A nurse is caring for a visually impaired 20-month-old client who has not begun to walk. Which nursing diagnosis would be appropriate for this child?
1. Self-care Deficit
2. Impaired Physical Mobility
3. Impaired Home Maintenance
4. Delayed Development
4
Explanation:
1. Self-care Deficit does not apply to this age of child.
2. The child's mobility is not due to a physiologic problem, so impaired mobility is not appropriate.
3. There are not enough data to determine if home maintenance is impaired.
4. A 20-month-old child who is not walking is experiencing delayed development. Toddlers generally walk by 15 months of age.
You might also like to view...
Mr. Garcia has been taking antibiotics at home for the treatment of a respiratory infection for the past 6 days, and there is no evident improvement in his infection. Which of the following nursing assessments is most appropriate?
A) Assess Mr. Garcia's adherence to his medication regimen. B) Assess Mr. Garcia's home hygiene. C) Assess Mr. Garcia's understanding of his illness. D) Assess Mr. Garcia's use of herbal or alternative remedies.
Jane has had an occupational exposure to body fluids while irrigating a patient's wound. Her first ELISA test is positive. Jane
A) has AIDS. B) should have a second ELISA performed to confirm the first test. C) start antibiotic therapy with trimethoprim and sulfamethoxazole (Bactrim, Septra). D) plan to find a new job where she will not expose others to HIV.
A client is prescribed a diuretic that is to be taken twice a day. When instructing the client about the schedule for administration, the nurse would suggest that the client take the drug at which times?
A) In the early morning and at bedtime B) After lunch and dinner C) At breakfast and midafternoon D) Midmorning and before dinner
A nurse is conducting a teaching session for parents of infants. The nurse explains that which behavior indicates that an infant has developed object permanence?
a. Recognizes familiar face, such as mother b. Recognizes familiar object, such as bottle c. Actively searches for a hidden object d. Secures objects by pulling on a string