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Question
The nurse is caring for a client who is experiencing alcohol withdrawal. Which of the following diagnoses receives priority for a client in alcohol withdrawal?1. Risk for Injury
2. Ineffective Coping
3. Disturbed Sensory Perception
4. Disturbed Thought Processes
Answer
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Related questions
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A client is standing in the hallway on the phone arguing with the caller. As the client becomes increasing loud and argumentative, an appropriate action for the nurse to take would be to:1. Move the other clients away from the area providing the client privacy to continue the conversation.2. Stand next to the client and say in a calm, firm voice, "If you cannot lower your voice, you will lose your phone privileges indefinitely."3. Walk up to the client and softly say, "This conversation appears to be getting you upset, tell this person that you will talk later and come sit with me to discuss what is bothering you."4. Do nothing. The client does not pose any danger as the person the client is angry with is not physically present.
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A client who is a construction supervisor has a history of becoming violent when the client's workers do not complete their work within the established deadline. Police have been called to the worksite multiple times for behaviors including loud shouting and destruction of property. The most appropriate expected outcome related to resolving this problem would be for the client to:1. Identify personal needs.2. Refrain from impulsive behavior.3. Refrain from self-injury and from injuring others.4. Identify alternative methods for expressing anger.
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The nurse suspects that a male client may become violent. Which verbal cue might have indicated this? The client:1. Receives news that his wife is filing for divorce and begins sobbing inconsolably.2. Demands, "Give me my medicine now or you"ll be sorry."3. Begins pacing the hall exhibiting clenched jaw and fists.4. States, "I don"t know why people seem afraid of me."
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A client with a history of epilepsy has recently experienced more frequent seizures, often followed immediately by episodes of aggressive behavior. Which biological abnormality is likely to be present in this client?1. A mutation on the genes that encode components of the serotonin system2. Serum toxicity resulting from chronic exposure to lead3. A deficit of gamma-aminobutyric acid4. A problem with the amygdala/temporal lobe
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Identify which of the following would be detrimental for the nurse desiring to manage stress when working with a client/family in crisis.1. Drink plenty of water and eat a balanced and healthy diet2. Participate in memorials and rituals3. Talk about your emotions4. Maintain a consistent work assignment
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Which statement by a client would suggest that the ABCs of crisis counseling have been met?1. "I am really glad we did this counseling."2. "I will call you if I need you."3. "I now know some better ways of coping."4. "I will miss working with you."
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In order to improve diet, an eager mental health client bought a juicing machine. The nurse knows that grapefruit juice may interfere with some psychotropic medications. Upon checking the client's medical records, the nurse finds the client's medication should not cause a problem with including grapefruit juice in the client's diet. The client is probably taking:1. Antidepressants.2. Anticonvulsants.3. Atypical antipsychotics.4. Benzodiazepines.
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Introspective or meditative techniques may be useful for clients who:1. Are highly anxious.2. Have multiple problems.3. Are severely depressed, delusional, or hallucinating.4. Are mentally and emotionally healthy.
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Taking into consideration the client's level of motivation and ability to manage complex instructions, a nurse counsels a client seen for repeated episodes of anxiety to consider adding the use of complementary and/or alternative modalities to help manage the anxiety. The nurse may suggest which of the following CAM modalities?1. Kudzu2. Running3. Acupressure4. Ginkgo
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Q:
Which of the following statements made by the nurse displays a positive attitude about client autonomy and self-determination?1. "I comfortable with clients deciding what the programs, schedule, activities, or rules will be."2. "Clients should not be permitted to decide their own treatment goals."3. "Clients should not be permitted to comment on each other's behaviors or treatment goals while in group."4. "I am sad when a client does not choose my plan of care."
Q:
The nurse is reviewing the plan of care with a client who has been diagnosed with schizophrenia. The client is not compliant with the medications he has been placed on for treatment of his illness. Which of the following is the most appropriate response by the nurse in order to modify the plan of care?1. "I am going to tell the doctor you have not been taking your medication and she will be upset with you."2. "Why would you stop taking your medications? That is stupid."3. "Tell me what is going on with your medications."4. "Does your family know you stopped taking your medication?"
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A client with chronic paranoid schizophrenia was recently referred to a psychosocial rehabilitation "clubhouse" program following discharge from the inpatient psychiatric unit. Which of the following client goals is most appropriate for this situation?1. The client will attend recreational and educational group activities on a daily basis.2. The client will obtain food, clothing, and transportation services.3. The client will obtain a sponsor and attend weekly AA meetings.4. The client will identify career goals and develop a resume of job experiences.
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Which of the following laboratory studies is performed because the client is taking lithium?1. Hemoglobin2. CBC3. Liver function4. Thyroid function
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Which of the following laboratory studies are routinely done on patients taking second generation antipsychotic medications?1. Hemoglobin and hematocrit2. Renal functions3. Thyroid functions4. Serum glucose levels
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A family member says to the nurse, "I think my sister needs more medication because she says she cannot sit still and is moving her legs back and forth." The client's risperidone (Risperdal) was recently increased to 10 mg daily. What is the correct nursing response?1. "I will check with your sister because what you are describing sounds like a side effect called akathisia."2. "I will check to see what your sister has been prescribed because some clients get anxious when their medications are increased."3. "I will see if your sister has been prescribed a medication to counteract the dystonic reaction that she is having."4. "I will call the doctor and report that your sister is developing a tolerance to risperidone and the dose is not effective."
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What is the primary rationale for the nurse asking a client on antidepressant medication about changes in sexual functioning?1. Antidepressants used frequently contributes to sexual promiscuity and tragic regrets.2. A side effect of antidepressants may be sexual dysfunction that contributes to nonadherence.3. Cultural attitudes about sexual functioning may impact the effectiveness of the antidepressant medication.4. A lack of libido is a symptom of depression that may interfere with the client's relationships.
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The nurse instructs the clients to take the medications that are prescribed because the psychiatrist knows what is best for the client. How would the nurse's supervisor evaluate the effectiveness of the nurse's teaching?1. The nurse is demonstrating a paternalistic attitude that may contribute to client nonadherence.2. Teaching the client to take all medications should help keep the client out of the hospital.3. The nurse is helping the client develop trust in the psychiatrist.4. The nurse is giving simple instructions that will be readily accepted by the client.
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The client received aripiprazole (Abilify) on admission to the inpatient unit with a diagnosis of schizophrenia, paranoid type. Which of the following would the nurse note as a sign that the aripiprazole is becoming effective?1. The client paces in the hall and engages in solitary activities most of the day.2. The client sleeps for shorter periods of time during the day.3. The client establishes eye contact and remains in conversation with the nurse for longer periods.4. The client eats only the food that is in its original container such as individual packages of crackers.
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The nurse would be alert to assess for signs of lithium toxicity in a patient with which of the following lithium levels?1. 1.5 mEq/l2. 0.1 mEq/l3. 0.5 mEq/l4. 1.0 mEq/l
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A nurse skillful in the writing process knows that this talent may benefit the client because a well-written behavioral contract:1. Teaches the client about past mistakes to lead to a successful outcome.2. Provides everything needed for a cure.3. Teaches the client to embrace the future helps overcome past misdeeds.4. Can promote successful outcomes.
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The nurse student taking care of a client with schizophrenia has difficulty keeping up with the client's music therapy and individual therapy times. The nurse knows, however, that the case manager is helpful in maintaining the routines and schedules of:1. Self-study.2. All clients on the unit.3. Cognitive behavioral interventions..4. Clients in music therapy.
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The nurse knows that a client who has panic attacks when she sees waterfalls because she had been physically assaulted in a park with a waterfall, would benefit from the feature of cognitive and behavioral treatment of:1. Suggesting alternative behavior.2. Seeking social support.3. Reframing.4. Expressing affection.
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A client admitted with borderline personality disorder complains during group therapy that she, "always falls for the bad guy." She has been in and out of rehabilitation and abuse crisis centers. The nursing student knows this client would benefit from:1. Intrapsychic cognitive therapy.2. Family conflict therapy.3. Dialectical behavioral therapy.4. Self-reflective therapy.
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The nurse therapist skilled in rational emotive therapy (RET) helps clients identify:1. Cognitive causes for rational beliefs.2. Health-damaging beliefs and practices.3. Rational thoughts and healthy emotions.4. Irrational thoughts and develop more rational life philosophies.
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A nursing student receiving D's on quizzes decides to begin studying with a group of students known to make A's. The nursing instructor knows that the student is exhibiting what type of behavior?1. Modeling2. Attributing3. Self-efficacy4. Assuming
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The nurse is assessing a client with nicotine addiction. The nurse knows the client plans to compete in a marathon several months away and asks the client to imagine snapping a cigarette in half and winning the marathon whenever the urge to smoke occurs. The nurse knows that shaping one's thoughts so that they have control over a particular situation, thereby creating a successful behavior change, is called:1. Communication.2. Mastery imagery.3. Image restructuring.4. Positive imagery.
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The mother of a young child diagnosed with conduct disorder asks the nurse to recommend a qualified nurse to provide family therapy. The nurse knows that:1. Nurse family therapists should be clinical specialists or advanced practitioners in mental health nursing.2. Nurses with a bachelor's degree are qualified to provide family therapy if they are nationally certified in mental health nursing.3. Nurses are not reimbursed by third party insurers to provide family therapy.4. Nurses specializing in family therapy are expensive and it is difficult to get a timely appointment.