Nursing Process II Quiz

Which nursing intervention is appropriate for assessing a client with end-stage chronic kidney disease?

What intervention should be included in the care plan for a client experiencing Kussmaul respirations?

Which intervention is most effective for managing dry mouth in a client with end-stage chronic kidney disease?

Which method should be prioritized when teaching discharge instructions to an elderly client with low literacy?

What is the most appropriate type of discharge teaching for a client with low literacy and COPD?

If the desired outcomes for a client with ESKD were not achieved, what is the first action to take?

How should a nurse respond if a client with COPD expresses a desire to look up health information online?

Which of the following signs is most important to monitor for during the evaluation phase for a client with ESKD?

Implementation:
- Nursing interventions: Assess, monitor, observe, and provide procedures, medications, and client education.

Evaluation:
- Reassess the client to determine if desired outcomes were achieved.
- Adapt the care plan based on the new assessment, identifying potential errors or problems.
- Make adjustments as needed.

Cognitive: Thought processes and intellect.
- Example: Choosing low-sodium foods.
Psychomotor: Physicality and actions.
- Example: Insulin injection administration.
Affective: Emotions and feelings.
- Example: Client willingness to learn about the disease process.
Instructional Methods:
- Written materials: Use simple language and appropriate reading levels.
- Demonstrations: Show clients how to perform skills.
- Other resources: Videos, audio recordings, books, validated websites.
Evaluation Methods:
- Teach-back: The client explains the learning back to the nurse.

Client with end-stage chronic kidney disease (ESKD):
- Assess for jugular vein distention (JVD).
- Provide frequent mouth rinses.
- Observe for Kussmaul respirations.
- Monitor for melena.

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