Chapter 17 nursing diagnosis – Flashcards

After assessing a patient, a nurse develops a standard formal nursing diagnosis. What is the rationale for the nurses actions?

Which diagnosis will the nurse document in a patient's care plan that is NANDA approved?

A nurse develops a nursing diagnostic statement for a patient with a medical diagnosis of pneumonia with chest x-ray results of the lower lobe infiltrates. Which nursing diagnosis did the nurse write?

The nurse is reviewing a patient's plan of care, which includes the nursing diagnostic statement, impaired physical mobility related to tibial fracture as evidenced by patient inability to ambulate. Which part of the diagnostic statement does the nurse need to revise?

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A nurse is using assessment data gathered about a patient in combining critical thinking to develop a nursing diagnosis. What is the nurse doing?

A patient presents to the emergency department following a motor vehicle crash and suffers a right femur fracture. The leg is stabilized and a full leg cast. Otherwise the patient has no major injuries, is in good health, and reports only moderate discomfort. Which is the most pertinent nursing diagnosis the nurse will include in the plan of care?

The nurse is reviewing a patient database for significant changes and discovers that the patient has not voided in over eight hours. The patients kidney function lab results are abnormal and the patient's oral intake has significantly decreased since previous shift. Which step of the nursing process should the nurse proceed to after this review?

A patient with a spinal cord injury is seeking to enhance urinary elimination abilities by learning self catheterization versus assisted catheterization by home health nurses and family members. The nurse adds readiness for enhanced urinary elimination in the care plan. Which type of diagnosis did the nurse write

A nurse administers an antihypertensive medication to a patient at the scheduled time of 900. The nursing assistive personnel then reports to the nurse at the patient's blood pressure was low when it was taking at 08 30. The NAP states she was busy and had not had a chance to tell the nurse. The patient begins to complain of dizziness and light headed. The blood pressure is rechecked and it has dropped even lower. In which phase of the nursing process did the nurse first make an error?

A nurse add the following diagnoses to a patient care plan. Constipation related to decreased gastrointestinal motility secondary to pain medication administration as evidenced by patient reporting no bowel movement in seven days abdominal distention and abdominal pain. Which element did the nurse write as the defining characteristic?

The patient database reviews that a patient has decreased oral take, decreased oxygen saturation when ambulating, reports shortness of breath when getting out of bed, and a productive cough. Which elements will the nurse identify as defining characteristics for the diagnostic label of activity intolerance?

A nurse performs an assessment on a patient. Which assessment data will the nurse use as an etiology for acute pain?

A new nurse writes the following diagnoses on a patient care plan. Which nursing diagnosis will close to the nurse manager to intervene?

A patient has a bacterial infection and left lower leg. Which nursing diagnosis was the nurse add to the patient care plan?

A nurse adds a nursing diagnosis to a patient care plan. Which information did the nurse document?

A charge nurse is evaluating a new nurses plan of care. Which finding the charge nurse to follow up?

A patient exhibits the following symptoms. Tachycardia, increased thirst, headache, decreased urine output it, and increased body temperature. The nurse analyzes the data. Which nursing diagnosis will the nurse assign to the patient?

Which question would be most appropriate for a nurse to ask a patient to assist in establishing a nursing diagnosis of diarrhea?

A nurse assesses a patient has not going did in six hours. Which question should the nurse asked to assist in establishing a nursing diagnosis?