The nurse is caring for a patient with Guillain-Barré syndrome (GBS). Which area(s) should the care plan address? (Select all that apply.)
a. Assessment of advancing paralysis
b. Provision for ventilation support
c. Maintenance of adequate nutrition
d. Prevention of complications of immobility
e. Assessment of hypertension
A, B, C, D
The nurse should include assessment of paralysis, provision for ventilation support, nutritional maintenance, and prevention of complications from immobility. The care plan should address assessment of hypotension rather than hypertension.
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The nurse is caring for a client who just had amniocentesis and was told that the fetus has Down syndrome. What is an appropriate outcome goal for this client?
A) To complete the work of grieving during the hospital stay B) To begin the process of grieving the loss of a normal baby C) To accept the upcoming birth of a baby with special needs D) To consider the possibility of a therapeutic abortion
A nurse is assessing a teenage patient with acne vulgaris. The patient's mother states, "I keep telling him that this is what happens when you eat as much chocolate as he does." What aspect of the pathophysiology of acne should inform the nurse's response
A) A sudden change in patient's diet may exacerbate, rather than alleviate, the patient's symptoms. B) Chocolate is not among the foods that are known to cause acne. C) Elimination of chocolate from the patient's diet will likely lead to resolution within several months. D) Diet is thought to play a minimal role in the development of acne.
Which behavior by parents or teachers will best assist the child in negotiating the developmental task of industry?
a. Identifying failures immediately and asking the child's peers for feedback b. Structuring the environment so that the child can master tasks c. Completing homework for children who are having difficulty in completing assignments d. Decreasing expectations to eliminate potential failures
The parents of a child who is critically injured wish to stay in the room while the child is receiving emergency care. Which nursing action is most appropriate in this situation?
1. Asking the healthcare provider if the parents can stay with the child 2. Allowing the parents to stay with the child 3. Escorting the parents to the waiting room and assuring them that they can see their child soon 4. Telling the parents that they do not need to stay with the child