A client with the diagnosis of schizophrenia sitting all alone and talking quietly. Which action should the PN take?
Ask the client if he is currently hearing voices.
Have the unlicensed assistive personnel (UAP) escort the client down to his room.
Record the event but do not disturb the client.
Administer an as-needed (PRN) dose of haloperidol.
The Correct Answer is A
The appropriate action for the practical nurse (PN) in this situation would be to ask the client if he is currently hearing voices. This step is important to assess the client's current state and gather information about his experiences. By directly asking the client about hearing voices, the PN can gain insight into the client's symptoms and determine if there is a need for further intervention or support.
B. Having the unlicensed assistive personnel (UAP) escort the client to his room may not be necessary at this point, as the client may simply be engaging in self-talk or may prefer some time alone. However, if the client's behavior becomes disruptive, agitated, or poses a safety risk, involving the UAP or taking other appropriate measures may be warranted.
C. Recording the event is important for documentation purposes, but it should not be the only action taken. It is crucial to actively assess the client's well-being and address any potential concerns or needs.
D. Administering an as-needed (PRN) dose of haloperidol without further assessment or consulting the healthcare provider would be inappropriate. Medication decisions should be based on a comprehensive evaluation of the client's symptoms and the healthcare provider's recommendations.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","E"]
Explanation
Correct:
B- Making these changes will also help me avoid other chronic health conditions. This statement indicates an understanding because the client recognizes that the lifestyle changes discussed will not only help prevent or manage diabetes but also have a positive impact on other chronic health conditions such as cardiovascular disease and obesity.
E- If I have symptoms like increased thirst and urination, I should come in and get my blood sugar checked. This statement indicates an understanding because the client acknowledges the importance of monitoring their blood sugar levels if they experience symptoms commonly associated with diabetes, such as increased thirst and urination.
Incorrect choices:
A- If my fasting blood sugar is less than 100 next time, I can go back to my usual eating habits. This statement indicates a misunderstanding. It suggests that as long as the client's fasting blood sugar is below 100, they can resume their previous eating habits, which is not accurate. It's important to emphasize that long-term lifestyle changes are necessary, regardless of individual blood sugar readings.
C- I can never eat sugar again. This statement indicates a misunderstanding. While it's important to minimize the consumption of sugary foods and beverages, it's not necessary to completely eliminate all sugar from the diet. Moderation and mindful consumption are key.
D- If I make the changes we talked about, I will not get type 2 diabetes. This statement indicates a misunderstanding. While making positive lifestyle changes can significantly reduce the risk of developing type 2 diabetes, it does not guarantee complete prevention. Genetic and other factors can still influence an individual's susceptibility to the condition.
Correct Answer is B
Explanation
Hypoglycemia occurs when blood glucose levels drop below normal levels. It is commonly associated with diabetes mellitus and can result from various factors such as excessive insulin or oral hypoglycemic medication, delayed or missed meals, increased physical activity, or alcohol consumption.
Tremors, or shaking hands, are one of the early signs of hypoglycemia. They can occur due to the brain's response to low blood glucose levels. Other early signs of hypoglycemia may include sweating, palpitations, anxiety, hunger, and weakness.
A. Polyuria, or excessive urination, is not typically associated with hypoglycemia. It is more commonly seen in conditions such as hyperglycemia or diabetes insipidus.
C. Bradycardia, or a slow heart rate, is not a characteristic sign of hypoglycemia. It can occur in some cases of severe hypoglycemia, but it is not an early sign.
D. Difficulty swallowing is not directly related to hypoglycemia. It may be caused by other factors such as neurological or muscular conditions, esophageal disorders, or structural abnormalities in the throat or esophagus.
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