Which nursing diagnosis is written appropriately and correctly?
Cough related to long history of smoking.
Risk for injury related to cluttered home.
Needs assistance with bathing related to bed rest.
Poor home maintenance related to laziness.
The Correct Answer is B
Choice A rationale
This nursing diagnosis is incorrectly written because "cough" is a clinical sign or symptom rather than a nursing diagnosis. Additionally, "long history of smoking" is a medical history factor rather than a specific related factor that a nurse can independently treat through nursing interventions. A more appropriate nursing diagnosis would be Ineffective Airway Clearance related to retained secretions or excessive mucus, which focuses on the human response that the nurse can actually manage.
Choice B rationale
This nursing diagnosis is written correctly according to professional standards. "Risk for injury" is an official NANDA-I approved nursing diagnosis that identifies a potential problem. The phrase "related to cluttered home" identifies a specific environmental factor that the nurse can address through teaching, safety assessments, and referrals. It follows the proper format of identifying the patient's vulnerability and the contributing factors in the environment that increase the likelihood of an adverse event occurring.
Choice C rationale
This statement is written as a need or a task rather than a nursing diagnosis. "Needs assistance with bathing" describes a patient requirement, but the official nursing diagnosis should be Bathing Self-Care Deficit. Furthermore, "bed rest" is a medical order rather than a physiological or psychological rationale for the deficit. A correct diagnosis focuses on the patient's inability to perform the activity and the underlying cause, such as musculoskeletal impairment or severe physical weakness.
Choice D rationale
This diagnosis is inappropriate because it uses judgmental and non-professional language. Terms like "laziness" are subjective and derogatory, violating the ethical requirement for objective and respectful documentation. Nursing diagnoses must be based on objective data and neutral observations. A more professional way to state this would be Impaired Home Maintenance related to insufficient energy or lack of resources, focusing on the actual barriers the patient faces rather than labeling their personal character or motivation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Nocturia refers to the physiological need to wake up one or more times during the night to void. It often results from conditions like congestive heart failure, diabetes mellitus, or prostatic hypertrophy. While it disrupts sleep and quality of life, it is defined by the timing and frequency of urination rather than the presence of physical pain or difficulty during the actual act of micturition itself.
Choice B rationale
Polyuria is characterized by the excretion of an abnormally large volume of urine, typically exceeding 2.5 to 3 liters over a 24 hour period in adults. This is frequently seen in uncontrolled diabetes mellitus due to osmotic diuresis or in diabetes insipidus due to a lack of antidiuretic hormone. It describes the quantity of urine produced rather than any discomfort, pain, or difficulty experienced during the voiding process.
Choice C rationale
Pyuria is the presence of white blood cells or pus in the urine, which typically indicates an underlying inflammatory process or infection within the urinary tract. While pyuria often accompanies painful urination in the context of a urinary tract infection, the term specifically describes the cellular content of the urine specimen rather than the subjective sensation of pain or the physical difficulty of passing urine from the bladder.
Choice D rationale
Dysuria is the specific medical term used to describe any sensation of pain, burning, or discomfort during urination. It is a common symptom of lower urinary tract infections, such as cystitis or urethritis, where the mucosal lining is inflamed. The irritation of the nerves in the urethral or bladder wall leads to the characteristic painful sensation. This term directly addresses the difficulty and pain mentioned in the question.
Correct Answer is C
Explanation
Choice A rationale
Thinking that critical thinking is restricted to the intensive care setting is a misconception that ignores the universal application of cognitive skills. Nurses in all environments, from community health to long-term care, must analyze data and prioritize care. Restricting this definition to a high-acuity environment fails to recognize that clinical judgment is necessary for safe practice regardless of the patient's stability or the complexity of the equipment.
Choice B rationale
Suggesting that a system of thinking is purely academic and rarely used in clinical practice undermines the foundation of evidence-based nursing. Clinical practice requires the constant application of theoretical knowledge to real-world scenarios to ensure patient safety. If thinking were only academic, nurses would rely on rote memorization rather than adapting to the unique physiological and psychological needs of each individual patient during their daily shift.
Choice C rationale
Critical thinking is defined as a systematic, disciplined process of actively and skillfully conceptualizing, applying, and evaluating information. In nursing, it involves purposeful, self-regulatory judgment that results in interpretation and inference. By forming and shaping one's thinking, a nurse can avoid cognitive biases and ensure that clinical decisions are based on sound logic and verified data. This systematic approach is essential for identifying subtle changes in patient status.
Choice D rationale
A problem-solving approach that involves testing solutions until one works is better described as trial and error. This method is often inefficient and can be dangerous in a healthcare setting where a patient's life is at stake. Critical thinking differs because it uses existing knowledge and evidence to predict outcomes and choose the most effective intervention initially, rather than relying on accidental success through repetitive, unguided attempts.
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