A client, aged 16 years, comes to the crisis clinic. The nurse learns she is being molested by her
uncle.
The client told her mother of the uncle's behavior, but the mother accused the daughter of
lying. The client describes feeling "all confused" and subsequently cutting her wrists. Nursing
diagnoses that would be appropriate to consider developing include (more than one choice may be
correct)
A. ineffective coping related to crisis involving attempted sexual abuse by uncle.
B. disturbed thought processes related to anxiety associated with crisis of sexual abuse.
C. anxiety rel ated to threat to emotional and physical safety caused by sexual abuse.
D. compromised family coping related to mother's cooperation with uncle's sexual abuse of client.
A, B, C
Rationale: Defining characteristics for diagnoses A, B, and C are present. Option D: The nurse
cannot assume the mother is cooperating with the uncle's attempted sexual abuse of the client. This
would require investigation.
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Which strategy is least effective in formulating political action?
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Which of the following illustrates a common error when writing client outcomes?
A) Client will drink 100 mL of fluid every 2 hours from 6 a.m. to 9 p.m. B) Client will demonstrate correct sequence of exercises by next office visit. C) Client will be less anxious and fearful before and after surgery. D) On discharge, client will list five symptoms of infection to report.
Select the group of drug agents that are listed in increasing order of their duration of action.
A. Tiotropium (Spiriva), Albuterol (Proventil), Salmeterol/fluticasone (Advair) B. Albuterol (Proventil), Salmeterol/fluticasone (Advair), Tiotropium (Spiriva) C. Albuterol (Proventil), Tiotropium (Spiriva), Salmeterol/fluticasone (Advair) D. Salmeterol/fluticasone (Advair), Albuterol (Proventil), Tiotropium (Spiriva)