A nurse is caring for a client following an involuntary admission to an acute mental health facility. The client states, "I'm afraid they will give me drugs that put me to sleep." Which of the following statements should the nurse make?
"I will make sure that we respect your right to refuse medications."
"You will need to rest so that you can recover from the episode that brought you here."
"Why do you think your provider will prescribe you medications that will make you sleep?"
"It's not your choice to be here, so you have to accept the treatment we plan for you."
The Correct Answer is A
A. "I will make sure that we respect your right to refuse medications." – This response respects the client's autonomy and reassures them that their rights will be upheld.
B. "You will need to rest so that you can recover from the episode that brought you here." – This statement dismisses the client's concerns rather than addressing them.
C. "Why do you think your provider will prescribe you medications that will make you sleep?" – While open-ended questions can encourage discussion, this does not directly reassure the client about their rights.
D. "It's not your choice to be here, so you have to accept the treatment we plan for you." – This statement is inappropriate and disregards the client's legal rights.
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Related Questions
Correct Answer is D
Explanation
A. A client who had a right hemisphere stroke – While a stroke may cause weakness on one side, BP measurements can still be taken unless there are additional contraindications like lymphedema or a fistula.
B. A client who had dialysis and is using an arteriovenous shunt in the left lower forearm – BP should never be taken on the arm with an AV shunt, but this does not mean the right arm is unavailable.
C. A client who had blood drawn from the right antecubital area 1 hr ago – Blood draws do not typically affect BP measurements significantly unless there is excessive bruising or infiltration.
D. A client who has a right peripherally inserted central catheter (PICC) – Correct. Blood pressure cuffs can cause compression on the PICC line, leading to catheter occlusion, displacement, or thrombosis. The nurse should instruct the AP to use the opposite arm.
Correct Answer is A
Explanation
A. Muscle twitching – Hypocalcemia (normal range: 8.5–10.5 mg/dL) causes neuromuscular excitability, leading to muscle twitching, tetany, and positive Chvostek's and Trousseau's signs.
B. Hypertension – Hypocalcemia does not cause hypertension; instead, it may lead to hypotension.
C. Bounding pulse – Hypocalcemia does not cause a bounding pulse; it may cause weak and irregular pulses.
D. Hypoactive bowel sounds – Hypocalcemia is more likely to cause hyperactive bowel sounds and diarrhea rather than hypoactive bowel sounds.
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