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When the counselor asks the members of the post-traumatic stress disorder (PTSD) support group to draw pictures of their traumatic experiences, the nurse understands that the primary purpose for drawing is to achieve what outcome?
- A. Deal consciously with painful memories
- B. Bond with other group members
- C. Receive approval from group members
- D. Justify participation in the group
Correct Answer: A
Rationale: Drawing traumatic experiences externalizes memories, helping clients confront and process painful events in a controlled, therapeutic way.
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The nurse assesses the client every 15 minutes. What objective evidence will the nurse detect that indicates that the restraints are too tight? Select all that apply.
- A. The client reports being unable to move the right hand.
- B. The client's fingers and toes are pale.
- C. The client reports having pain.
- D. Capillary refill is greater than 6 seconds.
- E. There is excoriation around the wrist.
- F. The client reports numbness and tingling.
Correct Answer: B,D,F
Rationale: Pallor, prolonged capillary refill, and numbness indicate impaired circulation, suggesting restraints are too tight and compromising blood flow.
The client experiencing severe withdrawal symptoms due to alcohol dependence is prescribed chlordiazepoxide 100 mg oral x 1 then 50 mg every 2 hours until symptoms are controlled. The medication is supplied in 50-mg tablets. The nurse administered the initial dose 2 hours ago and the client is still agitated and tremulous. How many tablets should the nurse prepare to administer at this time?_ tablet(s) (Record your answer as a whole number.)
Correct Answer: 1
Rationale: Proportion: 50 mg/1 tablet = 50 mg/X tablets; X = 1 tablet.
The client uses methamphetamine regularly. Which subjective quote documented by the nurse demonstrates the client using pathological projection as a coping mechanism?
- A. “I’m here to get help. Everything will be all right again if I can just stop using drugs.”
- B. “My dad and I don’t get along. He thinks that I’m a failure and can’t do anything right.”
- C. “I’m not giving up alcohol just the methamphetamine. I never had a problem with alcohol.”
- D. “I can’t go back to work. I’d be so embarrassed if anyone found out I’ve been in treatment.”
Correct Answer: B
Rationale: Blaming dad for failure (B) is projection. Simplifying issues (A) is ignoring dismissing alcohol (C) is denial embarrassment (D) is perfectionism.
Which technique is most therapeutic for helping clients with dementia remain oriented?
- A. Address all clients using their first name.
- B. Ask clients to identify their goals for the day.
- C. Assign clients to greet visitors each day.
- D. Post large calendars with the current date.
Correct Answer: D
Rationale: Large calendars provide a constant visual cue, aiding orientation to time in clients with dementia.
The client who sustained a brain injury from an MVA is now experiencing aggression impulsivity and poor judgment. In teaching the family which area of the brain illustrated should the nurse identify as being affected?
- A. Line A
- B. Line B
- C. Line C
- D. Line D
Correct Answer: B
Rationale: The prefrontal cortex (Line B) modulates judgment aggression and impulsivity. Cortex (A) controls motor functions hypothalamus (C) regulates temperature/fluids and cerebellum (D) manages balance. image4.png