Author Question: The nurse is identifying care goals for a client who is prone to getting hurt. Which care goal ... (Read 89 times)

Brittanyd9008 · **on:** Jul 23, 2018

The nurse is identifying care goals for a client who is prone to getting hurt. Which care goal should the nurse select for this client?

1. Assess the client's mental status.
2. Keep the client dependent on the staff for all care.
3. Make all choices for the client.
4. Remain free from injury.

Question 2

The nurse is planning care for a client who is prone to falling. Which nursing diagnoses should the nurse use for this client?

1. Deficient Knowledge
2. Risk for Injury
3. Risk for Disuse Syndrome
4. Risk for Suffocation

spencer.martell · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

Correct Answer: 4
Rationale 1: The nurse will need to assess the client's mental status to help accomplish this goal.
Rationale 2: Keeping the client dependent on the staff for care does not encourage independence.
Rationale 3: Making all choices for the client does not encourage independence.
Rationale 4: The major goal for a client who is at risk for injury is for the client to remain injury-free.

Answer to Question 2

Correct Answer: 2
Rationale 1: Deficient Knowledge deals with injury prevention. A client who is already prone to falls may not have the cognitive ability for a knowledge deficient.
Rationale 2: Risk for Injury is a state in which the individual is at risk as a result of environmental conditions such as a fall.
Rationale 3: Risk for Disuse Syndrome is a deterioration of body system as the result of prescribed or unavoidable musculoskeletal inactivity.
Rationale 4: Risk for Suffocation is inadequate air available for inhalation.