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Which question during the client interview is likely to generate the most information?
- A. Tell me about your family.
- B. Are you currently married?
- C. Who is your nearest relative?
- D. Give me a list of your family members.
Correct Answer: A
Rationale: An open-ended question about family prompts detailed responses, providing comprehensive insight into social support and history.
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The client taking disulfiram has a throbbing headache diaphoresis and sudden vomiting. Which possible conclusions by the nurse should be explored first?
- A. The client may have developed influenza.
- B. The client may have recently consumed alcohol.
- C. The client may have recently taken a cough suppressant.
- D. The client may have eaten foods that interact with disulfiram.
Correct Answer: B
Rationale: Alcohol ingestion (B) causes disulfiram reaction (headache diaphoresis vomiting). Influenza (A) cough suppressants (C)
Which nursing action is especially important when administering medications to a depressed client?
- A. Encouraging the client to drink a full glass of water
- B. Checking that the client has swallowed all oral medications
- C. Giving the medications on an empty stomach before meals
- D. Having the client take each medication separately
Correct Answer: B
Rationale: Ensuring medications are swallowed prevents hoarding, a risk in depressed clients with suicidal ideation.
When the anxious client summons the nurse and reports feeling weak and dizzy, which nursing action is most appropriate at this time?
- A. Helping the client to relax
- B. Giving the client something to eat
- C. Administering oxygen by cannula
- D. Taking the client's vital signs
Correct Answer: D
Rationale: Taking vital signs assesses for physiological causes of weakness and dizziness, ensuring appropriate intervention for the anxious client.
The nurse explains to the client's family the alcoholic's recovery process. What is the first step in recovering from alcohol?
- A. Admitting an inability to control drinking
- B. Forming a close support network
- C. Relying on some form of religious belief
- D. Checking into an inpatient rehabilitation unit
Correct Answer: A
Rationale: Admitting powerlessness over alcohol is the foundational step in recovery models like Alcoholics Anonymous, as it acknowledges the problem and initiates the commitment to change.
If the client has been taking an antidepressant for several weeks, which outcome would be the most desired therapeutic effect?
- A. The client is feeling less depressed.
- B. The client is eating more nutritiously.
- C. The client is having fewer food binges.
- D. The client is feeling less suicidal.
Correct Answer: C
Rationale: Reducing binge episodes is the primary goal for bulimia treatment, as antidepressants target the compulsive behaviors associated with the disorder.