Which of the following would be a priority nursing diagnosis for a 73-year-old male patient with heart failure?
a. Constipation related to immobility
b. Risk for infection related to IV lines
c. Activity intolerance related to an imbalance of oxygen and demand
d. Self-care deficit
ANS: C
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Which action will have the greatest impact on the successful implementation of a planned change?
1. Disciplining individuals who continue to be resisters to the change 2. Ensuring there are no remaining pockets of disagreement when the change occurs 3. Continually rewarding those working toward the change and ignoring those who are not 4. Creating a supportive environment for those undergoing the change
The nurse is caring for a male client with a major depressive disorder who has not responded well to various treatments in the past. The latest treatment method has resulted in slight improvement in the client's symptoms
On this particular day, the client has a very positive affect and says he feels "amazingly better." The nurse should: a. Congratulate him on his recovery. b. Document the client's improvement. c. Ask him what he feels has helped him feel better so suddenly. d. Assess the client for signs and symptoms of suicidal thoughts.
A nurse is discussing the plan of care with a client who is preparing for discharge. The client has a strong objection to portions of the plan of care
The nurse recognizes that there is a conflict. Which response by the nurse indicates an understanding of the client's position and a willingness to collaborate regarding the discharge plan? A) "You are not being cooperative in your plan of care." B) "This plan of care was ordered by the physician." C) "Let's talk about what your objections are and possible solutions or alternatives." D) "I will ask your family to convince you that this plan of care is best."
The nurse has completed her assessment of a client admitted with delirium tremens. Which of the following is the nursing priority for a client in alcohol withdrawal?
1. Ineffective Coping 2. Disturbed Thought Processes 3. Risk for Suicide or Injury 4. Disturbed Sensory Perception