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:

A hemoglobin level of 13 g/dL is within the normal range and is not specifically indicative of HELLP syndrome.

Choice B rationale:

A blood urea nitrogen (BUN) level of 8 mg/dL is within the normal range and is not typically associated with HELLP syndrome.

Choice C rationale:

Elevated bilirubin levels are a characteristic feature of HELLP syndrome, which involves liver dysfunction.

Choice D rationale:

A hematocrit level of 38% is within the normal range and is not specifically indicative of HELLP syndrome.

A. Determine if the client is experiencing command hallucinations. B. Arrange for the client to have consistent staff assignments. C. Administer lorazepam to the client. D. Use the client's name when talking to him.

Correct Answer is A

Explanation

Choice A rationale:

Assessing for the presence of command hallucinations is a priority, as they can pose a risk to the client's safety and the safety of others.

Choice B rationale:

Consistent staff assignments can be important for clients with schizophrenia, but immediate safety concerns should take precedence.

Choice C rationale:

Administering medication is not the priority action unless there is a specific reason to do so based on the assessment.

Choice D rationale:

Using the client's name is respectful and helpful, but it is not the priority action in this scenario.

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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 reviewing the laboratory results of a client who has HELLP syndrome. Which of the following findings should the nurse expect?

Correct Answer is C

Explanation

A nurse is caring for a newly admitted client who has schizophrenia. Which of the following actions is the nurse's priority?

Correct Answer is A

Explanation

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