Which of the following would be the most appropriate nursing diagnosis for a client admitted with Addison's disease?
Impaired skin integrity
Fluid volume overload
Imbalanced nutrition: more than body requirements
Risk for injury
The Correct Answer is D
Choice A Reason: Impaired skin integrity is not the most appropriate nursing diagnosis for a client with Addison's disease, as it does not reflect the main problem of adrenal insufficiency and cortisol deficiency.
Choice B Reason: Fluid volume overload is not the most appropriate nursing diagnosis for a client with Addison's disease, as it does not reflect the main problem of adrenal insufficiency and aldosterone deficiency.
Choice C Reason: Imbalanced nutrition: more than body requirements is not the most appropriate nursing diagnosis for a client with Addison's disease, as it does not reflect the main problem of adrenal insufficiency and weight loss.
Choice D Reason: Risk for injury is the most appropriate nursing diagnosis for a client with Addison's disease, as it reflects the main problem of adrenal insufficiency and hypotension, which can cause falls, fainting, or shock.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason: Applying a transparent dressing to the drain site is not an appropriate action for the nurse to take, as it may trap moisture and bacteria and increase infection risk.
Choice B Reason: Clamping the tubing when the client ambulates is not an appropriate action for the nurse to take, as it may cause bile accumulation and leakage and increase pressure and pain.
Choice C Reason: Placing the client into Fowler's position is an appropriate action for the nurse to take, as it helps to promote drainage and prevent reflux of bile into the liver.
Choice D Reason: Securing the tubing to the client's gown is not an appropriate action for the nurse to take, as it may cause tension and displacement of the drain and increase discomfort and bleeding.
Correct Answer is B
Explanation
Choice A Reason: Painful urination is not a common finding in BPH, but it may indicate a urinary tract infection or bladder stones.
Choice B Reason: Decreased urinary stream is a common finding in BPH, as the enlarged prostate compresses the urethra and obstructs the flow of urine.
Choice C Reason: Critically elevated PSA level is not a common finding in BPH, but it may indicate prostate cancer or prostatitis.
Choice D Reason: Urge incontinence is not a common finding in BPH, but it may indicate an overactive bladder or neurogenic bladder.
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