Author Question: The nurse interviewed a client who was uncooperative, answered questions with minimal responses, and ... (Read 242 times)

amal · **on:** Jul 19, 2018

The nurse interviewed a client who was uncooperative, answered questions with minimal responses, and rarely made eye contact. Which is the most complete documentation of baseline data obtained during the interview?

A. Appears uncooperative. Exhibits characteristics of depression.
B. Maintains poor eye contact throughout interview process. Unable to answer interview questions due to depression.
C. States I don't need to be here' when discussing admission status. Maintains minimal eye contact and offers little data related to triggers for admission.
D. Unwilling to respond openly during interview.

Question 2

A client is assigned the nursing diagnosis of impaired social interaction R/T sociocultural differences AEB client stating, Although I'd like to, I don't join in because I don't speak the language so good.

Which correctly written outcome addresses this client's problem?

A. The client will collaborate with nursing staff to set specific goals by day 3.
B. The client will participate in one group activity of choice by day 2.
C. The client will express a desire to interact with others.
D. The client will become increasingly independent by discharge.

chjcharjto14 · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

ANS: C
Documentation occurs in the implementation phase of the nursing process. All charting entries to the client's legal record should be objective and based on assessed data. Implications and generalizations should be avoided.

Answer to Question 2

ANS: B
In the planning phase of the nursing process, the nurse works with the client to identify expected outcomes for a plan individualized to the client need or to the situation.