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