A nurse is caring for a client who has borderline personality disorder (BPD).
Check the 6 assessment findings that require immediate follow-up:.
Financial situation.
Increased use of mood-altering substances.
Sexual behaviors.
Hepatitis Viral Study (HAA) results.
BUN level.
Hgb level.
Sodium level.
Being admitted frequently
Recent loss of a parent
Correct Answer : B,C,D,G,H,I
Choice A rationale:
Financial situation is a concern but it does not require immediate follow-up in a medical context.
Choice B rationale:
Increased use of mood-altering substances is a serious concern. The client has been drinking heavily and asking for their “nerve” pill, which could indicate substance misuse.
Choice C rationale:
The client’s sexual behaviors, specifically having multiple partners and not using condoms, pose a risk for sexually transmitted infections.
Choice D rationale:
The positive Hepatitis Viral Study (HAA) indicates the presence of a viral hepatitis infection, which requires immediate medical attention.
Choice E rationale:
The BUN level is within the normal range (10 to 20 mg/dL), so it does not require immediate follow-up.
Choice F rationale:
The Hgb level is within the normal range (12 to 18 g/dL), so it does not require immediate follow-up.
Choice G rationale:
The sodium level is below the normal range (136 to 145 mEq/L), indicating hyponatremia, which requires immediate medical attention.
Choice H rationale:
The frequency of facility admissions indicates that the client’s condition is not being managed effectively and requires immediate reassessment.
Choice I rationale:
The recent loss of a parent is a significant life event that could exacerbate the client’s mental health issues and substance misuse, requiring immediate follow-up.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
This statement is confrontational and may make the client defensive.
Choice B rationale:
This statement provides the client with a choice, promoting autonomy and encouraging self-care.
Choice C rationale:
This statement is forceful and does not respect the client’s autonomy.
Choice D rationale:
Ignoring the client’s lack of self-care does not address the issue and could potentially harm the client.
Correct Answer is ["A","B","C","E"]
Explanation
Choice A rationale:
Lithium is a mood stabilizer commonly used in the treatment of bipolar disorder.
Choice B rationale:
Valproate is an antiepileptic and mood-stabilizing medication commonly used to treat bipolar disorder.
Choice C rationale:
Carbamazepine is an anticonvulsant medication that has been found effective in managing mood swings in bipolar disorder.
Choice D rationale:
Donepezil is primarily used to treat Alzheimer’s disease and is not typically used in the treatment of bipolar disorder.
Choice E rationale:
Paroxetine is a type of antidepressant known as an SSRI, and it can be used in the treatment of bipolar disorder.
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