Nokea
A client with a history of alcohol use disorder is admitted to the hospital for detoxification. Which of the following symptoms shouldn't the nurse expect to observe during withdrawal?
- A. Tremors
- B. Hallucinations
- C. Diaphoresis
- D. Bradycardia
Correct Answer: D
Rationale: During alcohol withdrawal, the nurse should expect to observe symptoms such as tremors, hallucinations, and diaphoresis. Seizures may also occur during severe withdrawal. Bradycardia is not typically associated with alcohol withdrawal; instead, tachycardia (an increased heart rate) is more commonly observed due to the stimulant effects of alcohol withdrawal on the sympathetic nervous system.
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Which of the following is an uncommon symptom of schizophrenia?
- A. Delusions
- B. Fatigue
- C. Disorganized speech
- D. Catatonia
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
Which of the following interventions should not be implemented for a client with anorexia nervosa?
- A. Monitor daily caloric intake and weight
- B. Establish a structured eating plan
- C. Encourage the client to exercise
- D. Provide liquid supplements as prescribed
Correct Answer: C
Rationale: Interventions for a client with anorexia nervosa should focus on monitoring daily caloric intake and weight, establishing a structured eating plan, providing liquid supplements as prescribed, and offering rewards for weight gain. Encouraging exercise is not recommended as it can worsen the condition by increasing energy expenditure and potentially reinforcing unhealthy behaviors associated with anorexia nervosa.
A client with schizophrenia is prescribed an antipsychotic medication. Which of the following side effects shouldn't the nurse monitor for?
- A. Tardive dyskinesia
- B. Decreased need for sleep
- C. Orthostatic hypotension
- D. Hyperglycemia
Correct Answer: B
Rationale: The correct answer is B, 'Decreased need for sleep.' While antipsychotic medications can cause side effects like tardive dyskinesia, orthostatic hypotension, and hyperglycemia, a decreased need for sleep is not a common side effect. It is important for the nurse to monitor the client for the known side effects of antipsychotic medications to ensure early detection and appropriate management.
A client with bipolar disorder is experiencing a manic episode. Which intervention should the nurse implement to ensure the client's safety?
- A. Provide a structured environment with minimal stimuli.
- B. Monitor the client closely for signs of exhaustion.
- C. Encourage the client to rest and sleep as needed.
- D. Encourage the client to engage in regular physical activity.
Correct Answer: A
Rationale: During a manic episode in bipolar disorder, individuals may exhibit increased energy levels, impulsivity, and reduced need for sleep, which can lead to risky behaviors and accidents. Providing a structured environment with minimal stimuli helps to reduce the risk of overstimulation and impulsive actions, thereby promoting the client's safety. This intervention aims to create a calm and controlled setting that can prevent potential harm to the client during this phase of the disorder.
A client with bipolar disorder is experiencing a depressive episode. Which of the following interventions should the nurse avoid implementing?
- A. Encourage participation in activities
- B. Promote adequate nutrition and hydration
- C. Monitor for suicidal ideation
- D. Discourage verbalization of feelings
Correct Answer: D
Rationale: In caring for a client with bipolar disorder in a depressive episode, the nurse should implement interventions that promote mental well-being. Encouraging participation in activities, promoting adequate nutrition and hydration, and monitoring for suicidal ideation are all essential components of care. Discouraging verbalization of feelings is counterproductive as it hinders the therapeutic process and communication, which are crucial for the client's emotional expression and recovery.