A nurse in a psychiatric unit is admitting a client who attacked a neighbor. The nurse should know that the client can be kept in the hospital after the 72-hr hold is ever for which of the following conditions?

The client is unwilling to accept that treatment is needed

The client states that she does not like the neighbor

The client is a danger to herself or others

The client states that she plans to move out of the state immediately

Answer and Explanation

The Correct Answer is C

A. The client is unwilling to accept that treatment is needed.

This alone may not be sufficient to keep the client under a 72-hour hold. While a person's refusal to accept treatment may indicate a need for care, it might not meet the criteria for involuntary commitment unless there is an immediate danger to the individual or others.

B. The client states that she does not like the neighbor.

Disliking a neighbor is not typically a sufficient reason to place someone under a 72-hour psychiatric hold. The criteria for involuntary commitment usually revolve around a person's potential to harm themselves or others due to their mental state.

C. The client is a danger to herself or others.

Explanation:

In many jurisdictions, a 72-hour psychiatric hold, also known as an involuntary psychiatric hold or emergency detention, allows mental health professionals to detain a person who is considered a danger to themselves or others due to their mental condition. This is done to ensure the safety of the individual and those around them. The hold provides a brief period during which a psychiatric assessment can be conducted to determine the appropriate course of action for the person's mental health treatment.

D. The client states that she plans to move out of the state immediately.

While this statement might raise concerns about the client's stability, it generally would not meet the criteria for a 72-hour hold unless there is clear evidence that the client's immediate move would pose a risk to their own safety or the safety of others. The hold is more focused on imminent danger rather than potential future actions.

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Correct Answer is A

Explanation

A. Schedule regular weigh-in times: Monitoring the client's weight on a regular schedule is important in managing anorexia nervosa. It helps track progress and any potential complications related to weight loss.

B. Allow the client to eat at any time: For individuals with anorexia nervosa, there is typically a structured meal plan that is carefully monitored by healthcare professionals. Allowing the client to eat at any time might disrupt the planned nutritional intake.

C. Provide privacy when friends visit: Privacy is important, but it should be balanced with ensuring the client's safety and adherence to the treatment plan. Visitors might need to be supervised to prevent any behaviors that could exacerbate the disorder.

D. Compliment the client for weight gain: While support and encouragement are important, complimenting a client for weight gain might inadvertently reinforce a focus on body image and reinforce disordered eating behavior. It's crucial to provide positive reinforcement for adherence to the treatment plan and progress in recovery, rather than emphasizing weight changes.

A. A client who takes gabapentin as part of treatment phenytoin for a seizure disorder. B. A client who has chronic alcohol use disorder. C. A client who takes heparin to prevent deep vein thrombosis. D. A client who has asthma.

Correct Answer is B

Explanation

Gabapentin and phenytoin are not directly associated with causing vitamin B deficiencies. However, certain antiseizure medications could potentially affect nutrient absorption over time.

B) A client who has chronic alcohol use disorder.

Explanation:

Chronic alcohol use disorder can lead to a deficiency in several B vitamins, particularly vitamin B1 (thiamine), vitamin B2 (riboflavin), vitamin B3 (niacin), vitamin B6 (pyridoxine), vitamin B9 (folate), and vitamin B12 (cobalamin). Alcohol interferes with the absorption and utilization of these vitamins in the body, and individuals with alcohol use disorder are often at risk for malnutrition and vitamin deficiencies.

C) A client who takes heparin to prevent deep vein thrombosis:

Heparin is an anticoagulant and does not directly impact the absorption or utilization of vitamin B.

D) A client who has asthma:

Asthma itself does not significantly increase the risk of vitamin B deficiencies. Vitamin B deficiencies are more commonly associated with factors like malnutrition, certain medical conditions, or medications that impact absorption, as seen in chronic alcohol use disorder.

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A nurse in a psychiatric unit is admitting a client who attacked a neighbor. The nurse should know that the client can be kept in the hospital after the 72-hr hold is ever for which of the following conditions?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing care for a client who has anorexia nervosa. Which of the following nursing interventions should the nurse take?

Correct Answer is A

Explanation

A nurse is caring for a group of clients. The nurse should recognize which of the following clients is at risk for a vitamin B, deficiency.

Correct Answer is B

Explanation

A nurse is making a home visit to a client who has Alzheimer's disease and the client's partner. Which of the following observations indicates to the nurse that the partner is experiencing caregiver role strain?

A nurse is caring for a hospitalized client who tells lies about other clients. The other clients on the unit frequently complain to the nursing staff about the client's disruptive behaviors. Which of the following initial actions should the nurse take?

A client who has major depressive disorder states to the nurse that he and his family would be better off if he were gone. Which of the following is the nurse's priority response?

A nurse is caring for a client who reports an upset stomach after taking chlorpromazine. Which of the following responses should the nurse make?

A nurse is providing discharge teaching for a client who has multiple medication prescriptions and must take the medications at specific intervals when at home. Which of the following instructions should the nurse include in the teaching?

A nurse is teaching a client who has a new prescription for chlorpromazine. Which of the following client statements indicates an understanding of the teaching?

A nurse is performing an admission assessment for a client who is receiving treatment following a situational crisis. Which of the following assessments by the nurse is the highest priority?

A nurse is providing discharge teaching to a client who has bipolar disorder and will be discharged with a prescription for lithium. The nurse could teach the client which of the following factors puts her at risk for lithium toxicity?