The nurse is attempting to instruct a client on ways to eliminate smoking. The client tells the nurse that he has no health problems because of smoking and does not understand why he needs to quit
Which of the following is interfering with the nurse's ability to instruct the client in health promotion behaviors?
1. Motivation
2. Perception
3. Self-image
4. Maintenance
2
Perception is a client's sense and understanding of his current health status. If the client does not perceive a problem with current health maintenance activities, the nurse should not intervene at this time. Motivation is the internal drive or external stimulus to perform an action or thought. Maintenance is practicing a new behavior for an extended period of time. The client's self-image is not interfering with the nurse's ability to instruct the client in health promotion behaviors.
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The nurse instructs a woman about providing a clean-catch urine specimen. Which of the following statements indicates that the patient correctly understands the procedure?
a. "I will be sure to urinate into the ‘hat' you placed on the toilet seat." b. "I will wipe my genital area from front to back before I collect the specimen midstream." c. "I will need to lie still while you put in a urinary catheter to obtain the specimen." d. "I will collect my urine each time I urinate for the next 24 hours."
In a rush of words, a client tells the community mental health nurse "Everything's a mess! I can't
concentrate. My disability check didn't come. My roommate moved out and the rent is too much for me to pay on my own. To top it all off, my therapist is moving out of state. I don't know where to turn and I feel as though I'm coming apart at the seams.". A nursing diagnosis the nurse should consider for this client is a. decisional conflict related to challenges to personal values. b. spiritual distress related to ethical implications of treatment regimen. c. anxiety related to changes perceived as threatening to psychological equilibrium. d. deficient knowledge related to need to solve multiple problems affecting security needs.
The nurse is caring for a client who overdosed on acetylsalicylic acid (aspirin) 24 hours ago. The nurse expects to note which of the following findings associated with an anticipated acid-base disturbance?
1. Disorientation and dyspnea 2. Drowsiness, headache, and tachypnea 3. Tachypnea, dizziness, and paresthesias 4. Decreased respiratory rate and depth, cardiac irregularities
Air in the pleural space is:
a. Pleural effusion b. Pneumothorax c. Hemothorax d. Sputum