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A client with a history of substance abuse is admitted to the hospital for treatment of a new illness. Which of the following is the most important to assess upon admission?
- A. History of recent drug use.
- B. Current employment status.
- C. Family history of mental illness.
- D. Recent weight changes.
Correct Answer: A
Rationale: Assessing the history of recent drug use is crucial when admitting a client with a history of substance abuse. Understanding recent drug use helps in managing potential withdrawal symptoms, preventing drug interactions with the new treatment, and ensuring appropriate care. Assessing current employment status (choice B) is important for social and financial support but is not as crucial as assessing recent drug use in this scenario. Family history of mental illness (choice C) and recent weight changes (choice D) are also important aspects of assessment but are not as immediate and critical as evaluating recent drug use in a client with a history of substance abuse.
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A client with major depressive disorder is prescribed lithium carbonate. Which finding should the RN report to the healthcare provider?
- A. Serum lithium level of 0.8 mEq/L
- B. Blood urea nitrogen (BUN) level of 16 mg/dL
- C. Serum sodium level of 138 mEq/L
- D. Urine output of 800 mL in 24 hours
Correct Answer: B
Rationale: The correct answer is B. Elevated BUN levels may indicate renal impairment, which is crucial to report for clients on lithium due to its potential kidney effects. Option A, a serum lithium level of 0.8 mEq/L, is within the therapeutic range for lithium and does not require immediate reporting. Option C, a serum sodium level of 138 mEq/L, is within the normal range and not directly related to lithium therapy. Option D, urine output of 800 mL in 24 hours, may indicate a need for further assessment but is not the most critical finding to report compared to potential renal impairment indicated by an elevated BUN level.
A male hospital employee is pushed out of the way by a female employee because of an oncoming gurney. The pushed employee becomes very angry and swings at the female employee. Both employees are referred for counseling with the staff psychiatric nurse. Which factor in the pushed employee's history is most related to the reaction that occurred?
- A. Is worried about losing his job to a woman.
- B. Tortured animals as a child.
- C. Was physically abused by his mother.
- D. Hates to be touched by anyone.
Correct Answer: C
Rationale: The correct answer is 'C: Was physically abused by his mother.' The pushed employee's aggressive reaction can be attributed to his history of physical abuse. Research suggests that individuals who have experienced physical abuse may exhibit heightened aggressive responses due to trauma and learned behavior. Choices A, B, and D are incorrect: A is a stereotype-based assumption that does not have a direct correlation with the aggressive behavior observed; B, torturing animals, is concerning behavior but not directly linked to the aggressive response in this scenario; D, hating to be touched, is not the most relevant factor considering the situation described.
A female client is brought to the emergency department after police officers found her disoriented, disorganized, and confused. The nurse also determines that the client is homeless and slightly suspicious. This client's treatment plan should include what priority problem?
- A. Self-care deficit.
- B. Disturbed sensory perception.
- C. Ineffective community coping.
- D. Acute confusion.
Correct Answer: D
Rationale: The correct answer is 'D: Acute confusion.' In the given scenario, the client is disoriented, disorganized, and confused, indicating acute confusion. This is a priority issue to address for immediate safety and appropriate care. Option A, self-care deficit, is not the priority as the client's safety and mental status take precedence. Option B, disturbed sensory perception, does not align with the client's presentation of confusion. Option C, ineffective community coping, is not the immediate concern as the client's cognitive state needs urgent attention.
A female client reports feeling hopeless and is unable to stop crying. She explains that she is worried about losing her job. Since the client's husband recently lost his job, she feels her employment is essential to the family's survival. To evaluate the effectiveness of cognitive-behavioral techniques, which client outcomes should the nurse include in the plan of care?
- A. Relates insights into problematic relationships
- B. Demonstrates a healthy relationship with her husband
- C. Describes how the family can resolve problems
- D. Changes thought patterns related to problem-solving
Correct Answer: D
Rationale: The correct answer is D. Cognitive-behavioral therapy focuses on changing thought patterns by guiding the client to engage in problem-solving strategies to address the current situation. This approach helps individuals modify negative thinking patterns and develop more adaptive ways to cope with challenges. Choices A, B, and C are incorrect because while they may be important aspects to consider in therapy, the primary focus in cognitive-behavioral therapy is on identifying and changing negative thought patterns rather than exploring relationships or family problem-solving skills.
After receiving treatment for anorexia, a student asks the school nurse for permission to work in the school cafeteria as part of the school's work-study program. What action should the nurse take?
- A. Recommend assignment to the receptionist's office.
- B. Suggest that the student work in the athletic department.
- C. Refer the student to a psychiatrist for further discussion.
- D. Determine the parents' opinion of the work assignment.
Correct Answer: A
Rationale: Clients with anorexia are often fixated on food and exercise, which can exacerbate their condition. By recommending assignment to the receptionist's office, the nurse provides an environment that minimizes exposure to food-related triggers. Working in the cafeteria may intensify the student's preoccupation with food, making it an unsuitable choice. Referring the student to a psychiatrist without exploring less triggering work options first may not be necessary. Determining the parents' opinion is important, but in this context, the focus should be on selecting a work environment that supports the student's recovery.