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 ["D","F","G"]
Explanation
Based on the provided information, the following components should be included in the treatment regimen for this client:
- Oral anti-diabetic:
While oral medications are common in managing type 2 diabetes, the current information does not suggest immediate initiation of pharmacotherapy based solely on the random blood sugar result without further evaluation.
- Weight-reduction treatment: With a BMI of 28, the client is considered overweight. Weight reduction is an important aspect of managing diabetes and improving overall health. The treatment regimen should include strategies to promote weight loss, such as dietary modifications and increased physical activity.
- Exercise planning: Regular exercise is beneficial for managing diabetes and promoting overall health. The treatment regimen should include an exercise plan tailored to the client's abilities and preferences. This may involve aerobic exercises, strength training, and flexibility exercises.
- Nutrition education: Nutrition plays a crucial role in diabetes management. The client should receive education on healthy eating habits, portion control, carbohydrate counting, and the importance of a balanced diet. The treatment regimen should include ongoing nutrition education and support.
The following options should not be included in the treatment regimen for this client:
- Short-acting insulin: Based on the information provided, there is no indication for the immediate use of short-acting insulin in this client.
- Long-acting insulin: Similar to short-acting insulin, there is no indication for the immediate use of long-acting insulin in this client.
- Extra carbohydrates: Extra carbohydrates may not be necessary for this client unless prescribed by a healthcare professional to manage hypoglycemia or specific dietary needs.
Correct Answer is B
Explanation
Bathing a bedfast client with the bed in a high position poses a potential risk to the client's safety. Lowering the bed to a safe height is important to prevent falls and injuries during the bathing procedure. The PN should promptly intervene and instruct the UAP to lower the bed to an appropriate level before continuing with the bathing process.
A. While remaining in the room to supervise the UAP is important, it should be done after ensuring the client's safety by lowering the bed. If the bed is not lowered, the risk of injury remains, and the PN should take immediate action to address the safety concern.
C. Determining if the UAP would like assistance is a valid consideration, but it should be secondary to addressing the safety issue of the bed height. Once the bed is lowered, the PN can assess if additional assistance is required and provide support accordingly.
D. Assuming care of the client immediately may be necessary if the client is in immediate danger or experiencing an urgent medical situation. However, in this case, the primary concern is addressing the safety issue related to the bed height, and the PN can address this by instructing the UAP to lower the bed.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.
