A nurse is collecting data from a client who has recently stopped smoking.
Which of the following findings should the nurse recognize as a manifestation of acute nicotine withdrawal?

Tachycardia.

Nervousness.

Weight loss.

Vomiting.

Answer and Explanation

The Correct Answer is B

It occurs because nicotine stimulates the release of dopamine, a neurotransmitter that regulates mood and pleasure. When nicotine intake is stopped, dopamine levels drop and cause anxiety and irritability.

Choice A is wrong because tachycardia, or rapid heart rate, is not a symptom of nicotine withdrawal. In fact, smoking can increase blood pressure and heart rate, so quitting smoking may lower them.

Choice C is wrong because weight loss is not a symptom of nicotine withdrawal. On the contrary, weight gain is more likely to occur after quitting smoking, because nicotine suppresses appetite and increases metabolism.

Choice D is wrong because vomiting is not a symptom of nicotine withdrawal. Vomiting may be a side effect of some nicotine replacement therapies, such as patches or gum, but it is not caused by the lack of nicotine itself.

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Correct Answer is B

Explanation

“I will not play soccer until my doctor tells me I can.” This statement indicates that the client understands the risk of splenic rupture due to splenomegaly and the need to avoid contact sports until the spleen returns to normal size.

Choice A is wrong because antibiotics are not effective for infectious mononucleosis, which is caused by a virus.

Choice C is wrong because varicella booster is not related to infectious mononucleosis and there is no evidence that the client needs it.

Choice D is wrong because jaundice (yellowing of the eyes and skin) is not a common manifestation of infectious mononucleosis and may indicate another condition such as hepatitis.

Normal ranges for spleen size are 7 to 14 cm in length and 3 to 4 cm in thickness.

A. Warn the client that the staff will use seclusion as a consequence if there are repeated reports of hallucination. B. Keep the facility’s security personnel constantly visible to the client throughout treatment. C. Collaborate with the client to develop a daily physical exercise routine. D. Agree that the hallucinations are real if the client exhibits aggressive behavior toward other clients.

Correct Answer is C

Explanation

Collaborate with the client to develop a daily physical exercise routine. This intervention can help reduce aggression and impulsivity in schizophrenia by providing an outlet for frustration, enhancing self-esteem, and improving mood. Physical exercise can also improve physical health and reduce the risk of metabolic syndrome associated with antipsychotic medications.

Choice A is wrong because warning the client that the staff will use seclusion as a consequence if there are repeated reports of hallucination is punitive and threatening. This can increase the client’s anxiety, paranoia, and hostility, and may worsen the psychotic symptoms. Seclusion should only be used as a last resort when the client poses a serious danger to self or others, and not as a punishment or coercion.

Choice B is wrong because keeping the facility’s security personnel constantly visible to the client throughout treatment is intimidating and stigmatizing. This can also increase the client’s fear, distrust, and resentment, and may trigger aggressive behavior. Security personnel should only be involved when there is an imminent risk of violence, and not as a routine measure.

Choice D is wrong because agreeing that the hallucinations are real if the client exhibits aggressive behavior toward other clients is reinforcing the delusional belief and rewarding the aggression. This can also confuse the client and undermine the therapeutic relationship.

The nurse should acknowledge the client’s experience of hallucinations, but not endorse them as reality. The nurse should also set clear limits on aggressive behavior and use de-escalation techniques to calm the client.

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A nurse is collecting data from a client who has recently stopped smoking. Which of the following findings should the nurse recognize as a manifestation of acute nicotine withdrawal?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching about self-care with an adolescent client who has infectious mononucleosis with splenomegaly. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is B

Explanation

A nurse is contributing to the plan of care for a newly-admitted client who has schizophrenia and a history of aggressive behavior. Which of the following interventions should the nurse include in the initial plan?

Correct Answer is C

Explanation

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A nurse is collecting data from a client who has recently stopped smoking.
Which of the following findings should the nurse recognize as a manifestation of acute nicotine withdrawal?