An adolescent with a gunshot wound presents to the emergency room with his distraught parents. He states he saw his teacher and several classmates shot by a fellow classmate
As a result of the shooting incident,the nurse expects this adolescent to be at risk for
1. post-traumatic stress disorder.
2. school phobia.
3. depression.
4. conduct disorder.
Answer:1
Rationale: Acute stress,parental stress,and the degree of the psychological trauma exposure are variables predictive of post-traumatic stress disorder (PTSD). School phobia,depression,and conduct disorder may possibly occur later,but the risk of PTSD is most likely,based on the acute stress of the shooting.
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The nurse is teaching the patient about angina pectoris. Which of the following statements by the patient indicates that he has understood the teaching?
A) "I will avoid exercise because it will precipitate my angina." B) "As long as I take my medicines, I will not need to decrease my fat intake." C) "My high blood pressure has no effect on my episodes of chest pain." D) "High fat in the diet and smoking can cause my episodes of chest pain."
When planning to assess a client's temperature, the nurse realizes that the safest, least invasive method of temperature measurement is:
1. Rectal 2. Oral 3. Axillary 4. Tympanic membrane
The nurse may include which of the following nursing diagnoses for a patient taking an antineoplastic medication?
1. Decreased cardiac output 2. Deficient fluid volume 3. Social isolation 4. Imbalanced nutrition: more than body requirements
After the death of a Native American man, the nurse opened a window to allow spirits to leave. This action is an example of which attribute of the concept of cultural competence?
a. Adapting interventions based on cultural practices (Tailoring) b. Gaining information about cultural differences (Knowledge) c. Considering the effects of another's values and experiences (Understanding) d. Showing appreciation for cultural differences (Respect)