Nokea
Which statement regarding hospital admittance is most accurate?
- A. The client cannot be committed involuntarily unless the client is uncooperative at this time.
- B. The client cannot be committed involuntarily unless the client poses harm to self or others.
- C. The client cannot be committed involuntarily unless the client cancels office appointments.
- D. The client cannot be committed involuntarily unless the client refuses to take medications.
Correct Answer: B
Rationale: Involuntary commitment requires evidence of harm to self or others.
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Of the following community resources, which referral is the nurse most likely to suggest for this client?
- A. Alcoholics Anonymous
- B. Al-Anon
- C. Alateen
- D. The Substance Abuse Council
Correct Answer: C
Rationale: Alateen supports teens affected by a family member's alcoholism.
Which of the following is the best indication that haloperidol (Haldol) is achieving a therapeutic effect?
- A. The client no longer hears voices.
- B. The client sleeps more than before.
- C. The client thinks of himself or herself as a good person.
- D. The client feels more energetic and rested.
Correct Answer: A
Rationale: Reduction in hallucinations indicates therapeutic efficacy.
Which test should the nurse use to more objectively assess the toddler's overall development?
- A. Denver II Developmental Screening Test
- B. Scholastic Aptitude Test (SAT)
- C. Stanford-Binet test
- D. Weber's test
Correct Answer: A
Rationale: The Denver II is designed to screen developmental milestones in young children.
Which assessment finding best indicates that a child taking methylphenidate hydrochloride (Ritalin) is experiencing undesirable side effects?
- A. The child has altered elimination patterns.
- B. The child develops intolerance to certain foods.
- C. The child has an elevated blood pressure.
- D. The child has evidence of skin breakdown.
Correct Answer: C
Rationale: Elevated blood pressure is a concerning side effect of Ritalin.
Which assessment findings are most characteristic of a 10-month-old infant with the diagnosis of failure to thrive?
- A. The infant cries vigorously when handled.
- B. The infant has a delay in developmental milestones.
- C. The infant appears pale and lethargic.
- D. The infant's sucking and grasp reflexes
- E. The infant has delayed understanding of speech.
Correct Answer: B,C,E
Rationale: Delayed milestones, pallor, lethargy, and speech delays are hallmark signs of failure to thrive.