The nursing diagnosis that would have the highest priority in the care of the client who has become comatose following cerebral hemorrhage is which of the following?
Disturbed body image
Risk for unstable blood glucose
Impaired urinary elimination
Ineffective airway clearance
The Correct Answer is D
Choice A reason: Body image is psychosocial, not urgent in coma. Airway is critical. This errors per nursing priorities. It’s universally distinct, lower priority.
Choice B reason: Glucose risk is secondary; airway ensures survival in coma. This misaligns with nursing standards. It’s universally distinct, not immediate.
Choice C reason: Urinary issues rank below airway in comatose priority. This errors per nursing hierarchy. It’s universally distinct, less urgent than breathing.
Choice D reason: Airway clearance is top priority in coma, ensuring oxygenation. This aligns with nursing standards. It’s universally recognized, distinctly life-saving.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Flu vaccines prevent disease, a primary prevention strategy. This aligns with public health standards. It’s universally recognized, distinctly preemptive care.
Choice B reason: Policy development isn’t prevention; vaccines are primary. This errors per nursing definitions. It’s universally distinct, not a prevention level.
Choice C reason: Tertiary manages existing illness; vaccines prevent it. This misaligns with public health standards. It’s universally distinct, post-disease care.
Choice D reason: Secondary screens for disease; vaccines prevent it primarily. This errors per nursing standards. It’s universally distinct, not preventive focus.
Correct Answer is D
Explanation
Choice A reason: Designing a game teaches healthy choices, a primary prevention. Weighing identifies obesity, per nursing standards. This errors as it’s not secondary. It’s universally distinct, focusing on prevention, not detection.
Choice B reason: Dieting after weight gain is tertiary, managing obesity. Weighing screens early, per public health. This misaligns with secondary prevention. It’s universally distinct, treatment-based.
Choice C reason: Exercise presentations are primary, preventing obesity onset. Weighing detects it, per nursing standards. This errors as it’s not secondary. It’s universally distinct, preemptive not screening.
Choice D reason: Weighing students screens for obesity, a secondary prevention strategy. This aligns with public health standards. It’s universally applied, distinctly identifying at-risk children effectively.
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