The nurse is prioritizing a client's problem list. Which of the following problems should receive the highest priority?
Ineffective Sexuality Pattern
Risk for Social Isolation
Activity Intolerance
Imbalanced Nutrition: less than body requirements
The Correct Answer is D
D. This problem indicates that the client is not receiving adequate nutrition to meet metabolic needs, which can lead to malnutrition and compromised healing. Addressing imbalanced nutrition is crucial for maintaining health and supporting recovery.
A. This problem refers to disturbances in sexual function or satisfaction. While important to address, it is not typically considered a high priority compared to other physiological or safety-related issues unless it B This problem indicates the potential for the client to experience loneliness or social disconnection, which can impact mental and emotional well-being. While addressing social isolation is important for holistic care, it may not be as urgent as issues related to physical health or safety.
C This problem indicates the inability to endure physical activities or exercise due to insufficient physiological or psychological energy. Activity intolerance can be a significant concern post-operatively or in clients with chronic conditions, as it can affect recovery and overall functional ability.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
D. Assessing the client is the nurse's first responsibility when a medication error is suspected. The nurse should promptly assess the client's condition to determine if any harm has occurred as a result of the error. This assessment includes vital signs, physical assessment, and evaluation of any signs or symptoms related to the medication error.
A. Documenting the medication error is important for accurate record-keeping and subsequent investigation. However, it should not be the nurse's first action. The priority should be to assess and address any potential harm to the client.
B. Calling the physician may be necessary depending on the severity of the error and the client's condition. However, it is not the first responsibility of the nurse in response to a suspected medication error. The nurse's primary concern should be the immediate assessment and management of the client's condition.
C. Notifying the supervisor or charge nurse is an important step to report the incident and seek guidance on next steps. Supervisors can assist in managing the situation, implementing corrective measures, and ensuring appropriate documentation and reporting procedures are followed. This is typically one of the first actions after ensuring the client's safety.
Correct Answer is A
Explanation
A. This response acknowledges the patient's concern directly. It demonstrates empathy by indicating that the nurse understands the client's feelings of apprehension or anxiety about self-injection. By expressing understanding, the nurse shows empathy towards the client's emotional state.
B. This question shows concern for the patient's well-being and invites them to share their experiences. While it demonstrates a caring attitude, it focuses more on physical comfort rather than directly addressing the client's emotional concerns. While this question shows a caring attitude, it doesn't specifically convey empathy regarding the client's emotional state or concerns.
C. This question seeks to gather information about the client's symptoms. It shows clinical interest and concern for the client's physical condition, but it doesn't directly convey empathy towards their emotional state or concerns. This question is important for assessing the client's condition but does not demonstrate empathy towards their emotional experience or concerns.
D. This response seeks clarification on the client's request or statement. It shows willingness to understand the client's needs or preferences. While it shows attentiveness and willingness to assist, it doesn't directly convey empathy towards the client's emotional concerns or validate their feelings.
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