Author Question: The nurse is updating the plan of care for a patient with a stage III pressure ulcer and a nursing ... (Read 95 times)

nevelica · **on:** Jul 22, 2018

The nurse is updating the plan of care for a patient with a stage III pressure ulcer and a nursing diagnosis of Impaired skin integrity. Which of the following outcomes when met indicate progression toward goals? (Select all that apply.)

a. Ask whether patient's expectations are being met.
b. Prevent injury to the skin and tissues.
c. Obtain the patient's perception of interventions.
d. Reduce injury to the skin.
e. Reduce injury to the underlying tissues.
f. Restore skin integrity.

Question 2

The nurse works in a pediatric medical day care centre. An important aspect of the nurse's role is to determine whether children are achieving developmental milestones.

Which one of the following characterizes the cognitive development of a 2-year-old child? a. Using short sentences to express independence
b. Initiating play with other children
c. Recognizing right and wrong
d. Having a vocabulary of at least 1000 words

meganmoser117 · **Reply #1 on:** Jul 22, 2018

Answer to Question 1

B, D, E, F
Optimal outcomes are to prevent injury to skin and tissues, reduce injury to skin, reduce injury to underlying tissues, and restore skin integrity. Asking the patient's perceptions and whether expectations are being met allows one to obtain information regarding the experience, but these are not actual measurable outcomes.

Answer to Question 2

A

Feedback
A The 2-year-old child uses short sentences to express independence and control.
B The 2-year-old child may engage in solitary play and begin to participate in parallel play. The preschool child may initiate play with other children.
C The 2-year-old child does not understand the concepts of right and wrong.
D The 2-year-old child has a vocabulary of up to 200 words.