An adult male client is admitted to a mental health facility with the diagnosis of depression following the breakup of a long-term engagement. He states that he couldn't "commit to marriage
" In conducting his admission assessment, the nurse learns that during his childhood he did not feel guided, nurtured, or accepted by his parents. One of the goals for this client is to help him develop a positive personal identity. Which intervention should the nurse implement to meet this goal? a. Improve his strength in the ability to adapt to new situations.
b. Develop the ability to establish and maintain an intimate relationship.
c. Discern his feelings about relationship choices and level of commitment.
d. Outline his life's dream.
C
Discerning his feelings about relationship choices and commitment best meets the needs of this client at this time in his life. Improving his ability to adapt and developing his ability to establish and maintain an intimate relationship are not indicated in the scenario as an issue. Outlining his life's dream assists in building a positive personal identity but is too broad a task for this client at this time.
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A nurse is caring for a 29-year-old female who has labs drawn. The results come back indicating that the neutrophil count is below 1,500 cells/mm3 . What is the most likely diagnosis for this patient?
A) Aplastic anemia B) Chronic ideopathic thrombocytopenia C) Sickle cell disease D) Leukopenia
A hospitalized child is receiving calcium via a peripheral IV site. Which action by the nurse is most important?
A. Assess the IV for blood return hourly. B. Document the infusion and child's response. C. Facilitate the next blood draw for calcium. D. Teach parents and child about the drug.
The nurse demonstrates Florence Nightingale's theory of nursing with what intervention?
1. Respecting the patient's culture and incorporating cultural needs in the plan of care 2. Promoting good health and treating those who are ill in a holistic manner 3. Understanding how to motivate people to practice a healthy lifestyle and reduce risks 4. Teaching other nurses how to deliver the highest quality of nursing care.
Which client response during assessment of the eye and vision indicate to the nurse that the client has normal accommodation?
A. Both pupils constrict when a light is shined at one eye. B. The client blinks in response to a threatening movement. C. Both pupils constrict when focusing on an object being moved in toward the nose. D. The client is able to hold an upward gaze without moving the head for 15 seconds.