Nursing Process ADPIE – PrepU questions with correct answers

On admission, a client is completely immobilized by an acute exacerbation of multiple sclerosis. Two days later, the client cries frequently and refuses to see family members. The nurse formulates a nursing diagnosis of Hopelessness. To address this diagnosis, the nurse should include which intervention in the care plan? Answer Encouraging the client to verbalize feelings (Explanation: Encouraging clients to verbalize feelings is an example of therapeutic communication, which the nurse uses to help the client express and work through feelings and problems related to his condition. Administering sedation, limiting visits, or reminding the client of his responsibilities wouldn't help him work through feelings.) Which outcome is therapeutic and realistic when the nurse is planning care for a female client with major depression and borderline personality disorder who is hospitalized for self-mutilation and threats of suicide? Answer The client will appropriately verbalize anger and sad feelings to the nurse. (Explanation: The client needs to ventilate and discuss feelings of anger and sadness with the nurse to decrease behaviors of self-harm. Other alternatives such as punching the pillow may be helpful to the client in expressing anger and rage. The nurse helps the client to develop safe methods of handling intense feelings. The other options—staying in her room when feeling overwhelmed, leaving the group when angry, and asking for medication when feeling out of control—are inappropriate because they will not help the client understand herself or her feelings. Additionally, those options will not foster growth in autonomy and responsibility for self.) A nurse is completing discharge teaching for the client who has left-sided hemiparesis following a stroke. When investigating the client's home environment, the nurse should focus on which nursing diagnosis? A