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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.
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A healthcare professional is assessing a client diagnosed with anorexia nervosa. Which of the following findings shouldn't the professional expect?
- A. Amenorrhea
- B. Lanugo
- C. Hypotension
- D. Hyperkalemia
Correct Answer: D
Rationale: When assessing a client diagnosed with anorexia nervosa, healthcare professionals should expect findings such as amenorrhea, lanugo, hypotension, and bradycardia. Hyperkalemia is not typically associated with anorexia nervosa; instead, hypokalemia, which is low potassium levels, is more commonly seen in these individuals due to malnutrition and other factors.
Which of the following characteristics is not a feature of borderline personality disorder?
- A. Intense fear of abandonment
- B. Unstable relationships
- C. Impulsivity
- D. Grandiosity
Correct Answer: D
Rationale: Borderline personality disorder is characterized by an intense fear of abandonment, unstable relationships, impulsivity, and chronic feelings of emptiness. Grandiosity, which involves an inflated sense of self-importance, is typically associated with narcissistic personality disorder rather than borderline personality disorder.
A client with major depressive disorder is prescribed an antidepressant. Which of the following instructions should the nurse exclude from the teaching?
- A. It may take several weeks for the medication to take effect
- B. Avoid alcohol while taking this medication
- C. Discourage the client from washing her hands
- D. You may experience an increase in energy before your mood improves
Correct Answer: C
Rationale: The nurse should not include the instruction to discourage the client from washing her hands in the teaching for a client prescribed an antidepressant. This instruction is not relevant to the medication regimen. Instead, the nurse should educate the client that it may take several weeks for the medication to take effect, to avoid alcohol, not to discontinue the medication abruptly, and that there may be an increase in energy before mood improves. Regular blood tests are not typically required for most antidepressants.
A nurse is providing education to a client who has been prescribed lithium for bipolar disorder. Which statement by the client indicates an accurate understanding of the medication?
- A. I should avoid eating aged cheeses and processed meats.
- B. I need to maintain a consistent sodium intake.
- C. I should drink plenty of fluids to stay hydrated.
- D. I can take over-the-counter medications without consulting my doctor.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A client with a history of alcohol use disorder is admitted to the hospital for detoxification. Which of the following symptoms shouldn't the nurse expect to observe during withdrawal?
- A. Tremors
- B. Hallucinations
- C. Diaphoresis
- D. Bradycardia
Correct Answer: D
Rationale: During alcohol withdrawal, the nurse should expect to observe symptoms such as tremors, hallucinations, and diaphoresis. Seizures may also occur during severe withdrawal. Bradycardia is not typically associated with alcohol withdrawal; instead, tachycardia (an increased heart rate) is more commonly observed due to the stimulant effects of alcohol withdrawal on the sympathetic nervous system.