Nursing Diagnosis Categories include all, except

Correct Answer: D

Rationale: Nursing diagnoses, per NANDA International, categorize patient conditions into specific types. 'Actual' diagnoses reflect current problems, like 'Acute Pain.' 'Risk' diagnoses indicate potential issues, such as 'Risk for Infection.' 'Possible' diagnoses suggest conditions needing more data, like 'Possible Anxiety.' 'Syndrome' and 'Wellness' are also recognized categories. 'Factual' isn't a standard term in this context; it's too vague and doesn't fit the diagnostic framework. These categories help nurses systematically identify and address health issues, ensuring care plans are precise and tailored. Excluding 'Factual' maintains the specificity required for effective nursing interventions.

Correct Answer: A

Rationale: Albumin treats ascites by raising oncotic pressure, pulling fluid from tissues into vessels. Slow infusion prevents overload, and fluid restriction avoids diluting the effect, maximizing fluid shift from the abdomen. Rapid infusion risks pulmonary edema, and liberal fluids counteract albumin's purpose. Nurses monitor volume status, optimizing therapy to relieve ascites without cardiovascular strain.

Correct Answer: B

Rationale: Formulating a nursing diagnosis involves the nurse and patient collaborating to identify health problems based on assessment data. The nurse collects subjective input (e.g., patient-reported symptoms) and objective findings (e.g., vital signs), then analyzes them with the patient's perspective to define needs and goals. This partnership ensures patient-centered care, reflecting the patient's experiences and priorities. Relatives may offer insights, but the primary focus is the patient's direct input, not family consensus. Doctors diagnose medical conditions, not nursing diagnoses, which address human responses to health issues distinct from medical roles. Nurse-doctor collaboration informs broader care, but nursing diagnosis formulation centers on nursing scope, not physician directive. The nurse-patient dynamic leverages the nurse's expertise and the patient's lived experience, making it the essential joint function for accurate, tailored nursing diagnoses.

Correct Answer: D

Rationale: Contemporary nursing demands autonomy and accountability nurses independently make decisions within their scope and take responsibility for outcomes, reflecting roles like educator, advocate, and clinician. This aligns with evolving healthcare, where nurses lead initiatives (e.g., patient education) and answer for care quality. Health promotion and illness prevention are key foci but specific tasks, not broad role examples. Providing bedside care is traditional, not fully capturing modern diversity (e.g., research, management). Following physician orders reflects dependence, not the autonomy defining today's practice. Autonomy and accountability encompass the knowledge (clinical expertise), skills (critical thinking), and attitudes (responsibility) needed for multifaceted roles, making this the best fit for contemporary nursing's scope.

Correct Answer: A

Rationale: An interview is an organized conversation with the client, systematically collecting subjective data e.g., symptoms, history via structured questions. This kickstarts the database, informing objective checks (e.g., vitals). Implementing physician orders is action, not data-gathering post-assessment. Delegation assigns tasks, not interviews, which nurses conduct directly. Determining nursing actions follows data collection, in planning, not the initial step. The interview's conversational structure e.g., asking about chest pain onset ensures comprehensive, client-centered data, making it the foundational method for establishing an accurate nursing database.