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Which nursing action is most appropriate at this time?
- A. Criticize the nature of the client's rude behavior.
- B. Support the emaciated client who was targeted by the remark.
- C. Invite others in the group to respond to the situation.
- D. Embarrass the bulimic client with a similar comment.
Correct Answer: B
Rationale: Supporting the targeted client validates their feelings and maintains a safe group environment, addressing the immediate emotional impact.
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Which question best assesses the client's long-term memory?
- A. What is your current age?
- B. What is today's date?
- C. What is your date of birth?
- D. What occurred last January?
Correct Answer: C
Rationale: Recalling date of birth tests long-term memory, as it requires retrieving well-established, distant personal information.
The client has developed paranoia as a result of regular methamphetamine use. The nurse uses cognitive reappraisal to confront the client’s persecutory thoughts. Which question should the nurse ask the client?
- A. “How can you look at this differently?”
- B. “Why would they want to cause you harm?”
- C. “What did you do that makes others not like you?”
- D. “How do you feel when others create problems for you?”
Correct Answer: A
Rationale: Reappraisal via alternative perspectives (A) aids restructuring. “Why” (B) or blame (C) reinforce distortion feelings (D) aren’t cognitive.
Which clients are most likely to be members of an obsessive-compulsive disorder (OCD) support group? Select all that apply.
- A. A 30-year-old who performs handwashing five times per hour
- B. A 35-year-old who wears gloves when touching a public faucet
- C. A 40-year-old who is sexually promiscuous
- D. A 45-year-old who drinks a fifth of whiskey daily
- E. A 50-year-old who cannot throw anything away
- F. A 60-year-old who repeatedly checks the locks on locked doors
Correct Answer: A,B,E,F
Rationale: Compulsive handwashing, glove-wearing, hoarding, and lock-checking are characteristic OCD behaviors involving repetitive actions to reduce anxiety.
The best rationale for having the client reflect on the statements is that during the middle years of life, adults tend to do what?
- A. Assess their accomplishments
- B. Set unreasonable goals
- C. Envy others' achievements
- D. Doubt their judgment
Correct Answer: A
Rationale: Middle adulthood involves evaluating life achievements, per Erikson's generativity vs. stagnation stage, often prompting reflection on regrets.
If a schizophrenic client says, 'Wing ding, the world is a ring,' which response by the nurse is most therapeutic?
- A. How clever. You've made up a poem.
- B. I don't understand what you mean.
- C. Let's talk about what's happening today.
- D. Tell me more about what you're thinking.
Correct Answer: B
Rationale: Acknowledging the nurse's lack of understanding gently prompts clarification, fostering communication without reinforcing delusional content.