A nurse is caring for a client who reports a recent increase in stressors. Which of the following concepts should the nurse use to develop necessary context to both understand and deliver nursing care for this client?

Justified vs. unjustified

Adaptive vs. maladaptive

Right vs. wrong

Good vs. bad

Answer and Explanation

The Correct Answer is B

B. This concept involves understanding how individuals respond to stressors and whether their coping strategies are effective in managing stress and promoting well-being. By assessing whether the client's responses to stress are adaptive (i.e., helpful and constructive) or maladaptive (i.e., harmful or ineffective), the nurse can tailor interventions to support the client in developing healthier coping mechanisms and managing stress more effectively.

A. Although understanding the client's perception of the stressors is important, labeling them as justified or unjustified may not fully capture the complexity of the client's experience or their individual response to stress.

C This concept involves evaluating the moral or ethical implications of the client's actions or decisions in response to stressors.

D. While assessing the client's behaviors and their impact on health and well-being is important, labeling them as inherently good or bad may oversimplify the complexity of the client's experience.

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Correct Answer is A

Explanation

A. Acute toxicity to sedatives, especially at high doses, can lead to various central nervous system effects, including severe hallucinations. Hallucinations can involve distorted perceptions of sensory experiences, such as seeing, hearing, or feeling things that are not present. These hallucinations may be vivid, intense, and disturbing, especially during acute intoxication.

B. Negative symptoms are more commonly associated with chronic psychotic disorders like schizophrenia rather than acute toxic reactions.

C. Prolonged hallucinations are less characteristic of acute toxicity and are more commonly seen in conditions like schizophrenia or certain drug-induced psychotic disorders.

D. Prolonged delusions typically characterize chronic psychotic disorders rather than acute toxic reactions.

A. Allow the client to control the conversation. B. Ask the client a series of questions about who assaulted them. C. Insist the client report the incident. D. Touch the client for reassurance.

Correct Answer is A

Explanation

A. Allowing the client to control the conversation empowers them to share their experience at their own pace and in their own way. This approach fosters trust and facilitates open communication between the nurse and the client.

B. While gathering relevant information about the assault may be necessary for documentation and reporting purposes, it's important to approach the topic with sensitivity and respect for the client's emotional well-being.

C. Pressuring the client to report the incident against their will can further traumatize them and undermine their sense of control. Reporting the assault is a personal decision that should be made by the client based on their individual circumstances and preferences.

D. Touch can be a powerful form of nonverbal communication that conveys empathy, support, and reassurance. However, it's important to obtain the client's consent before initiating any form of physical contact, especially considering the sensitive nature of the situation.

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A nurse is caring for a client who reports a recent increase in stressors. Which of the following concepts should the nurse use to develop necessary context to both understand and deliver nursing care for this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has substance use disorder and is experiencing acute toxicity to sedatives, but has no history of schizophrenia spectrum disorders. Which of the following manifestations should the nurse expect the client to experience?

Correct Answer is A

Explanation

A nurse is speaking with a client who experienced physical assault. Which of the following actions should the nurse take?

Correct Answer is A

Explanation

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