A patient admitted with nephrotic syndrome is being cared for on a medical unit. When writing this patient's care plan, what nursing diagnoses should the nurse prioritize?
A) Constipation related to immobility
B) Risk for injury related to altered thought processes
C) Hyperthermia related to the inflammatory process
D) Excess fluid volume related to excessive protein losses in the urine
Question 2
A nurse has assessed a patient's orientation during the initial head-to-toe assessment near the beginning of a shift. The patient is able to state his own full name and knows the name of the hospital but is unable to identify the month and the year.
How should the nurse best document this assessment finding?
A) Patient is demonstrating signs of decreased neurological function.
B) Patient is disoriented.
C) Patient is oriented to person and place, but unable to state month and year.
D) Patient is oriented to person, oriented to place, but not oriented to time.
Client on IV patient-controlled analgesia (PCA).
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A functional renal unit.
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