A nurse is caring for a client in an emergency department.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress
The Correct Answer is []
Based on the provided nurses' notes, the client exhibits symptoms that may suggest a brief psychotic disorder, characterized by delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior. The client's history of similar episodes and family history could support this diagnosis. To assess the client's progress, the nurse should monitor the client's ability to care for themselves and assess any suicide risk due to the client's recent stressors and emotional state. Actions that could be beneficial include reducing external stimuli to prevent sensory overload and engaging with the client several times each day to establish trust, which can help alleviate anxiety and foster a therapeutic environment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Adding medication directly to enteral feeding can cause clogging of the tube and interfere with medication absorption.
B. Flushing with only 5 mL of water is insufficient. Typically, the tube should be flushed with 15-30 mL of water before and after administering each medication to ensure the tube is clear and to prevent clogging.
C. Dissolving medications together may lead to drug interactions or alterations in drug absorption and should be avoided.
D. Using a syringe to allow the medications to flow by gravity ensures that the medications are delivered safely and steadily. After each medication is administered, the tube should be flushed with water to ensure it is clear and to prevent interactions between different medications.
Correct Answer is A
Explanation
A. Newborn genetic screening is typically performed after 24 hours of age to ensure accurate results and allow for the detection of certain genetic conditions.
B. Newborn genetic screening is typically performed only once, shortly after birth, and is not routinely repeated at 2 months of age.
C. Newborn genetic screening does not typically require the baby to drink water prior to the test.
D. While blood is drawn from the baby for genetic screening, it is typically obtained from the baby's heel, not the inner elbow.
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