A nurse is caring for a 10-year old child with Intellectual Developmental Disorder who has an IQ of 45. Which child capability would the nurse expect to observe? The child:

cannot answer the nurse when spoken to.

may need complete supervision when performing hand hygiene.

is allowed to use safety scissors with adult guidance.

follows directions independently when given an assignment.

Answer and Explanation

The Correct Answer is B

B. Children with IDD often require additional support and supervision in performing daily tasks, including personal hygiene routines like handwashing. Depending on the specific needs and abilities of the child, they may require varying levels of assistance and supervision.
A. Communication abilities can vary widely among children with IDD, and many may be able to understand and respond to simple questions or instructions, albeit with some difficulty.
C. Safety scissors are specifically designed for children to use safely, with features such as blunt tips and plastic blades to minimize the risk of injury. Allowing a child with IDD to use safety scissors with adult guidance can promote independence while ensuring safety.
D. Children with IDD often face challenges in following directions and completing tasks independently, particularly those with lower IQ scores.

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Correct Answer is C

Explanation

C. Administering naloxone is often the priority action for a client exhibiting symptoms of opiate intoxication, especially if they are experiencing significant respiratory depression or unconsciousness. Naloxone is a medication used to rapidly reverse the effects of opioids, including respiratory depression and sedation.
A. Opening the crash cart is not the priority action for a client exhibiting symptoms of opiate intoxication unless the client's condition deteriorates rapidly, leading to a life-threatening emergency such as respiratory depression or cardiac arrest.
B. This intervention is important for clients experiencing respiratory depression, hypoxemia, or altered mental status due to opiate overdose. However, it may not be the highest priority action if the client's respiratory status is stable
D. Contacting the client's parents or guardians is important for obtaining medical history, consent for treatment (if applicable), and support. However, it may not be the highest priority action in the immediate management of opiate intoxication.

A. denial. B. separation-individuation. C. splitting. D. reaction formation.

Correct Answer is C

Explanation

C. Splitting is characterized by viewing people and situations in extremes, either all good or all bad, without recognizing the complexity that usually exists in most circumstances. This black-and-white thinking can lead to rapidly shifting perceptions of others, as seen in the client's sudden change from idealizing the nurse to devaluing them.
A. Denial is a defense mechanism where the individual refuses to accept reality or acknowledge an aspect of reality that is apparent to others. In this scenario, the client is not denying any aspect of reality.
B. Separation-individuation is a developmental process where individuals establish autonomy and a sense of self separate from others, particularly from primary caregivers. This process is more relevant in infancy and early childhood.
D. Reaction formation is a defense mechanism where an individual behaves in a manner opposite to their true feelings or impulses. In this scenario, the client's expression of hatred towards the nurse does not appear to be a case of reaction formation, as there is no indication that the client actually harbors feelings of care or admiration towards the nurse.

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A nurse is caring for a 10-year old child with Intellectual Developmental Disorder who has an IQ of 45. Which child capability would the nurse expect to observe? The child:

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Naxlex Comprehensive Predictor Exams

The nurse in the Emergency Department (ED) assesses a 17-year-old client exhibiting symptoms of opiate intoxication. Which of the following should be the nurse's priority action?

Correct Answer is C

Explanation

The nurse has recently set limits for a client with borderline personality disorder. The client tells the nurse, "You used to care about me. I thought you were wonderful. Now I can see that I was mistaken. You are hateful." This outburst can be assessed as:

Correct Answer is C

Explanation

A physician mentions to the nurse that a child with Attention Deficit-Hyperactivity Disorder (ADHD) will begin medication therapy. The nurse should prepare a plan to teach the family about:

The nurse working with a teen, who has a history of being moody and withdrawn, will make the establishment of a therapeutic alliance a priority because:

The nurse is caring for a client who is experiencing mania. The client is pacing, cannot sit, and has pressured speech. Which meal will the nurse provide to best meet the nutritional needs of this client?

The nurse is assisting a victim of spousal abuse to create a plan for escape if it becomes necessary. The nurse would recommend that the victim bring:

The nurse is educating clients about recovery from alcohol abuse. Which statement indicates that learning has occurred?

A client with borderline personality disorder reported to the nurse in the clinic that they feel empty and anxious and wants to cut their arms. The nurse should:

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