A nurse is caring for a newly admitted client who has obsessive-compulsive disorder and frequently performs ritualistic behaviors. The nurse should expect which of the following client responses if ritualistic behavior is restricted?

Replaces it with a different ritualistic behavior

Reports auditory hallucinations

Expresses relief from not having to perform the ritual

Experiences panic-level anxiety

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Replacing the ritual with a different ritualistic behavior is possible, but it does not necessarily predict the initial response when the restriction is first imposed.

Choice B rationale:

Reporting auditory hallucinations is not a typical response to restricting ritualistic behavior in someone with OCD.

Choice C rationale:

Expressing relief from not having to perform the ritual is unlikely, as ritualistic behaviors in OCD are often driven by distress and anxiety.

Choice D rationale:

If ritualistic behavior is restricted in an individual with obsessive- compulsive disorder (OCD), they may experience panic-level anxiety due to their inability to engage in their usual coping mechanism. OCD rituals are often performed to reduce anxiety, and restricting them can lead to increased distress.

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Correct Answer is C

Explanation

Choice A rationale:

Placing the newborn under a radiant warmer is not directly related to addressing breastfeeding-related jaundice.

Choice B rationale:

Supplementing breastfeeding with formula is not the first-line approach and may interfere with establishing successful breastfeeding.

Choice C rationale:

Breastfeeding-related jaundice can occur if the newborn is not effectively breastfeeding and not getting enough milk. Assessing the effectiveness of breastfeeding is important to address the underlying cause of jaundice.

Choice D rationale:

Administering Rho(D) immune globulin is unrelated to addressing jaundice in a breastfed newborn.

A. Initiate a high-protein diet for the client. B. Encourage the client to eat high-fiber foods. C. Administer laxatives to the client PRN daily. D. Provide the client with six small meals per day.

Correct Answer is B

Explanation

Choice A rationale:

A high-protein diet might not be recommended for a client with chronic pancreatitis, as certain high-protein foods can exacerbate symptoms.

Choice B Rationale:

Encouraging the client to eat high-fiber foods can help manage symptoms of chronic pancreatitis, as well as promote regular bowel movements and prevent constipation.

Choice C rationale:

Administering laxatives daily is not typically part of the management plan for chronic pancreatitis and can lead to dependency.

Choice D rationale:

Providing six small meals per day might be helpful, but the specific dietary content is important for managing chronic pancreatitis.

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A nurse is caring for a newly admitted client who has obsessive-compulsive disorder and frequently performs ritualistic behaviors. The nurse should expect which of the following client responses if ritualistic behavior is restricted?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is creating a plan of care for a newborn who is breastfed and appears jaundiced. Which of the following interventions should the nurse include?

Correct Answer is C

Explanation

A nurse is planning care for a client who has chronic pancreatitis. Which of the following interventions should the nurse include in the plan?

Correct Answer is B

Explanation

A nurse is preparing to administer 800 mg of phenytoin via IV infusion to a client who is experiencing status epilepticus. Which of the following actions should the nurse take when administering the medication?

A nurse is evaluating the effectiveness of the plan of care for a client who has experienced sexual assault. Which of the following findings indicates effectiveness of the plan of care?

A nurse is providing teaching to a client who has type 1 diabetes and is planning to become pregnant. Which of the following information should the nurse include?

A nurse in an emergency department is assessing a client who has experienced a right hemispheric stroke. Which of the following findings should the nurse expect?

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A nurse is assessing a client who has delirium. Which of the following manifestations should the nurse expect? (Select all that apply.)

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