A client who is experiencing paralysis of the left arm curses at the practical nurse (PN) and throws a hairbrush against the wall using the right arm. How should the PN respond?

Acknowledge the client's anger and offer to listen.

Play some soft music to help relax the client.

Initiate deep breathing exercises to soothe the client.

Offer to return later when the client is calmer.

Answer and Explanation

The Correct Answer is A

A. Acknowledging the client's anger and offering to listen validates their feelings and provides an opportunity for the client to express their emotions. This approach can help de-escalate the situation and address the underlying frustrations related to their condition.
B. Playing soft music might be soothing but does not directly address the client's expressed anger or the immediate situation. It is not as effective as acknowledging and listening to the client's concerns.
C. Initiating deep breathing exercises might be helpful but is less effective than directly acknowledging the client's anger and providing a space for them to talk about their feelings.
D. Offering to return later may avoid the immediate conflict but does not address the client’s current emotional state or provide support. It is better to engage with the client in the moment to manage their anger and offer support.

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Correct Answer is {"A":{"answers":"B"},"B":{"answers":"C"},"C":{"answers":"A"},"D":{"answers":"C"},"E":{"answers":"A"}}

Explanation

Coarse breath sounds are typically associated with respiratory distress, indicating fluid or secretions in the airways.

Irritability can be a sign of both cerebral edema and respiratory distress as it may stem from hypoxia or increased intracranial pressure.

Seizure activity is more specifically related to cerebral edema, which can increase intracranial pressure and provoke seizures.

Decreased level of consciousness can occur in both conditions: cerebral edema (due to increased intracranial pressure) and respiratory distress (due to hypoxia).

Bradycardia is more indicative of cerebral edema, especially when associated with increased intracranial pressure and resultant autonomic dysregulation.

A. Document suspected abuse using the physical findings as supporting evidence. B. Establish trust with the client to ensure basic needs and open communications are met. C. Medicate the client as prescribed to ensure adequate rest and interventional therapies. D. Contact social services to investigate the personnel at the skilled care facility.

Correct Answer is B

Explanation

A. While documentation is essential, establishing a trusting relationship with the client is a more immediate priority to address their basic needs and gather information.
B. Establishing trust with the client is crucial to ensure their basic needs are met and to create an environment where the client feels safe to communicate openly. This foundational step is necessary before other interventions can be effectively implemented.
C. Medicating the client as prescribed is important for their overall care but does not address the immediate need to build trust and assess their situation comprehensively.
D. Contacting social services is a necessary step if abuse is suspected, but it should follow the initial assessment and establishment of trust with the client to gather accurate information.

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A client who is experiencing paralysis of the left arm curses at the practical nurse (PN) and throws a hairbrush against the wall using the right arm. How should the PN respond?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Exhibits Click to mark whether the following are signs and symptoms of cerebral edema, respiratory distress, or both.

Correct Answer is {"A":{"answers":"B"},"B":{"answers":"C"},"C":{"answers":"A"},"D":{"answers":"C"},"E":{"answers":"A"}}

Explanation

Correct Answer is B

Explanation

A 3-year-old male is being discharged after surgical correction of cryptorchidism. Which postoperative instruction is most important for the practical nurse (PN) to re-emphasize to the parents about the child's activities at home?

Exhibits What factors are important in determining level of hypoxemia that the child may have experienced during the submersion? Select all that apply.

An unlicensed assistive personnel (UAP) is assisting with the care of a client with a peripherally inserted central venous catheter (PICC). Which guidance should the practical nurse (PN) provide to the UAP?

The practical nurse (PN) is assisting with the plan of care for a client who is receiving the nonsteroidal anti-inflammatory drug ketorolac for painful muscle spasms of the back. Which intervention should the PN include in the client's plan of care?

An older adult client is admitted to the psychiatric unit for assessment of a recent onset of dementia. The practical nurse (PN) notes that in the evening this client often becomes restless, confused, and agitated. Which intervention is most important for the PN to implement?