A male client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink six (6) hours before admission. Based on this response, nurse Lorena should expect early withdrawal symptoms… Read More »
While looking out the window, a client with schizophrenia remarks, “That school across the street has creatures in it that are waiting for me.” Which of the following terms best describes what the creatures represent? A. Anxiety attack B. Projection C. Hallucination D. Delusion Correct Answer: D. Delusion A… Read More »
Nurse Helen is assigned to care for a client with anorexia nervosa. Initially, which nursing intervention is most appropriate for this client? A. Providing one-on-one supervision during meals and for one (1) hour afterward. B. Letting the client eat with other clients to create a normal mealtime atmosphere. C. Trying to persuade the client… Read More »
The doctor has prescribed haloperidol (Haldol) 2.5 mg. I.M. for an agitated client. The medication is labeled haloperidol 10 mg/2 ml. The nurse prepares the correct dose by drawing up how many milliliters in the syringe? A. 0.3 B. 0.4 C. 0.5 D. 0.6 Correct Answer: C.… Read More »
A client with schizophrenia tells the nurse, “My intestines are rotted from the worms chewing on them.” This statement indicates a:A. Delusion of persecution A. Delusion of persecution B. Delusion of grandeur C. Somatic delusion D. Jealous delusion Correct Answer: C. Somatic delusion Somatic delusions focus on… Read More »
A female client begins to experience alcoholic hallucinosis. Nurse Joy is aware that the best nursing intervention at this time? A. Keeping the client restrained in bed. B. Checking the client’s blood pressure every 15 minutes and offering juices. C. Providing a quiet environment and administering medication as needed and prescribed. D. Restraining… Read More »
The nurse enters the room of a client with a cognitive impairment disorder and asks what day of the week it is: what the date, month, and year are; and where the client is. The nurse is attempting to assess: A. Confabulation B. Delirium C. Orientation D. Perseveration … Read More »
During the assessment stage, a client with schizophrenia leaves his arm in the air after the nurse has taken his blood pressure. His action shows evidence of: A. Somatic delusions B. Waxy flexibility C. Neologisms D. Nihilistic delusions Correct Answer: B. Waxy flexibility The correct answer is… Read More »
Which of the following drugs should Nurse Mary prepare to administer to a client with a toxic acetaminophen (Tylenol) level? A. Deferoxamine mesylate (Desferal) B. Succimer (Chemet) C. Flumazenil (Romazicon) D. Acetylcysteine (Mucomyst) Correct Answer: D. Acetylcysteine (Mucomyst) The antidote for acetaminophen toxicity is acetylcysteine. It enhances… Read More »
A client with obsessive-compulsive disorder is hospitalized in an inpatient unit. Which nursing response is most therapeutic? A. Accepting the client’s obsessive-compulsive behaviors. B. Challenging the client’s obsessive-compulsive behaviors. C. Preventing the client’s obsessive-compulsive behaviors. D. Rejecting the client’s obsessive-compulsive behaviors. Correct Answer: A. Accepting the client’s obsessive-compulsive behaviors… Read More »