A patient is diagnosed with a tumor of the right dorsolateral aspect of the spinal cord in the upper thoracic region. Which nursing diagnosis would have a high priority?
1. Risk for urinary retention related to disruption of the reflex arc
2. Risk for injury related to disruption of pain transmission pathways
3. Risk for fluid volume excess related to cord compression
4. Risk for ineffective thermoregulation related to disruption of autonomic regulation
Correct Answer: 2
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The nurse is caring for a patient who is to begin receiving external radiation for a malignant tumor of the neck. While providing patient education, what potential adverse effects should the nurse discuss with the patient?
A) Impaired nutritional status B) Cognitive changes C) Diarrhea D) Alopecia
An experienced staff nurse describes feeling emotionally burdened and yet engages actively in gossip and spreading rumors about other staff members. The clinical nurse leader can assess these behaviors as consistent with
a. antisocial personality disorder. b. mild-to-moderate depression. c. depersonalization. d. burnout.
Which of the following nursing diagnoses is an example of a wellness diagnosis?
A) Acute Pain C) Readiness for Enhanced Parenting B) Risk for Infection D) Possible Chronic Low Self-Esteem
The certified nursing assistant (CNA) is feeding a patient and notes that the patient is having difficulty swallowing. She reports this to the primary registered nurse. What should the nurse do first?
a. Assign the task to a more experienced CNA b. Feed the patient herself c. Assess the patient and place on NPO status d. Call the primary care provider