Which is a well-written short-term goal for a socially withdrawn patient who tells a nurse of a wish to reduce social isolation? By day 2, the patient will:
a. express desire to go shopping.
b. participate in one unit activity.
c. become more independent.
d. be more outgoing.
B
Short-term goal statements should be specific, measurable, attainable, current, adequate, and mutually accepted. The correct option includes a timeframe as well as meeting the existing criteria for a short-term goal. "More outgoing" and "more independent" are not measurable. Expressing a desire to go shopping is a statement rather than an action.
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A patient had abdominal surgery. The incision has been closed by primary intention, and the staples are intact
To provide more support to the incision site and decrease the risk of dehiscence, it would be appropriate to apply which of the following? a. Steri-Strips b. Abdominal binder c. T-binder d. Paper tape
The nurse is caring for a patient who just had surgery. What is the nurse's highest priority?
A) Assessing for hemorrhage B) Maintaining a patent airway C) Managing the patient's pain D) Assessing vital signs every 15 minutes
Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP)
Which of the students' following statements best captures an aspect of the two health problems? A) "Both diseases can result from inadequate production of thrombopoietin by megakaryocytes." B) "ITP can be either inherited or acquired, and if it's acquired, it involves an enzyme deficiency." C) "Both of them involve low platelet counts, but in TTP, there can be more, not less, hemostasis. D) "TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma."
The RN has chosen the nursing diagnosis of Risk for impaired skin integrity related to immobility. The correct goal/outcome statement for the diagnosis would be:
a. patient will sit in chair at bedside for 15 minutes after each meal. b. nurse will assist patient to chair every shift. c. nurse will assess skin and record condition every shift. d. patient will change position frequently.