Which of the following nursing diagnoses is most appropriate for the client with acute systolic heart failure?
1. Excess Fluid Volume
2. Disturbed Body Image
3. Imbalanced Nutrition: more than body requirements
4. Ineffective Airway Clearance
Excess Fluid Volume
Rationale: The client with acute systolic heart failure will have excess fluid volume. If there is an imbalance in nutrition, it is more likely to be less than body requirements. Ineffective airway clearance is not applicable, since these clients do not have issues with clearing the airway as much as issues with impaired gas exchange. It is not common for the client to have disturbed body image related to heart failure.
You might also like to view...
A client tends to use the defense mechanism of displacement. The client's husband, whom she loves very much, yells at her for not having dinner ready when he comes home from work
Knowing that the client uses displacement as a defense mechanism, a nurse should anticipate that the client would most likely react by: A) Telling her husband he has no right to yell at her. B) Yelling at their son for slouching in his chair. C) Burning dinner. D) Saying to her husband, "I'll try to do better tomorrow."
Lifestyle factors and risk factors can directly affect health. Lifestyle factors and risk factors influence the numbers of illnesses and deaths. A nurse is reviewing with the client aspects the client's current lifestyle
What is the highest priority lifestyle and risk factor that this client can control? A) Smoking B) Nutrition C) Genetic makeup D) Stress
A 19-year-old college student was smoking a cigarette and drinking a cup of coffee in the smoking lounge. How might he expect these substances to make him feel?
A. Euphoric, with decreased fear and anxiety, and ready for a nap B. Immune from pain, anxiety, or fear, and ready for an intimate encounter C. Ostracized because no one appreciates being very close to a smoker D. Relaxed, alert, and ready to study for his exams
Which of the following programs requires recipients to find jobs or enroll in job training programs?
a. Aid to Families with Dependent Children (AFDC) b. Medicaid c. Temporary Assistance to Needy Families (TANF) d. Women, Infants, and Children (WIC)