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Author Question: A new nurse writes the following nursing diagnoses on a patient's care plan. Which nursing diagnosis ... (Read 126 times)

Lobcity

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A new nurse writes the following nursing diagnoses on a patient's care plan. Which nursing diagnosis will cause the nurse manager to intervene?
 
  a. Wandering
  b. Hemorrhage
  c. Urinary retention
  d. Impaired swallowing

Question 2

A nurse performs an assessment on a patient. Which assessment data will the nurse use as an etiology for Acute pain?
 
  a. Discomfort while changing position
  b. Reports pain as a 7 on a 0 to 10 scale
  c. Disruption of tissue integrity
  d. Dull headache



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beccamahon

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Answer to Question 1

ANS: B
Hemorrhage is a collaborative problem, not a nursing diagnosis; the nurse manager will need to correct this misunderstanding with the new nurse. Nurses manage collaborative problems such as hemorrhage, infection, and paralysis using medical, nursing, and allied health (e.g., physical therapy) interventions. Wandering, urinary retention, and impaired swallowing are all examples of nursing diagnoses.

Answer to Question 2

ANS: C
Disruption of tissue integrity is a possible cause or etiology of pain. A report of pain, headache, and discomfort are examples of things a patient might say (subjective data or defining characteristics) that may lead a nurse to select Acute pain as a nursing diagnosis.





 

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