A nurse formulates several nursing diagnoses then prioritizes using Maslow's hierarchy. What nursing diagnosis should have the highest priority?

Altered Nutrition: Less Than Body Requirements

Ineffective Coping

Risk for Falls

Impaired Mobility

Answer and Explanation

The Correct Answer is A

A. Maslow’s hierarchy prioritizes physiological needs first, including nutrition, hydration, and oxygenation. This is the most immediate concern.

B. While mental health is important, psychosocial needs are a lower priority than basic physiological needs like nutrition.

C. Fall prevention is essential, but it is a potential problem rather than an existing physiological issue, making it a lower priority than inadequate nutrition.

D. Mobility is important, but ensuring adequate nutrition is more critical to prevent further complications such as muscle wasting and delayed wound healing.

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Correct Answer is B

Explanation

A. Patient will be offered laxatives or stool softeners this shift. This is incorrect because offering a medication is an intervention rather than an outcome. Outcomes should focus on the patient’s response to nursing care.

B. Patient will have one soft, formed bowel movement by the end of shift. This is correct because it is a specific, measurable, achievable, realistic, and time-bound (SMART) goal. The outcome directly addresses the problem of constipation and provides a clear indicator of improvement.

C. Patient will not take any pain medications this shift. This is incorrect because withholding pain medication is not an appropriate strategy for managing constipation. Instead, interventions such as increasing fiber, fluids, activity, or stool softeners should be considered.

D. Patient will walk unassisted to the bathroom by the end of the shift. This is incorrect because, although mobility can help improve bowel function, it does not directly measure the resolution of constipation. The outcome should focus on bowel movement frequency and consistency.

A. Skip a meal break to catch up on charting. B. Offer to complete another nurse's task. C. Plan time for disruptions. D. Complete the easiest tasks first.

Correct Answer is C

Explanation

A. Skipping breaks can lead to burnout.

B. Taking on another nurse’s task may cause delays in primary responsibilities.

C. Planning for interruptions improves efficiency and prioritization.

D. Completing the easiest tasks first may not be the most efficient approach.

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A nurse formulates several nursing diagnoses then prioritizes using Maslow's hierarchy. What nursing diagnosis should have the highest priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a patient with a nursing diagnosis of Constipation related to slowed gastrointestinal motility secondary to pain medications. Which outcome is most appropriate for the nurse to include in the plan of care?

Correct Answer is B

Explanation

A nurse is discussing time management strategies with another nurse. The nurse should include which of the following as an example of a time management strategy?

Correct Answer is C

Explanation

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