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A healthcare professional is assessing a client with suspected substance use disorder. Which of the following findings should the healthcare professional not expect?
- A. Neglect of responsibilities
- B. Increased tolerance to the substance
- C. Withdrawal symptoms when not using the substance
- D. Unsuccessful attempts to cut down or control use
Correct Answer: B
Rationale: Findings in a client with substance use disorder typically include neglect of responsibilities, withdrawal symptoms when not using the substance, and unsuccessful attempts to cut down or control use. Increased tolerance to the substance is a common phenomenon in substance use disorder and is expected as the individual requires higher doses to achieve the same effect.
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A healthcare professional is assessing a client who is experiencing severe anxiety. Which of the following is an appropriate intervention?
- A. Encourage the client to talk about their feelings.
- B. Provide a quiet and calm environment.
- C. Encourage the client to exercise vigorously.
- D. Encourage the client to participate in group activities.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A client with schizophrenia is experiencing auditory hallucinations. Which intervention should the nurse implement to address this symptom?
- A. Encourage the client to discuss the voices.
- B. Tell the client that the voices are not real.
- C. Provide reality-based feedback to the client.
- D. Distract the client from the voices.
Correct Answer: C
Rationale: When a client with schizophrenia is experiencing auditory hallucinations, providing reality-based feedback is a therapeutic intervention. This helps the client differentiate between what is real and what is not, aiding in reducing the impact of hallucinations. Encouraging the client to discuss the voices may validate the hallucinations, telling the client that the voices are not real dismisses their experience, and distracting the client may not address the underlying issue of the hallucinations.
When caring for a client with major depressive disorder, what is the most appropriate short-term goal for the client?
- A. The client will report a decrease in depressive symptoms.
- B. The client will establish a sleep routine.
- C. The client will improve social interactions.
- D. The client will set realistic goals for the future.
Correct Answer: A
Rationale: The most appropriate short-term goal for a client with major depressive disorder is for them to report a decrease in depressive symptoms. This goal is specific, measurable, and achievable, focusing on the primary symptoms of the disorder. By monitoring and assessing the client's self-reported improvement in depressive symptoms, the healthcare team can track progress and adjust interventions accordingly.
During an assessment, a nurse observes a client showing signs of moderate anxiety. Which symptom is not typically associated with moderate anxiety?
- A. Fidgeting
- B. Laughing inappropriately
- C. Palpitations
- D. Nail biting
Correct Answer: C
Rationale: When assessing a client with moderate anxiety, the nurse should anticipate signs such as fidgeting, laughing inappropriately, and nail biting. These behaviors are common manifestations of increased stress levels. Palpitations, on the other hand, are more commonly associated with severe anxiety or panic attacks. Other symptoms of severe anxiety may include restlessness, difficulty concentrating, muscle tension, and sleep disturbances.
A client is diagnosed with obsessive-compulsive disorder (OCD), and a nurse is planning care. Which of the following interventions should the nurse exclude from the care plan?
- A. Allowing the client to perform rituals initially
- B. Discouraging the client from washing their hands
- C. Monitoring for suicidal ideation
- D. Providing a structured schedule of activities
Correct Answer: C
Rationale: The correct answer is monitoring for suicidal ideation. When caring for a client with OCD, interventions should include allowing the client to perform rituals initially, setting limits on the time allowed for rituals, encouraging the client to verbalize feelings, and providing a structured schedule of activities. Monitoring for suicidal ideation is crucial in assessing the client's safety and mental health status, but it is not a direct intervention specific to managing OCD symptoms.