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stions and Answers
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,Nursing Diagnosis Handbook 12th Edition Ackley Test Bank q q q q q q q
1.
During the assessment of a client with left-sided weakness who is right-
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hand dominant, the nurse identifies that the client needs assistance with ambulation. Which of the fo
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llowing would be the most relevant defining characteristic for the nursing diagnosis of self-
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care deficit: bathing in this client?
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a. Inability to access bathroom hj h j hj
b. Inability to dry body hj h j hj
c. Inability to wash body hj hj h j
d. Inability to regulate bath water hj hj hj h j
ANSWER: a
POINTS: 100
2.
The nurse is developing a plan of care for a client who has left-
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sided weakness. Since there is only a tub for bathing in the home, the nurse recognizes that there is
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a self-care deficit: bathing related to which of the following?
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a. Severe anxiety hj
b. Environmental barriers hj
c. Inability to perceive body part hj h j h j h j
d. Inability to perceive spatial relationships hj hj hj h j
ANSWER: b
POINTS: 100
3.
The nurse is planning care for a client with severe dementia who becomes agitated during bathing. Wh
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following outcomes would be most applicable for this client’s nursing diagnosis of self-care deficit: bathing?
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a. Client will state satisfaction with ability to use adaptive devices to bathe.
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b. Client will bathe self safely with minimal difficulty.
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c. Client will bathe with assistance of caregiver as needed and report satisfaction.
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d. Client will bathe with assistance without exhibiting defensive behaviors.
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ANSWER: d
POINTS: 100
4.
The nurse is developing the plan of care for a client with dementia. Which of the following interventio
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ns should the nurse include to preserve the client’s dignity during bathing?
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a. Provide privacy and encourage client participation.
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b. Give analgesics 30 minutes prior to bathing.
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c. Provide client with a padded shower chair.
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d. Use a prepackaged bath.
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ANSWER: a
POINTS: 100
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,5.
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, In planning care for a client with dementia, the nurse should train caregivers bathing the client to use w
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hich of
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