A patient has met the goals and outcomes mutually agreed upon for ...

[dbose]

A patient has met the goals and outcomes mutually agreed upon for improvement of ventilatory status. What should the nurse do next?
 
  a. Modify the care plan.
  b. Discontinue the care plan.
  c. Create a nursing diagnosis that states goals have been met.
  d. Reassess the patient's response to care and evaluate interventions.

Question 2

The patient has a methicillin-resistant Staphylococcus aureus (MRSA) infection in an abdominal surgical wound.
 
  The patient is in a private room, is receiving vancomycin (Vancocin) for the MRSA, and pain is well controlled with a morphine sulfate patient-controlled analgesia (PCA) pump, and is receiving docusate sodium (Colace) to prevent constipation. During the nurse's rounds, the patient begins complaining of ringing in the ears. Which is the most likely cause for the patient's tinnitus? a. Surgical anesthesia
  b. Morphine sulfate
  c. Vancomycin
  d. Docusate sodium

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Answer to Question 1

B
After a nurse determines that expected outcomes and goals have been met and evaluation confirms it, the nurse discontinues that portion of the care plan. The nurse modifies a care plan when goals are not met. Create a nursing diagnosis occurs after assessment, not during evaluation. Reassessing the patient occurs if the goals are not met.

Answer to Question 2

C
Ototoxic medications, such as analgesics, antibiotics (such as vancomycin and aminoglycosides), or diuretics, affect hearing acuity, balance, or both, with the most common symptom being tinnitus (ringing in the ears). Surgical anesthesia, morphine, and docusate sodium do not have the side effect of ototoxicity or tinnitus.