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

Answer and Explanation

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.

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Correct Answer is B

Explanation

Choice A reason: "There is no reason to worry. This surgeon has an excellent reputation.” is not the best nursing response. This response shows false reassurance, which is a communication technique that involves minimizing or dismissing the other person’s feelings or situation. It also shows authority, which is a communication barrier that involves using one’s position or status to inﬂuence or persuade the other person. It does not address the client’s emotions or needs, and may sound patronizing or condescending. Therefore, this choice is incorrect.

Choice B reason: “It sounds as though you have mixed feelings about the surgery. Can you tell me more about how you feel?” is the best nursing response. 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 emotions, and invites them to express their concerns or fears. Therefore, this choice is correct.

Choice C reason: "The benefits outweigh the risks. You can be confident that the surgery should be done.” is not the best nursing response. This response shows persuasion, which is a communication technique that involves using logic or evidence to convince or inﬂuence 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 does not address the client’s emotions or needs, and may sound coercive or manipulative. Therefore, this choice is incorrect.

Choice D reason: "You are bound to feel much beter once it is all over with.” is not the best nursing response. This response shows cliché, which is a communication technique that involves using overused or trite expressions that lack meaning or sincerity. It also shows avoidance, which is a communication barrier that involves shifting the focus away from the other person’s feelings or situation. It does not address the client’s emotions or needs, and may sound vague or insincere. Therefore, this choice is incorrect.

A. Goals that the patient and his family ask the nursing staﬀ to accomplish. B. Goals that are set slightly higher than the patient can achieve C. Goal statements that are observable and measurable D. Goals that the patient should reach as a result of planned nursing interventions

Correct Answer is ["A"]

Explanation

Choice A reason: A desired patient outcome or expected outcome is a goal that the patient and his family ask the nursing staﬀ to accomplish. This ensures that the patient’s needs and preferences are respected and met.

Choice B reason: A desired patient outcome or expected outcome is not a goal that is set slightly higher than the patient can achieve. This would be unrealistic and demotivating for the patient.

Choice C reason: A desired patient outcome or expected outcome is not a goal statement that is observable and measurable. This is a characteristic of a well-writen goal statement, but not a definition of a desired patient outcome or expected outcome.

Choice D reason: A desired patient outcome or expected outcome is a goal that the patient should reach as a result of planned nursing interventions. This shows the link between the nursing process and the patient’s progress.

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Which of the following are approved nursing diagnoses? (Select all that apply)

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Naxlex Comprehensive Predictor Exams

A client with carotid stenosis has just discussed an upcoming surgery with the physician. The client tells the Practical Nurse (PN), “I wonder if I should let him cut my neck open?” Which nursing response is best?

Correct Answer is B

Explanation

Which statements describe a desired patient outcome or expected outcome? (Select all that apply)

Correct Answer is ["A"]

Explanation

The nurse preceptor is instructing the new nurse on appropriate communication techniques. The new nurse indicates a need for further teaching on using assertive communication, if she does which of the following when communicating with patients? Select one answer

A nurse who is assigned to care for six clients is administering a tube feeding to a client when another client spills breakfast coﬀee on her chest and abdomen. What actions by the nurse are best? (Select all that apply)

A nurse is caring for a client who is hearing-impaired and takes which approach to best facilitate communication? (Select all that apply)

A client is to be discharged from an acute care facility after treatment for right leg thrombophlebitis. The nurse notes that the client’s leg is pain free, without redness or edema. The nurse’s actions reﬂect which phase of the nursing process? Select one answer

During a physical examination, the Practical Nurse (PN) discovers that the client demonstrates signs of ﬂushed, dry, hot skin; dry oral mucus membranes; and temperature elevation. The PN will treat these data as the basis of a nursing diagnosis plan, as they represent:

The Practical Nurse recognizes the communication technique of receiving information and examining responses to