When a problem is suspected, but lacks enough data to support it, the nursing diagnosis is:

A wellness nursing diagnosis

A syndrome nursing diagnosis

A ‘risk for’ nursing diagnosis

An actual nursing diagnosis

Answer and Explanation

The Correct Answer is C

Choice A reason: This is incorrect because it shows that the problem is not suspected, but rather the client has a desire to improve or maintain a level of health. A wellness nursing diagnosis describes a potential or actual health state that can be enhanced.

Choice B reason: This is incorrect because it shows that the problem is not suspected, but rather the client has a cluster of related problems that are associated with a specific situation or event. A syndrome nursing diagnosis describes a patern of responses that are linked by a common cause.

Choice C reason: This is correct because it shows that the problem is suspected, but lacks enough data to support it. A ‘risk for’ nursing diagnosis describes a potential problem that may occur if certain risk factors are present.

Choice D reason: This is incorrect because it shows that the problem is not suspected, but rather the client has signs and symptoms that indicate an actual health issue. An actual nursing diagnosis describes a current problem that has been validated by data.

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Correct Answer is D

Explanation

Choice A reason: Gives the same message to the patient verbally and nonverbally is an example of using assertive communication, not a sign of needing further teaching on it. Assertive communication is a communication style that involves expressing one’s thoughts, feelings, and needs in a clear, respectful, and confident manner. It also involves using congruent verbal and nonverbal cues, such as eye contact, tone of voice, and body language, to reinforce the message and avoid confusion or misunderstanding. Therefore, this choice is incorrect.

Choice B reason: Speaks firmly and positively is an example of using assertive communication, not a sign of needing further teaching on it. Assertive communication is a communication style that involves expressing one’s thoughts, feelings, and needs in a clear, respectful, and confident manner. It also involves using firm and positive language, such as “I” statements, active verbs, and constructive feedback, to convey the message and avoid aggression or passivity. Therefore, this choice is incorrect.

Choice C reason: Is unapologetic is an example of using assertive communication, not a sign of needing further teaching on it. Assertive communication is a communication style that involves expressing one’s thoughts, feelings,

and needs in a clear, respectful, and confident manner. It also involves being unapologetic for one’s opinions, beliefs, or values, as long as they do not harm or disrespect others. It does not mean being rude or arrogant, but rather being honest and authentic. Therefore, this choice is incorrect.

Choice D reason: Agrees to do whatever the patient requests is a sign of needing further teaching on using assertive communication, not an example of it. Agreeing to do whatever the patient requests is a communication style that involves suppressing one’s thoughts, feelings, and needs in order to please or avoid conﬂict with others. It is a form of passive communication, which can lead to resentment, frustration, or loss of self-esteem. It can also compromise the quality of care or the safety of the patient or the nurse. Therefore, this choice is correct.

A. Select one answer B. Symptoms C. Urinary retention D. Signs of ﬂuid overload

Correct Answer is A

Explanation

Choice A reason: This is correct because symptoms are subjective or objective manifestations of a health problem that are perceived or reported by the client.

Choice B reason: This is incorrect because urinary retention is a specific condition that involves the inability to empty the bladder completely, which is not related to the data presented.

Choice C reason: This is incorrect because signs of ﬂuid overload are opposite to the data presented, such as edema, weight gain, crackles in the lungs, and distended neck veins.

Choice D reason: This is incorrect because data clustering is a process of grouping related data together to identify paterns and potential problems, not a type of data itself.

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When a problem is suspected, but lacks enough data to support it, the nursing diagnosis is:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse preceptor is instructing the new nurse on appropriate communication techniques. The new nurse indicates a need for further teaching on using assertive communication, if she does which of the following when communicating with patients? Select one answer

Correct Answer is D

Explanation

During a physical examination, the Practical Nurse (PN) discovers that the client demonstrates signs of ﬂushed, dry, hot skin; dry oral mucus membranes; and temperature elevation. The PN will treat these data as the basis of a nursing diagnosis plan, as they represent:

Correct Answer is A

Explanation

Family members awaiting the outcome of a suicide atempt are tearful. Which response by the Practical Nurse (PN) is therapeutic to the family at this time? * Select one answer

A client with chronic renal failure is admited with a heart rate of 122 beats/minute; a respiratory rate of 32 breaths/minute, a blood pressure of 190/110 mm Hg, neck vein distention, and bibasilar crackles. Which nursing diagnosis takes highest priority for this client? Select one answer

Subjective data provided by the client included complaints of intermitent chest pain upon exertion. When performing a complete physical examination, the nurse might use an organized approach such as which of the following? (Select all that apply)

In what step of the nursing process do the client and the nurse develop the goals? (Select all that apply)

A patient roughly asks the nurse to bring him some ice cream. An assertive response by the nurse is:

The young client says, “I’m really stressed out about this pregnancy.” When the Practical Nurse (PN) responds, “What about this pregnancy worries you?”, he or she is using the technique of:

When a problem is suspected, but lacks enough data to support it, the nursing diagnosis is:

The Practical Nurse (PN) explains that the major eﬀect of maintaining eye contact for 2 to 6 seconds during communication is to: