NURS 221 - Midterm
A patient is preparing for discharge following hip surgery and the patient will
likely require extensive physiotherapy. What assessment question should the
nurse prioritize? - correct answer ✔"Are you able to pay for the costs of your
physiotherapy treatments?"
A nurse is providing care for a patient who has undergone a partial foot
amputation for the treatment of osteomyelitis (bone infection). The nurse
observes that the patient will not look at her foot when the nurse changes the
dressing. How should the nurse best follow up this observation? - correct
answer ✔Gather more data to better understand the patient's behaviour.
A nurse is interviewing a new client admitted to the hospital for surgery. Which
action would the nurse perform in the introductory phase of the interview? -
correct answer ✔The nurse assesses the client's comfort and ability to
participate in the interview.
A client who gave birth yesterday refuses to eat the food provided by the
hospital. She states that she must eat special food brought from home by her
family. How would the nurse most appropriately address this situation? -
correct answer ✔The nurse should plan no action because the client is not
exhibiting a health problem.
A client who is scheduled for coronary angioplasty is concerned if the surgery
is safe and wonders whether it would be beneficial to him. Which nursing
diagnosis relates to this client's condition? - correct answer ✔Fear related to
potential risk and surgical outcomes
A client with a new colostomy often becomes short and sarcastic when nurses
attempt to teach him about the management of his new appliance. The nurse
has consequently documented "Noncompliance related hostility" on the
,client's chart. What mistake has the nurse made when choosing and
documenting this nursing diagnosis? - correct answer ✔presuming to know
the factors contributing to the problem
A nurse is reviewing the plan of care for a client and notes the following: "The
client verbalizes three signs of hypoglycemia to the staff accurately before
discharge." The nurse interprets this statement as a(n): - correct answer
✔outcome criteria
A client with multiple leg fractures following a motor vehicle accident tells the
nurse, "I am going crazy here. I have to wait 2 months before I can practice
walking, again." What is the priority nursing diagnosis? - correct answer
✔deficient diversional activity
A preceptor reviews the client outcomes written by a new nurse. Which
outcome is the priority for the client with paranoid delusions? - correct answer
✔Within 3 days, client will mingle in the day room without violence.
The home health nurse caring for a client with limited eyesight notes that the
client's route to the bathroom is cluttered. What is the most effective way for
the nurse to ensure the client's long-term safety? - correct answer ✔Assist
the client to identify strategies to promote safety in the home.
The nurse is preparing to implement plans of care with several clients. Which
action would be inappropriate for the nurse to perform? - correct answer
✔Respond to the postoperative client's question that baths are given only in
the morning.
A nurse in the ICU (intensive care unit) has been assigned to care for a client
who was seriously injured during a gang rape. The nurse was raped 6 months
ago and feels that she will be too upset to care for the client properly. How
, should the nurse deal with the assignment? - correct answer ✔Recognize
her limitations and ask for another nurse to be assigned.
A client has a nursing diagnosis of Possible Spiritual Distress. What is the
most appropriate nursing intervention? - correct answer ✔Discuss spirituality
with the client.
A nurse just reported to the oncoming shift that she had failed to do an
ordered dressing change. She reported to the nurse manager that this was
the second time this week she had not had time to do the dressing change.
The nurse manager recognized that the nurse normally was very punctual and
was known to provide good care for her clients however the unit census had
been very high on this particular week. The nurse manager knows that quality
care must be provided and reports this occurrence as what type of quality
approach? - correct answer ✔Quality by opportunity
The nurse is caring for Mr. H., a 35-year-old man who is hospitalized following
a motorcycle accident. He has a traumatic brain injury. The nurse is working
with Mr. H. on self-care behaviors. The following would help the nurse to
assess the success of the nursing interventions except which of the following?
- correct answer ✔Model self-care behaviors for the client.
Which action should the nurse take when client data indicate that the stated
goals have not been achieved? - correct answer ✔Review each preceding
step of the nursing process.
A health care facility plans to evaluate and revise the plan of care for a client
based on the client's health care records. The physician, dietitian, and nurse
involved in the client's care are required to collate all of the information for
easy access. Which style would the nurse conclude that the facility is following
in order to record the client details? - correct answer ✔SOAP chartin
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