A nurse is caring for a group of older adult clients. Which of the following manifestations indicates one of the clients is experiencing delirium?

A client requests extra blankets when the thermostat in the room indicates 25.6°C (78°F).

A client attempts to climb out of bed and repeatedly states she must get home.

A client refuses to get out of bed and has no motivation to attend to daily hygiene.

A client wants to know the current time while there is a clock on the wall.

Answer and Explanation

The Correct Answer is B

The correct answer is choice B.

Choice A rationale:

A client requesting extra blankets due to a room temperature discrepancy is not indicative of delirium. This behavior may simply stem from feeling cold, which is a logical response to a temperature below the client's comfort level.

Choice B rationale:

A client attempting to climb out of bed and repeatedly stating a need to get home is a manifestation of delirium. Delirium is characterized by sudden disturbances in consciousness and cognitive function, leading to confusion and altered perception. The client's behavior suggests a disoriented state and a distorted perception of reality.

Choice C rationale:

A client refusing to get out of bed and lacking motivation for daily hygiene might not necessarily indicate delirium. These symptoms could be related to other factors, such as depression or physical discomfort, which are not specific to delirium.

Choice D rationale:

A client wanting to know the current time when there is a visible clock on the wall doesn't indicate delirium. It might just reflect the client's desire to know the time, which is a common behavior and doesn't directly relate to cognitive disturbances associated with delirium.

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Correct Answer is D

Explanation

Choice A rationale:

Sweating is not an adverse effect commonly associated with buspirone (Buspar). While some side effects like dizziness, nausea, and headache might occur, sweating is not typically reported as a significant adverse effect of this medication.

Choice B rationale:

Decreased appetite is a potential adverse effect of buspirone (Buspar). However, it is not the most concerning in this context. Anxiety disorders like generalized anxiety disorder can lead to appetite changes, and while this should be monitored, it is not a priority compared to more severe adverse effects.

Choice C rationale:

Discolored urine is not a common adverse effect of buspirone (Buspar). Buspirone is primarily used to treat anxiety and does not usually cause changes in urine color. This effect is unrelated to the medication and likely has a different underlying cause.

Choice D rationale:

Hallucinations are a concerning adverse effect that should be reported to the provider. Hallucinations are not a typical side effect of buspirone and might indicate a more serious issue or an interaction with other medications. Reporting this symptom promptly is crucial to ensuring the client's safety and well-being.

A. Depression. B. Obsessive-compulsive disorder. C. Schizophrenia. D. Breathing-related sleep disorder. E. Anxiety.

Correct Answer is ["A","B","E"]

Explanation

Answer and explanation

The correct answers are choices A. Depression, B. Obsessive-compulsive disorder, E. Anxiety.

Choice A rationale:

Depression commonly coexists with eating disorders. The individual's distorted body image, feelings of low self-worth, and dietary restrictions can contribute to the development of depressive symptoms.

Choice B rationale:

Obsessive-compulsive disorder (OCD) often occurs alongside eating disorders. The obsessions and compulsions seen in OCD can overlap with behaviors related to food, eating rituals, and body image, reinforcing the eating disorder pathology.

Choice C rationale:

Schizophrenia is not typically considered a comorbidity of eating disorders. Schizophrenia involves disruptions in thought processes, emotions, and perceptions, which are distinct from the cognitive distortions and behaviors associated with eating disorders.

Choice D rationale:

Breathing-related sleep disorder is not a commonly recognized comorbidity of eating disorders. While sleep disturbances might occur in individuals with eating disorders due to physical discomfort or anxiety, a specific link to breathing-related sleep disorder is less established.

Choice E rationale:

Anxiety is a well-recognized comorbidity of eating disorders. Anxiety often accompanies the intense fears, worries, and preoccupations related to body weight, shape, and eating behaviors that are characteristic of eating disorders.

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A nurse is caring for a group of older adult clients. Which of the following manifestations indicates one of the clients is experiencing delirium?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is taking care of a client who has generalized anxiety disorder and is taking buspar (Buspirone). Which of the following adverse effects should the nurse report to the provider?

Correct Answer is D

Explanation

A nurse in the acute mental health unit is admitting a new client with an eating disorder. The nurse is aware that which of the following are considered comorbidities of eating disorders? (Select all that apply.)

Correct Answer is ["A","B","E"]

Explanation

A nurse is talking with a client diagnosed with schizophrenia. Suddenly the client states, "I'm frightened. Do you hear that? The voices are telling me to do terrible things." Which of the following responses by the nurse is appropriate?

A nurse is assessing a client who is sharing information regarding concerns about their marriage. The client states "My spouse and I argue most times." Which of the following statements by the nurse requires intervention by the charge nurse?

While in group therapy, a nurse is caring for a client who has cancer and is scheduled for immediate chemotherapy. The client tells the nurse that she wants to try nontraditional treatments first. Which of the following responses should the nurse make?

A nurse on a mental health unit is caring for a client who has generalized anxiety disorder. The client received a telephone call that was upsetting, and now the client is pacing up and down the hallways of the unit. Which of the following actions should the nurse take?

A nurse in the Emergency Department is caring for a client with symptoms of depression and admits to thoughts of self-harm with a plan. The client has a history of borderline personality disorder, depression, and substance abuse. Which of the following is the priority action by the nurse?

A nurse is reviewing medication records for several clients who have bipolar disorder. The nurse should recognize that which of the following medications are used to treat clients who have bipolar disorder? (Select all that apply.).

A nurse is caring for a client diagnosed with a mental illness on a psychiatric unit. Which of the following actions by the nurse demonstrates the ethical concept of autonomy?