The nurse identifies several nursing problems for a client who is incontinent and immobile after a stroke and is now experiencing diarrhea. The client resides at home, and the spouse is the primary caregiver. While planning care, the nurse should determine which problem has the highest priority?

Bowel incontinence.

Impaired bed mobility.

Fluid volume deficit.

Caregiver role strain.

Answer and Explanation

The Correct Answer is C

Choice A reason: While bowel incontinence is a concern, it does not pose an immediate threat to the client's physiological stability like fluid volume deficit does.

Choice B reason: Impaired bed mobility is important to address for long-term rehabilitation, but it is not the most immediate threat to life.

Choice C reason: Fluid volume deficit, especially due to diarrhea, can lead to dehydration and is a life-threatening condition that requires immediate intervention.

Choice D reason: Caregiver role strain is a significant issue but does not take precedence over the client's immediate physical health needs.

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Correct Answer is B

Explanation

Choice A reason: Analogies can be useful for explaining concepts but may not provide the hands-on practice needed for managing confrontational situations.
Choice B reason: Role-playing is an effective strategy for practicing communication skills, as it allows staff to simulate and navigate difficult conversations in a controlled environment.
Choice C reason: Return demonstration is typically used for teaching psychomotor skills and may not be as effective for communication training.
Choice D reason: Journaling is a reflective practice but does not offer the interactive experience needed to prepare for real-life scenarios involving angry family members.

A. Offer positive reinforcement. B. Provide physical demonstrations. C. Use simulation activities. D. Incorporate verbal analogies.

Correct Answer is C

Explanation

Choice A reason: Offering positive reinforcement is a good practice in teaching, but it does not directly facilitate the learning of problem-solving strategies.

Choice B reason: Physical demonstrations are more suited to teaching psychomotor skills rather than problem-solving strategies.

Choice C reason: Simulation activities allow individuals to practice problem-solving in a controlled environment, which can enhance learning and retention of these strategies.

Choice D reason: Verbal analogies can aid in understanding concepts, but they are less interactive and engaging than simulation activities when it comes to learning problem-solving strategies.

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The nurse identifies several nursing problems for a client who is incontinent and immobile after a stroke and is now experiencing diarrhea. The client resides at home, and the spouse is the primary caregiver. While planning care, the nurse should determine which problem has the highest priority?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse learns that members of the nursing staff are uncomfortable with responding to client family members who are angry. While designing a teaching session to help the staff respond more effectively in these situations, which instructional strategy is best for the nurse to use?

Correct Answer is B

Explanation

The nurse plans to encourage a group of young adult clients to engage in problem-solving strategies. Which action is most useful for the nurse to include during the teaching session?

Correct Answer is C

Explanation

When interviewing a client about sexuality/reproductive function, which is the best approach for the nurse to use?

While changing the dressing of a client who is immobile, the nurse notices the boundary of the wound has increased. Before reporting this finding to the healthcare provider, the nurse should evaluate which of the client's laboratory values?

A client who is 2 days postoperative for thoracic surgery is reporting incisional pain 2 hours after receiving pain medication. The client rates the pain as 5 on a pain scale of 0 to 10. After placing a call to the healthcare provider, which action should the nurse implement?

A family member is demonstrating wound care using sterile technique. Which action indicates to the nurse that additional teaching is needed?

Patient Data Exhibits Based on the trending heart rate and pain score, what should the nurse do? Select all that apply.

The nurse identifies several nursing problems for a client who is incontinent and immobile after a stroke and is now experiencing diarrhea. The client resides at home, and the spouse is the primary caregiver. While planning care, the nurse should determine which problem has the highest priority?