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 D

Explanation

Choice A reason: The apical heart rate is important for other assessments but does not directly assess for orthostatic hypotension.

Choice B reason: Pulse pressure is not specifically related to orthostatic hypotension assessment.

Choice C reason: Level of consciousness can be affected by orthostatic hypotension but is not the primary assessment.

Choice D reason: Blood pressure should be measured in both lying and standing positions to assess for orthostatic hypotension.

A. Print electronic medical record (EMR) from backup server. B. Wait for notification that the system has been rebooted. C. Identify information as late entry in the record. D. Notify information services department of the situation.

Correct Answer is D

Explanation

Choice A reason: Printing the EMR from the backup server may not be feasible without first addressing the system failure.

Choice B reason: Waiting for notification without taking action can delay patient care documentation.

Choice C reason: Identifying information as late entry is important but secondary to notifying the appropriate department to address the system issue.

Choice D reason: Notifying the information services department ensures that the issue is addressed promptly and appropriately.

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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 knows that a medication has the side effect of orthostatic hypotension. Which assessment should the nurse make before administering the medication?

Correct Answer is D

Explanation

After a scheduled downtime, the computer documentation system fails to restart. Which action should the nurse take first?

Correct Answer is D

Explanation

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