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A client with generalized anxiety disorder (GAD) is prescribed buspirone (BuSpar). Which information regarding side effects should be given to the client?
- A. The medication may cause cardiac arrest.
- B. Drink adequate amounts of fluid to prevent constipation
- C. The medication will not affect your vision.
- D. The risk of sedation is increased with this medication.
Correct Answer: B
Rationale: Cardiac arrest is not a common side effect of buspirone; it’s a rare and extreme outcome not typically associated with this medication. Buspirone can cause gastrointestinal side effects like constipation, so advising the client to drink adequate fluids helps mitigate this risk and supports overall health. There is no evidence that buspirone significantly affects vision as a common side effect, but this isn’t the most critical information to share. Buspirone is less sedating compared to other anxiolytics like benzodiazepines, so warning about increased sedation would be inaccurate.
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A nurse is caring for a client who was admitted with delirium five days ago. The client seeks permission from the nurse before performing ADLs. Which of the following actions should the nurse take?
- A. Quiz the client with orientation questions.
- B. Allow the client to function independently.
- C. Prepare the client for discharge.
- D. Determine the client's level of awareness.
Correct Answer: D
Rationale: Quizzing assesses but isn’t first. Independence is good but needs assessment first. Discharge is premature without evaluation. Determining awareness guides support, fitting delirium’s fluctuating nature.
A client describes flashbacks of a terrifying car crash in which he saw his best friend die. Which disorder should the nurse suspect in this situation?
- A. Panic disorder
- B. Obsessive-compulsive disorder
- C. Posttraumatic stress disorder
- D. Agoraphobia
Correct Answer: C
Rationale: Panic disorder involves unexpected and repeated episodes of intense fear, often without a specific trigger, and isn’t typically linked to flashbacks. Obsessive-compulsive disorder is characterized by unwanted repeated thoughts (obsessions) and actions (compulsions), not trauma-related flashbacks. PTSD involves re-experiencing a traumatic event through flashbacks and nightmares, directly matching the client’s symptoms of reliving the car crash. Agoraphobia is an anxiety disorder involving fear of places or situations that might cause panic, not tied to specific traumatic memories.
A nurse is conducting a home health visit for an older adult client who lives with family members. The nurse notices that the client has multiple unusual bruises, and, based on several other factors, the nurse suspects that the client has been physically abused. Which of the following actions should the nurse take first?
- A. Check the bruises at the next visit to the client's home.
- B. Institute more frequent visits to the client's home.
- C. Follow the agency's guidelines for reporting suspected abuse.
- D. Arrange referral for family therapy to deal with home stressors.
Correct Answer: C
Rationale: Delaying action by checking bruises later doesn’t address immediate safety. More frequent visits monitor but don’t act on the suspicion promptly. Following agency guidelines for reporting suspected abuse ensures the client’s safety first, as it’s the nurse’s legal and ethical duty. Therapy may help later but isn’t the first step without ensuring safety.
A nurse in an assisted-living facility is caring for a client who is in early stages of dementia. The client has been oriented to name and place and is usually cooperative. Which of the following nursing actions is appropriate if the client refuses to take morning medications?
- A. Notify the charge nurse of the need for evaluation of the client's level of competence.
- B. Ask the client to express her reasons for refusing the morning medications and document the event.
- C. Crush the pills, if not contraindicated, and hide them in the client's applesauce.
- D. Try to talk the client into adherence by telling her the possible implications of missing a dose.
Correct Answer: B
Rationale: Competence evaluation follows understanding refusal. Asking reasons respects autonomy and informs care. Crushing pills without consent is unethical and risky. Coercion dismisses client rights; understanding is better.
A nurse is caring for a client who has an anxiety disorder. Which of the following findings should the nurse recognize as a manifestation of mild anxiety?
- A. Incoherent speech
- B. Irritability
- C. Insomnia
- D. Chest pain
Correct Answer: B
Rationale: Incoherent speech indicates severe anxiety. Irritability is a mild anxiety sign, with maintained function. Insomnia suggests chronic anxiety. Chest pain aligns with severe anxiety or panic.