Nokea
What information is most helpful for the nurse to obtain next?
- A. The mother's expectations of an infant's behavior
- B. If the mother plans to finish high school
- C. The kinds of toys the mother has for the baby
- D. None of the above
Correct Answer: A
Rationale: Understanding the mother's expectations helps identify misconceptions contributing to the concern.
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Which behavior best indicates that an adolescent is at increased risk for suicide?
- A. Disobeying family rules
- B. Arguing with siblings
- C. Letting his grade average drop from a 92 to 88
- D. Becoming depressed over a recent breakup with a girlfriend
Correct Answer: D
Rationale: Depression following a breakup is a significant risk factor for suicide.
Of the following suggestions, which one would best prevent nursing personnel from becoming injured when providing the adolescent with care?
- A. Apply soft wrist restraints before ambulating the client.
- B. Ask a parent to care for the client.
- C. Explain steps involved in care before touching the client.
- D. Medicate the client immediately before ambulation.
Correct Answer: C
Rationale: Explaining steps reduces fear and potential for aggressive reactions.
Which of the following behaviors exhibited by the child demonstrates the most severe reaction to prolonged hospitalization?
- A. Clinging to the parents
- B. Shaking the crib frantically
- C. Thrashing about
- D. Ignoring the parents
Correct Answer: D
Rationale: Ignoring parents indicates severe emotional withdrawal, a significant concern.
What advice is most appropriate to give the parents at this time?
- A. Tell the parents to disregard their son's behavior; it is normal grieving.
- B. Advise the parents to tell their son to snap out of it; his life is not over.
- C. Suggest transferring their son to another school.
- D. Advise the parents to ask their son about having thoughts of suicide.
Correct Answer: D
Rationale: Directly addressing suicidal thoughts is critical for safety.
When the nurse documents this incident, which wording is most appropriate?
- A. Became angry for no reason and an assault occurred.
- B. Hit caregiver unexpectedly even though not provoked.
- C. Struck nursing assistant when being helped from bed.
- D. Attacked nursing assistant without prior warning.
Correct Answer: C
Rationale: Objective language like 'struck' accurately describes the incident without bias.