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The following North American Nursing Diagnosis Association (NANDA) nursing diagnostic stem was developed for a client on an inpatient unit: “Risk for injury.” Which assessment data most likely led to the development of this problem statement?

A charge nurse openly disagrees with a staff nurse’s suggestions during a staff meeting. After the meeting, the staff nurse in turn angrily criticizes a Nursing Assistive Personnel (NAP). What defense mechanism is the staff nurse demonstrating?

The nurse prepares discharge teaching for a patient. The HCP has prescribed Alprazolam (Xanax), prn patient anxiety. Which client assessment finding would cause the nurse to question HCP’s order?

A patient diagnosed with schizophrenia receives fluphenazine decanoate (Prolixin Decanoate) from a home health nurse. During one regularly scheduled home visit, the client refuses the medication. Which nursing intervention is ethically appropriate?

The nurse cares for a patient who is physically restrained. Which of the following nursing interventions would best help this patient cope with the experience?

The nurse working in a long-term care facility observes a geriatric patient who is confused and wandering in and out of every door. Which option reflects the least restrictive alternative for this client?

2. Which indicates a client is likely demonstrating a mental disorder?

The nurse is caring for a patient with an increased thyroid-stimulating hormone (TSH) level. Which symptoms should be expected in this patient? Select all that apply.

The emergency department nurse is providing discharge instructions to a 23-year-old man who was injured in a motor vehicle crash. The client stated, “My heart was racing when I saw the car coming through the red light was going to hit me. I didn’t know my heart could go that fast!” Which is the nurse’s best response?

How does the tone of “The Things They Carried” shift throughout the story?