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A nurse is assisting a client who has schizophrenia prepare a relapse plan. Which of the following statements should the nurse make?
- A. "You should be aware that excessive sleeping is an early sign of relapse."
- B. "Relapse is an indication that you are not taking your medications properly."
- C. "You should keep your provider's and therapist's number with you."
- D. "Taking an additional dose of medication is appropriate as soon as signs of relapse appear."
Correct Answer: C
Rationale: The correct answer is C because keeping the provider's and therapist's number with the client is crucial for quick access to support during a potential relapse. This step promotes timely intervention and communication with the healthcare team, which can help prevent escalation of symptoms. Option A is incorrect because excessive sleeping may not be a universal early sign of relapse for all individuals with schizophrenia. Option B is incorrect because relapse can occur despite proper medication adherence. Option D is incorrect because self-medicating without healthcare provider guidance can be dangerous and may worsen symptoms.
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A nurse is caring for an older adult client who had a cerebrovascular accident and has right-sided paralysis and aphasia. The client's son tells the nurse it is his fault because he did not insist that his mother live with him. Which of the following responses should the nurse make?
- A. "So, it seems that you feel responsible for what happened to your mother."
- B. "Your mother will be fine. You shouldn't worry so much."
- C. "Why do you blame yourself? You could not have prevented the stroke."
- D. "You are not responsible for your mother's stroke, but many people in your situation feel this way."
Correct Answer: A
Rationale: Correct Answer: A
Rationale:
A is the correct response because it acknowledges the son's feelings without dismissing or invalidating them. It shows empathy and understanding towards his guilt, opening up a conversation for further exploration of his emotions. It reflects active listening and validates his concerns.
Summary of Incorrect Choices:
B: This response minimizes the son's feelings and does not address his sense of guilt, which can further exacerbate his emotional distress.
C: While this response provides reassurance, it does not address the son's feelings of guilt and may come off as dismissive.
D: This response acknowledges the son's feelings but does not directly validate his sense of responsibility, missing an opportunity for therapeutic communication.
A charge nurse is preparing an educational session about addictive disorders for nursing staff. Which of the following should the nurse include as an etiological factor of addictive disorders? (Select all that apply.)
- A. Low self-esteem
- B. Family history of addiction
- C. Personality disorders
- D. Asian ethnicity
Correct Answer: A, B, C
Rationale: Low self-esteem, family history, and personality disorders are risk factors for addiction. Ethnicity is not a primary factor.
A nurse is caring for a client who is dying. The client says, "My mother died in the hospital, but I did not get there before she died." Which of the following statements should the nurse make?
- A. "We will call your family in time for them to get here."
- B. "I wonder if you are fearful of dying alone."
- C. "I will make sure a staff member is in your room at all times."
- D. "I will tell your family of your concern so that they can be here."
Correct Answer: B
Rationale: The correct answer is B: "I wonder if you are fearful of dying alone." This response shows empathy and addresses the client's emotional needs. It acknowledges the client's fear and opens up a conversation about their concerns. It allows the client to express their feelings and provides an opportunity for therapeutic communication.
Choice A is incorrect because it only focuses on calling the family and does not address the client's emotional state. Choice C is incorrect as it only ensures physical presence but does not address the client's emotional needs. Choice D is incorrect as it shifts the responsibility to the family without acknowledging the client's feelings.
A nurse is assessing a client who has a history of alcohol use disorder. Which of the following questions should the nurse include to determine how alcohol use affects the client's psychosocial behaviors?
- A. "Has alcohol use affected your performance at work?"
- B. "Have you received prior treatment for substance use disorder?"
- C. "Do you receive treatment for any mental health disorders?"
- D. "At what age did you begin drinking alcohol?"
Correct Answer: A
Rationale: The correct answer is A. By asking if alcohol use has affected the client's performance at work, the nurse can assess the impact of alcohol on the client's psychosocial behaviors, such as work productivity and relationships with colleagues. This question directly addresses the behavioral consequences of alcohol use.
Explanation for incorrect choices:
B: Asking about prior treatment for substance use disorder focuses on the past rather than the current impact on psychosocial behaviors.
C: Inquiring about treatment for mental health disorders is relevant but does not specifically address the psychosocial effects of alcohol use.
D: Asking at what age the client began drinking alcohol provides historical information but does not assess current psychosocial behaviors.
A nurse is assessing a client who has a diagnosis of conversion disorder. Which of the following is an expected finding?
- A. Frequent manic episodes.
- B. Refusal of medication due to paranoia.
- C. Preoccupation with manifestations of various illnesses.
- D. Involuntary loss of a sensory function.
Correct Answer: D
Rationale: The correct answer is D: Involuntary loss of a sensory function. In conversion disorder, physical symptoms are present without a known medical cause. This can manifest as sensory deficits such as blindness or paralysis. This finding is expected as it is a hallmark of conversion disorder. Manic episodes (A) are more indicative of bipolar disorder, medication refusal due to paranoia (B) may be seen in conditions like schizophrenia, and preoccupation with various illnesses (C) is characteristic of somatic symptom disorder. Therefore, the correct choice is D as it aligns with the presentation of conversion disorder.