Which of the following are approved nursing diagnoses? (Select all that apply)
Insufficient knowledge
Pupils round, reactive to light and accommodation
Pain
Impaired gas exchange
Correct Answer : A,C,D
Choice A reason: This is correct because it is an approved nursing diagnosis that describes a lack of cognitive information related to a specific topic.
Choice B reason: This is incorrect because it is not an approved nursing diagnosis, but rather a data or assessment finding that describes the condition of the client’s pupils.
Choice C reason: This is correct because it is an approved nursing diagnosis that describes an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
Choice D reason: This is correct because it is an approved nursing diagnosis that describes a decrease in oxygenation and/or elimination of carbon dioxide at the alveolar-capillary membrane.
Choice E reason: This is incorrect because it is not an approved nursing diagnosis, but rather a medical diagnosis that describes a malignant neoplasm of any body part.
Choice F reason: This is incorrect because it is not an approved nursing diagnosis, but rather a medical diagnosis that describes a dysfunction of the kidneys.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
This is the observation that indicates that the UAPs need additional information about the turning procedure because it is incorrect and may cause complications for the client. The client who had a hip arthroplasty with prosthesis placement should not keep both legs straight and together while turning because this may cause dislocation of the prosthesis, nerve damage, or bleeding. The client should keep the affected leg slightly abducted and supported with pillows or an abduction device.
A. An abduction pillow is placed between the client's legs when positioned is correct and does not indicate a need for additional information. This helps to maintain proper alignment and prevent dislocation of the prosthesis.
C. A turning sheet used under the client for turning and repositioning is correct and does not indicate a need for additional information. This helps to reduce friction and shear forces on the skin and prevent pressure ulcers.
D. The UAPs keep their backs straight and knees bent when moving the client is correct and does not indicate a need for additional information. This helps to protect their own musculoskeletal health and prevent injuries.
Correct Answer is B
Explanation
Choice A reason: "Alcoholism is a disease that affects the whole family.” is not the best response to the client’s husband. This response shows generalization, which is a communication technique that involves using statements that apply to most people in similar situations. It also shows lecturing, which is a communication barrier that involves giving unsolicited advice or information to the other person. It may make the client’s husband feel stereotyped, judged, or patronized, and may discourage further communication. Therefore, this choice is incorrect.
Choice B reason: "You sound frustrated in dealing with your wife’s drinking problem.” is the best response to the client’s husband. This response shows active listening, which is a communication skill that involves hearing, understanding, and responding to the client’s verbal and nonverbal messages. It also shows empathy, which is the ability to understand and share the feelings of another person. It acknowledges and validates the client’s husband’s emotions, and invites him to express his concerns or fears. Therefore, this choice is correct.
Choice C reason: "I think you are a good person to stay here with your wife.” is not the best response to the client’s husband. This response shows praise, which is a communication technique that involves giving positive feedback or recognition to the other person. It also shows assumption, which is a communication barrier that involves making judgments or guesses about what the other person thinks or feels. It may make the client’s husband feel uncomfortable, embarrassed, or pressured, and may not address his underlying feelings or needs. Therefore, this choice is incorrect.
Choice D reason: “Have you discussed this subject at the support group meetings?” is not the best response to the client’s husband. This response shows closed-ended questioning, which is a communication technique that involves asking questions that require a yes or no answer or a specific piece of information. It also shows probing, which is a communication barrier that involves asking too many or inappropriate questions to the other person. It may make the client’s husband feel defensive, invaded, or resentful, and may violate his privacy or confidentiality. Therefore, this choice is incorrect.
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