Nokea
Which assessment finding by the nurse is most suggestive to the obese client is taking dextroamphetamine (Dexedrine) at this time?
- A. The client stares blankly into space.
- B. The client monopolizes the discussions.
- C. The client wears sunglasses indoors.
- D. The client slurs words when speaking.
Correct Answer: B
Rationale: Monopolizing discussions reflects the hyperactivity and talkativeness associated with stimulant use like dextroamphetamine.
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The nurse correctly informs the caller that most people have which physical signs after recent marijuana use? Select all that apply.
- A. Shivering
- B. Inflamed eyes
- C. Rapid pulse
- D. Restlessness
- E. Pinpoint pupils
- F. Increased sex drive
Correct Answer: B,C,D
Rationale: Recent marijuana use commonly causes inflamed (red) eyes due to vasodilation, rapid pulse from cardiovascular stimulation, and restlessness from its psychoactive effects.
What suggestion can the nurse make if the client complains of feeling dizzy when taking doxepin (Sinequan) at bedtime as prescribed?
- A. Place a cool compress on your forehead.
- B. Get up slowly from a seated position.
- C. Remain in bed with your feet elevated above your heart.
- D. Take some deep breaths before getting out of bed.
Correct Answer: B
Rationale: Rising slowly minimizes orthostatic hypotension, a common side effect of doxepin, reducing dizziness.
The client expresses ambivalence about quitting smoking and also the fear of “getting fat” and “looking like a cow.” The client wonders if that is worse than smoking. Which response by the nurse is most helpful?
- A. “We could set up a diet for you to start at the same time to prevent you from gaining any weight.”
- B. “Don’t you think it would be much better to breathe more easily even if you gain a little weight?”
- C. “You don’t want to quit smoking because you think you might gain weight. Do you see yourself as overweight?”
- D. “It sounds like you are afraid of weight gain. Tell me about the good and bad things that might happen if you give up smoking.”
Correct Answer: D
Rationale: Acknowledging weight gain fear and exploring pros/cons (D) aids decision-making. Dieting (A) risks relapse health focus (B) dismisses fear closed question (C) limits discussion.
If a client is typical of other victims who remain in abusive relationships, what is the client most likely to believe?
- A. The client is not in any serious danger.
- B. The client can turn to the family for protection.
- C. The client can prevent the battering behavior.
- D. The client is free to leave the home at any time.
Correct Answer: C
Rationale: Victims often believe they can control or prevent the abuse, reflecting denial or rationalization that keeps them in the abusive situation.
The nurse performs a physical assessment and collects the client's health history. Which assessment findings would the nurse expect to note as the client discusses the phobia related to flying? Select all that apply.
- A. Hypotension
- B. Tachycardia
- C. Tremors
- D. Shortness of breath
- E. Uncontrollable crying
- F. Facial tics
Correct Answer: B,C,D
Rationale: Discussing the phobia triggers anxiety, leading to tachycardia, tremors, and shortness of breath due to sympathetic activation.