Which would be an expected outcome for a client with the nursing ...

[jc611]

Which would be an expected outcome for a client with the nursing diagnosis Self-Care Deficit related to cognitive impairment?
 
  1. The client will be able to name the staff that works on the day shift.
  2. The client will eliminate safety hazards in her environment.
  3. The client, with supervision, will brush her teeth.
  4. The nurse will stress the importance of adequate fluid intake.

Question 2

Which assessment finding would be normal with a client's hair when giving a shampoo?
 
  1. Dry, dark, thin
  2. Smooth, taut, shiny
  3. Smooth texture and not oily or dry
  4. Tender, warm scalp

[kjo;oj]

Answer to Question 1

Correct Answer: 3
Rationale 1: Cognitive impairment limits the client's ability to understand and comprehend; therefore naming the staff is not within the client's realm of understanding.
Rationale 2: Cognitive impairment limits the client's ability to understand and comprehend; therefore eliminating safety hazards is not within the client's realm of understanding.
Rationale 3: A client with cognitive impairment would be able to brush her teeth but only with supervision. The client would not voluntarily brush their teeth without prompting from the staff.
Rationale 4: Cognitive impairment limits the client's ability to understand and comprehend; therefore stressing adequate fluid intake is not within the client's realm of understanding.

Answer to Question 2

Correct Answer: 3
Rationale 1: The hair should not be dry or thin. This could be a sign of alopecia. Darkness would depend on hair color through the gene pool.
Rationale 2: Skin is assessed as being smooth, taut, or shiny, not hair.
Rationale 3: The hair should be smooth in texture and neither oily nor dry.
Rationale 4: A tender, warm scalp could indicate a problem, so this would not be normal.