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A nurse is caring for a client who has a history of opioid use disorder. Which medication should the nurse anticipate administering to prevent withdrawal symptoms?
- A. Methadone
- B. Disulfiram
- C. Naloxone
- D. Bupropion
Correct Answer: A
Rationale: The correct answer is A: Methadone. Methadone is a long-acting opioid agonist that helps manage withdrawal symptoms in clients with opioid use disorder. It reduces cravings and prevents withdrawal without causing euphoria. Disulfiram (B) is for alcohol use disorder, Naloxone (C) is an opioid antagonist used for opioid overdose reversal, and Bupropion (D) is an antidepressant and smoking cessation aid.
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A nurse is assessing a client who has histrionic personality disorder. Which of the following manifestations should the nurse expect?
- A. Suspicious of others
- B. Callousness
- C. Self-centered behavior
- D. Violates others' rights
Correct Answer: C
Rationale: The correct answer is C: Self-centered behavior. Histrionic personality disorder is characterized by attention-seeking behavior, excessive emotions, and a need for approval. Individuals with this disorder often exhibit self-centered behavior to gain attention and validation from others. Choice A is incorrect as suspicion of others is more indicative of paranoid personality disorder. Choice B, callousness, is not a typical feature of histrionic personality disorder, but rather more aligned with antisocial personality disorder. Choice D, violating others' rights, is more characteristic of individuals with antisocial personality disorder as well.
A nurse is working with a client who has an anxiety disorder and is in the orientation phase of the therapeutic relationship. Which of the following statements should the nurse make during this phase?
- A. We should discuss resources to implement in your daily life.
- B. Let me show you simple relaxation exercises to manage stress.
- C. We should establish our roles in the initial session.
- D. Let's talk about how you can change your response to stress.
Correct Answer: C
Rationale: Correct Answer: C
Rationale: During the orientation phase of the therapeutic relationship, establishing roles is crucial for setting boundaries and clarifying expectations. This helps build trust and create a safe environment for the client to open up. Discussing resources (A) and relaxation exercises (B) would be more appropriate in later phases once the therapeutic relationship is established. Talking about changing responses to stress (D) may be premature at this stage.
A nurse is admitting a client who has schizophrenia. The client states, "I'm hearing voices." Which of the following responses is the priority for the nurse to state?
- A. "What are the voices telling you?"
- B. "I realize the voices are real to you, but I don't hear anything."
- C. "Have you taken your medication today?"
- D. "How long have you been hearing the voices?"
Correct Answer: A
Rationale: The correct answer is A: "What are the voices telling you?" This response demonstrates active listening, assesses the content of the hallucinations, and helps the nurse understand the client's experience. It allows for further assessment and intervention planning. Choice B dismisses the client's experience, choice C focuses on medication compliance rather than addressing the immediate concern, and choice D addresses the duration of the hallucinations but doesn't address the current situation.
A nurse in a mental health clinic receives a request from a client who is undergoing psychotherapy to obtain a copy of the therapist's notes. Which of the following responses should the nurse make?
- A. "Are you not happy with your treatment?"
- B. "Why are you interested in seeing your therapist's notes?"
- C. "We can provide a copy of your records, but the therapist's notes are not included."
- D. "I don't think you will benefit from reviewing your therapist's notes right now."
Correct Answer: C
Rationale: The correct response is C: "We can provide a copy of your records, but the therapist's notes are not included." This response aligns with ethical guidelines and laws that protect the confidentiality of therapist-client communication. Providing therapist's notes without proper authorization may breach confidentiality and harm the therapeutic relationship. Other choices lack professionalism and may undermine the client's trust. Option A implies judgment and defensiveness. Option B can be seen as intrusive and may put the client on the defensive. Option D dismisses the client's request and may discourage open communication. Overall, option C respects confidentiality, maintains boundaries, and upholds the client's right to privacy.
A nurse is planning care for a client who has borderline personality disorder and engages in self-mutilation. Which intervention should the nurse include?
- A. Restrict the client's access to personal belongings.
- B. Encourage the client to express feelings of anger.
- C. Place the client in seclusion when self-injurious behavior occurs.
- D. Tell the client to stop the self-mutilation behavior.
Correct Answer: B
Rationale: The correct answer is B: Encourage the client to express feelings of anger. For a client with borderline personality disorder and self-mutilation behavior, it is essential to address underlying emotions. Encouraging the client to express feelings of anger can help them identify and process their emotions, reducing the likelihood of resorting to self-injury. Restricting access to personal belongings (A) may lead to feelings of frustration and exacerbate the behavior. Placing the client in seclusion (C) may cause feelings of abandonment and increase distress. Simply telling the client to stop self-mutilation (D) overlooks the complex emotional reasons behind the behavior.