The Nursing Process 1 - The Nursing Process 1 36 of 50 Answer Key Question 1 A nurse is developing a nursing diagnosis for a client Which information

The Nursing Process 1 - The Nursing Process 1 36 of 50...

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The Nursing Process 1 36 of 50 Answer Key Question 1 A nurse is developing a nursing diagnosis for a client. Which information should she include? You Selected: Factors influencing the client's problem Correct response: Factors influencing the client's problem Explanation: A nursing diagnosis is a written statement describing a client's actual or potential health problem. It includes a specified diagnostic label, factors that influence the client's problem, and any signs or symptoms that help define the diagnostic label. Actions to achieve goals are nursing interventions. Expected outcomes are measurable behavioral goals that the nurse develops during the evaluation step of the nursing process. The nurse obtains a nursing history during the assessment step of the nursing process. Question 2 A client who received general anesthesia returns from surgery. Postoperatively, which nursing diagnosis takes highest priority for this client? You Selected: Ineffective airway clearance related to anaesthesia Correct response: Ineffective airway clearance related to anaesthesia Explanation: Ineffective airway clearance related to anaesthesia takes priority for this client because general anaesthesia may impair a client's ability to clear secretions from his airway. Acute pain related to surgery , Deficient fluid volume related to blood and fluid loss from surgery , and Impaired physical mobility related to surgery, although important, are secondary. Question 3 A client is admitted to the health care facility after 3 days of nausea, vomiting, and fever. Which nursing diagnosis takes highest priority for this client? You Selected: Deficient fluid volume related to nausea and vomiting Correct response: Deficient fluid volume related to nausea and vomiting Explanation: Deficient fluid volume related to nausea and vomiting takes highest priority because vomiting causes loss of fluids and electrolytes. No evidence suggests that the client has a fluid volume excess or ineffective cardiopulmonary tissue perfusion. Although the client does have imbalanced nutrition, this nursing diagnosis isn't a high priority at this time. Question 4 Each morning, a nurse-manager assigns clients and additional tasks for the staff nurses to complete that day. During the shift, a crisis develops and one staff nurse doesn't complete the additional tasks. The next day, the nurse-manager reprimands this nurse. When the nurse tries to explain, the nurse-manager interrupts, saying that the nurse should have completed the tasks no matter what happened. Which leadership style is the nurse-manager exhibiting? You Selected: Autocratic Correct response: Autocratic Explanation: An autocratic leader retains all authority and responsibility and is concerned primarily with completing tasks and meeting goals. The autocratic leader does not emphasize free thinking in the daily care of clients. The autocratic leader sets rules and expects all to follow them. A democratic leader is people-centered, allows greater individual participation in decision making, and maintains open communication. A permissive or laissez-faire leader denies responsibility and abdicates her
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  • Spring '17
  • mrs. Vargovich
  • Nursing, Correct Response

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