A nurse is caring for a client who has autism spectrum disorder. Which of the following findings should the nurse expect?

Expressive affect

Ambivalence

Echolalia

Associative looseness

Answer and Explanation

The Correct Answer is C

A. Expressive affect: Individuals with autism spectrum disorder (ASD) often have difficulty expressing their emotions in a typical manner. They may display a restricted range of facial expressions or have difficulty conveying emotions through facial expressions and gestures. However, "expressive affect" typically refers to the appropriate display of emotions, which may not be characteristic of ASD.

B. Ambivalence: Ambivalence refers to conflicting feelings or attitudes about a situation or person. While individuals with ASD may experience a range of emotions, including ambivalence, it is not a specific characteristic associated with the disorder. Ambivalence is a common human experience and may occur in individuals with or without ASD.

C. Echolalia: Echolalia is a common communication characteristic observed in individuals with ASD. It involves the repetition or echoing of words or phrases spoken by others. This behavior may occur immediately after hearing the words or phrases (immediate echolalia) or may be delayed. Echolalia can serve various functions, including communication, self-regulation, or expression of anxiety.

D. Associative looseness: Associative looseness is a thought disorder characterized by a lack of logical connection between thoughts and ideas. It is typically associated with conditions such as schizophrenia rather than ASD. Individuals with ASD may exhibit difficulties with social communication, including challenges in maintaining conversations or understanding social cues, but this is different from the disorganized thinking observed in associative looseness.

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Correct Answer is D

Explanation

A. "You must be getting better. You look great!": This response could potentially be interpreted as positive reinforcement, but it carries the risk of making assumptions about the client's mental state solely based on their appearance. It implies that the client's improved grooming is solely due to their improvement in depression, which may not necessarily be the case. Additionally, it may inadvertently minimize the client's experience of depression by attributing their grooming to improvement rather than recognizing it as an achievement in itself.

B. "Everyone feels better after showering": This response generalizes the client's experience and minimizes the significance of their actions. It implies that grooming is merely a routine activity that everyone does and that feeling better is solely related to physical cleanliness. It fails to acknowledge the client's effort and positive behavior, which could be significant achievements for someone experiencing depression.

C. "Why are you all dressed up today? Is it a special occasion?": This response might put the client on the spot and make them feel uncomfortable or self-conscious about their appearance. It could also imply that there must be a specific reason for the client to take care of their grooming, rather than recognizing it as a positive step regardless of the reason. Additionally, it doesn't acknowledge the client's effort or provide validation for their behavior.

D. "I see you have done some grooming today.": This response acknowledges the client's effort and positive behavior without making assumptions or judgments about the client's mental state or improvement. It demonstrates observance and recognition of the client's actions, which can help build rapport and trust between the nurse and the client. Additionally, it opens the door for further conversation if the client wishes to discuss their grooming habits or how they are feeling.

A. Bleeding B. Pancreatitis C. Dysrhythmias D. Cataracts

Correct Answer is C

Explanation

A. Bleeding: Haloperidol, an antipsychotic medication, is not typically associated with bleeding as an adverse effect. Bleeding is more commonly associated with medications such as anticoagulants or antiplatelet agents.

B. Pancreatitis: While rare, pancreatitis is not a common adverse effect of haloperidol. This condition is more commonly associated with other factors such as gallstones, alcohol consumption, or certain medications.

C. Dysrhythmias: Haloperidol can prolong the QT interval on an electrocardiogram (ECG), which may lead to dysrhythmias, including torsades de pointes. Therefore, it is essential to monitor clients receiving haloperidol for signs and symptoms of dysrhythmias, such as palpitations, syncope, or sudden cardiac arrest.

D. Cataracts: While long-term use of antipsychotic medications like haloperidol may increase the risk of developing cataracts, this adverse effect is not typically observed in clients receiving haloperidol on a PRN basis for agitation.

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A nurse is caring for a client who has autism spectrum disorder. Which of the following findings should the nurse expect?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse caring for a client who has depression observes the client comes to breakfast freshly bathed, wearing clean clothes, and with combed and styled hair. Which of the following responses by the nurse is therapeutic?

Correct Answer is D

Explanation

A nurse is caring for a client who has severe manifestations of schizophrenia and is medicated PRN for agitation with haloperidol. The nurse should assess the client for which of the following adverse effects?

Correct Answer is C

Explanation

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