A client admitted to the psychiatric unit diagnosed with major depression wants to sleep during the day, refuses to take a bath, and refuses to eat. Which nursing intervention should the nurse implement first?
Assess the client's ability to communicate with the other staff members.
Arrange a meeting with the family to discuss the client's situation.
Administer the client's antidepressant medication as prescribed.
Establish a structured routine for the client to follow.
The Correct Answer is D
Choice A reason: Assessing communication ability is important but secondary to establishing a structured routine to address the client's immediate needs.
Choice B reason: Arranging a meeting with the family can provide support but is not the first priority in managing the client's depressive symptoms.
Choice C reason: Administering antidepressant medication is essential but must be part of an overall structured plan.
Choice D reason: Establishing a structured routine helps provide stability, encourages participation in daily activities, and addresses the client's refusal to eat and bathe.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Mononucleosis typically presents with fever, sore throat, and lymphadenopathy but does not commonly cause a rash on the hands and feet.
Choice B reason: Herpes simplex virus usually causes painful vesicular lesions rather than a diffuse rash on the hands and feet.
Choice C reason: Syphilis can present with a fever, sore throat, and a characteristic rash on the hands, palms, and soles of the feet, particularly in the secondary stage of the infection.
Choice D reason: Toxic shock syndrome is associated with high fever, rash, and shock, but the rash is not typically confined to the hands and feet.
Correct Answer is C,B,D,A
Explanation
The correct order is:
- Note date and time of the behavior.
- Discuss the issue privately with the UAP.
- Plan for scheduled break times.
- Evaluate the UAP for signs of improvement.
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