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.

Answer and Explanation

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.

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Correct Answer is C

Explanation

Choice A reason: Listing the procedural steps is helpful but does not demonstrate practical competence.

Choice B reason: Reviewing glycosylated hemoglobin levels provides information about long-term glucose control but does not directly assess the technique.

Choice C reason: Observing the adolescent as he demonstrates the self-injection technique ensures that he has understood and can correctly perform the procedure, providing the best evaluation of teaching effectiveness.

Choice D reason: Describing the level of comfort provides insight into his confidence but not necessarily his technical competence.

A. Call for an assistant. B. Close the room door. C. Finish the procedure. D. Respond to the code.

Correct Answer is A

Explanation

Choice A reason: Calling for an assistant allows the nurse to ensure the client receiving tracheostomy care is safe and monitored while responding to the code blue, which is a priority emergency situation.

Choice B reason: Closing the room door does not address the need for assistance with the ongoing procedure and the emergency.

Choice C reason: Finishing the procedure may delay the nurse's response to the code blue, which requires immediate attention.

Choice D reason: Responding to the code without ensuring the current client is safe can lead to potential complications during tracheostomy care.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is teaching a male adolescent recently diagnosed with type 1 diabetes mellitus (DM) about self-injecting insulin. Which approach is best for the nurse to use to evaluate the effectiveness of the teaching?

Correct Answer is C

Explanation

The nurse is performing tracheostomy care for a client when a code blue is called for another client on the unit who experiences a cardiopulmonary arrest. Which action should the nurse take?

Correct Answer is A

Explanation

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An unlicensed assistive personnel (UAP) leaves the unit without notifying the staff. In which order should the unit manager implement these interventions to address the UAP's behavior? (Place the actions in order from first on top to last on bottom.)

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A client newly diagnosed with diabetes mellitus suddenly becomes confused and weak. Which intervention(s) should the nurse implement? Select all that apply.

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