35

22問 • 2年前

問題一覧

A nurse has completed the data analysis of a client's nursing history. What should be included in the nursing diagnosis?

nursing priorities

Which inch intervention should the nurse perform as part of the nursing diagnosis process?

Direct, nursing interventions to meet the client. high priority needs.

The client is having problems swallowing fluids and as a result is dehydrated. Which is the most appropriate way of phrasing the problem in a diagnostic statement?

deficient fluid volume

What is the correct sequence when composing a diagnostic statement? 1. Etiology 2. Problem 3. signs and symptoms

2,1,3

what is the best description of the nursing diagnosis

Identification of the nursing care problem based on analysis of data

what is the rationale for the use of the accepted NANDA-I approved nursing diagnoses?

words and terms are the actual diagnostic labels on which the entire client-oriented

what information should be identifiable when reviewing a client medical diagnosis ? Select all that apply

The disease a person has, or is believed to have, The physiologic manifestations of The illness, A basis for prognosis, The foundation for future medical treatment decisions

The nurse has analyzed data regarding the client's chief concern. Which information should the nurse include in the nursing diagnosis?

Identification of the nursing care problem

A client who has sustained injuries as a result of a car accident is having trouble sleeping and constantly relives the incident. What diagnostic statement should nurse make for this client?

posttrauma response related to the automobile accident AEB Nightmares, insomnia

The nurse is preparing a two-part diagnostic statement for a client diagnosed with dyspnea who has been a longtime smoker. What phrasing should the nurse use to document the problem in the diagnostic statement?

impair breathing pattern

A nurse is formulating a three-part diagnostic statement for a client who had a motor vehicle accident. The client has bruises on the anterior chest and is unable to move independently when sitting up or lying down. Which diagnostic statement should the nurse document?

impaired mobility of anterior chest related to the motor vehicle accident AEB

Which statement accurately described the correct cues of a nursing care plan

individualize the nursing care plan to represent all unique aspects Of client care

which statement accurately guides the nurse when prioritizing nursing diagnoses

Rank nursing diagnoses in terms or importance

A nurse is planning the care of a client with a stomach infection and high fever. Which expected outcome should the nurse include for this client?

The clients temperature will calm down to normal range in two days

Which is the correct sequence for the planning of nursing care? 1. Establishing expected outcomes 2. Setting priorities 3. Writing a nursing care plan 4. Selecting nursing interventions

2,1,4,3

A client is admitted to an assisted living facility for continuing memory care for dementia. Who will be involved with the ongoing planning of the client's care at the assisted living center?

All healthcare team members involve an ongoing care of the client

A client is admitted for complications of a concussion following a motor vehicle accident. Which type of care plan will be implemented for the client?

individualized nursing care plan

A client is admitted to a medical unit for complications of type 1 diabetes mellitus and all the following nursing diagnoses are appropriately included in the care plan. Which nursing diagnosis would be the priority at this time?

imbalanced nutrition: less than body requirement related to and ability to use glucose

which characteristics must be present in an expected outcome ? select all that apply

client oriented, specific, reasonable, measurable

A client has had severe diarrhea for 4 days and a nursing diagnosis of fluid volume deficit related to active fluid loss has been identified for the client. Based on this information, which expected outcome is the most complete?

Client will intake 2,500 ml over next 24 hours

which nursing diagnosis has the priority

Ineffective airway clearance

A client has developed a swelling in the throat as a result of the medication's side effect. The client is having problems swallowing fluids and has developed dehydration. How should the nurse state the etiology of the problem when creating a diagnostic statement?

Effect of medication therapy