3. Obtaining an interpreter if necessary 4. Asking the mother questions about the child

Nursing