The nurse is considering using the NANDA nursing diagnosis Impaired Physical Mobility in the care plan of a newly admitted client. In order to make this problem statement more individual, the nurse should take which action?

1. Include what mobility is impaired.
2. Use Level 1, 2, 3, or 4 to describe immobility.
3. Describe what happens when the client attempts mobility.
4. Add strength assessment data.


Correct Answer: 1
Rationale 1: In order to make this broad nursing diagnosis more specific to the client, the nurse should include what mobility is impaired. For example, if the client cannot transfer from bed to chair, a more specific nursing diagnosis is Impaired Transfer Mobility.
Rationale 2: There are NANDA levels of activity intolerance, but not of immobility.
Rationale 3: Describing what happens when the client attempts mobility might be used in the "as manifested by" section of the nursing diagnosis, but not in the problem statement section.
Rationale 4: Strength assessment data might be used in the "as manifested by" section of the nursing diagnosis, but not in the problem statement section.

Nursing

You might also like to view...

Syphilis does not

a. Manifest itself through a lifetime b. Cause neurological impairment c. Present difficulty in diagnosis because of its cyclical nature of acute phase to dormancy d. Begin with a chancre, an open painless sore, only in the genital area

Nursing

The nurse is gathering data on a patient with acute bacterial pneumonia. This is an example of which step of the nursing process?

a. Assessment b. Planning c. Implementation d. Evaluation

Nursing

Identify the proper sequence for the steps the nurse should follow in changing the dressing on an incision that is closed with surgical staples

____ Apply antiseptic ointment to the suture line. ____ Cleanse the area around the incision with an appropriate cleansing solution. ____ Explain the procedure to the client. ____ Teach the client how to minimize stress on the incision line. ____ Note characteristics of any drainage. ____ Remove the old dressing using clean technique. ____ Apply the new dressing using sterile technique. Multiple Response Identify one or more choices that best complete the statement or answer the question.

Nursing

A patient's order for IV fluid states that D5NS is to be infused. Which of the following IV fluids should be given?

A) 5% dextrose B) 0.9% sodium chloride C) 5% dextrose with 0.9% sodium chloride D) Lactated Ringer's Solution

Nursing