A charge nurse in a mental health facility is teaching a newly licensed nurse how to perform an Abnormal Involuntary Movement Scale (AIMS) assessment on a client. The charge nurse should identify that the AIMS assessment is used for which of the following conditions?
Alcohol withdrawal
Tardive dyskinesia
Lithium toxicity
Opiate withdrawal
The Correct Answer is B
A. Alcohol withdrawal is assessed using tools such as the Clinical Institute Withdrawal Assessment (CIWA), not the AIMS.
B. The Abnormal Involuntary Movement Scale (AIMS) is a standardized tool used to detect and monitor tardive dyskinesia, which is a late-onset movement disorder associated with long-term use of antipsychotic medications. It evaluates involuntary movements of the face, mouth, extremities, and trunk.
C. Lithium toxicity is monitored through serum lithium levels and clinical signs (e.g., tremors, confusion), not the AIMS.
D. Opiate withdrawal is assessed with specific withdrawal scales such as the Clinical Opiate Withdrawal Scale (COWS), not the AIMS.
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Related Questions
Correct Answer is D
Explanation
A. Interrupting the client disrupts the flow of communication and conveys disinterest; active listening requires allowing the client to express thoughts fully.
B. Showing excessive emotion may distract from the client’s disclosure or make the client feel guilty; active listening emphasizes empathy without projecting personal feelings.
C. Maintaining appropriate eye contact is important; minimizing eye contact can signal disinterest or avoidance.
D. Avoiding looking at other clients helps the nurse focus attention entirely on the client, demonstrating respect and engagement, which are key components of active listening.
Correct Answer is C
Explanation
A. This statement refers more to psychodynamic therapy, which explores how past experiences influence current behaviors and emotions.
B. The nature versus nurture concept is related to developmental psychology and personality formation, not the core principle of cognitive therapy.
C. Cognitive therapy focuses on the client’s current thoughts, beliefs, and perceptions, with the understanding that distorted thinking patterns contribute to emotional distress and maladaptive behaviors. Therapy aims to identify and modify these dysfunctional thought patterns to improve mood and behavior, emphasizing the present rather than past experiences.
D. This statement also aligns more closely with psychodynamic approaches, which explore childhood experiences to understand present reactions, rather than the present-focused approach of cognitive therapy.
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