A nurse is contributing to the plan of care for a client who has a major depressive disorder. Which of the following recommendations should the nurse include in the plan of care?
Recommend the client spend time alone in his room.
Suggest the client exercise before going to bed.
Offer the client low-protein snacks throughout the day.
Encourage the client to use positive self-talk.
The Correct Answer is D
A. Social isolation can exacerbate depressive symptoms, so it's not recommended for the client to spend time alone in his room.
B. Exercise is generally beneficial for individuals with depression, but exercising before bedtime might interfere with sleep.
C. There's no evidence to support the direct relationship between low-protein snacks and managing major depressive disorder.
D. Correct. Encouraging the client to use positive self-talk can help counteract negative thought patterns that are often present in depression.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Correct. Observing the client during and after meals is a priority because clients with bulimia nervosa often engage in episodes of binge eating followed by purging behaviors. Monitoring the client's behavior during meals and immediately after can help assess for potential purging behaviors.
B. Incorrect. While involving the client in meal planning might be helpful, it is not the first action to address potential purging behaviors.
C. Incorrect. Instructing the client about effective coping strategies is important, but observing for potential purging behaviors is the initial action to address the client's immediate safety.
D. Incorrect. Referring the client to a support group is beneficial, but it is not the first action to address the client's immediate risk of purging behaviors.
Correct Answer is B
Explanation
A.Restraints should never be applied directly on the skin or under clothing, as this can cause irritation, pressure injuries, and make it difficult for the nurse to assess skin integrity. Restraints should be placed over the client's clothing to reduce friction and protect the skin.
B.Positioning the client in a sitting or semi-Fowler's position is preferred as it promotes comfort, minimizes the risk of aspiration, and allows the nurse to monitor the client's airway, breathing, and circulation more effectively. Lying flat can increase discomfort and respiratory difficulty, especially if the client is aggressive or agitated.
C.Restraints should never be tied to movable parts, like bed rails, as this could result in injury if the bed rail is moved up or down. Restraints should be tied to a non-movable part of the bed frame to ensure stability and prevent accidental tightening or loosening that could harm the client.
D.A belt restraint should be placed across the client’s waist or hips, not the chest, as a chest restraint can impede respiratory function, especially in an aggressive client who may be physically exerting themselves. The restraint should secure the client’s lower body to prevent them from standing or moving excessively, while still allowing safe breathing and circulation.
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