A nurse is caring for a client who is experiencing delirium. Which of the following findings should the nurse expect?
Catatonia
Echopraxia
Agraphia
Illusions
The Correct Answer is D
A. Catatonia. Catatonia involves significant motor disturbances such as rigidity, mutism, or excessive movement, commonly seen in schizophrenia or severe mood disorders. Delirium is characterized by acute confusion, fluctuating attention, and perceptual disturbances rather than motor abnormalities.
B. Echopraxia. Echopraxia is the involuntary repetition of another person’s movements, often linked to schizophrenia and autism spectrum disorders. Delirium primarily presents with disorientation, altered consciousness, and hallucinations rather than repetitive motor behaviors.
C. Agraphia. Agraphia is the loss of the ability to write due to neurological conditions like stroke or dementia. Delirium is an acute and reversible cognitive disturbance that affects attention and perception but does not typically result in isolated language deficits.
D. Illusions. Illusions involve the misinterpretation of real stimuli, such as mistaking a cord for a snake, and are common in delirium. This occurs due to the client's fluctuating mental status, impaired sensory perception, and difficulty distinguishing reality from distorted perceptions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Prolonged PT/INR. Prolonged PT/INR may occur due to liver dysfunction or vitamin K deficiency, but it is not a direct result of pancreatitis. In pancreatitis, the liver is usually functioning normally unless there is concurrent liver disease.
B. Elevated lipase. Elevated lipase is a hallmark laboratory finding in pancreatitis. Lipase is an enzyme produced by the pancreas, and its levels rise significantly during episodes of pancreatitis, making it a key indicator in diagnosing the condition.
C. Elevated ammonia. Elevated ammonia levels are more commonly associated with liver dysfunction, such as hepatic encephalopathy, rather than pancreatitis. Pancreatitis primarily affects the digestive system, not the liver directly.
D. Decreased albumin. Decreased albumin can be seen in various conditions, including liver disease and malnutrition, but it is not a specific finding for pancreatitis. In acute pancreatitis, albumin levels may not be significantly affected, while chronic pancreatitis can lead to malabsorption and potentially lower albumin levels over time.
Correct Answer is D
Explanation
A. Nausea. Epinephrine is not primarily used to treat nausea. It is a sympathomimetic medication that works by stimulating alpha and beta receptors, mainly to counteract severe allergic reactions, including respiratory distress and hypotension. Nausea is not a primary indication for its use.
B. Hand tremors. Epinephrine can cause hand tremors as a side effect due to its stimulant effects on the nervous system. However, it is not used to treat tremors, and the presence of tremors after administration is a common physiological response rather than a therapeutic effect.
C. Hyperglycemia. Epinephrine can increase blood glucose levels by stimulating glycogenolysis and inhibiting insulin secretion. However, it is not used for treating hyperglycemia, and its effects on glucose metabolism are incidental rather than a primary therapeutic action.
D. Shortness of breath. Epinephrine is commonly used to treat anaphylaxis, which can cause airway swelling and bronchospasm leading to shortness of breath. By stimulating beta-2 receptors, epinephrine relaxes bronchial smooth muscles, improving airflow and reducing respiratory distress.
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