Try Naxlex NCLEX-RN (Free-Trial)

A nurse on an inpatient mental health unit is monitoring a visit between a client who has a history of aggressive behavior and the client's partner. Which of the following observations should the nurse identify as an indication for potential violence?

The client is taking numerous deep, measured breaths

The client is calmly telling their partner that "the staff here is so controlling

The client is sitting with their head in their hands and appears to be crying

The client is pacing around the chair in which their partner is sitting

Answer and Explanation

The Correct Answer is D

The client is pacing around the chair in which their partner is sitting.

Rationale:

A. The client is taking numerous deep, measured breaths. This is not an indication of potential violence, but rather a coping strategy to calm down and regulate emotions.
B. The client is calmly telling their partner that "the staff here is so controlling." This is not an indication of potential violence, but rather a expression of frustration or dissatisfaction with the treatment setting.
C. The client is sitting with their head in their hands and appears to be crying. This is not an indication of potential violence, but rather a sign of sadness or distress.
D. The client is pacing around the chair in which their partner is sitting. This is an indication of potential violence, as it shows restlessness, agitation, and possible intimidation of the partner.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is B

Explanation

Aspirate contents from the tube and verify the pH level.

A. This is an incorrect action. Inserting air in the tube and listening for gurgling sounds in the epigastric area is not a reliable method to confirm NG tube placement, as it can produce falsepositive results due to air entering the stomach or intestines.
B. This is a correct action. Aspirating contents from the tube and verifying the pH level is a valid method to confirm NG tube placement, as gastric contents typically have a pH of less than 5.5, while intestinal or respiratory contents have a higher pH.
C. This is an incorrect action. Reviewing the medical record for previous x-ray verification of placement is not sufficient to confirm NG tube placement, as the tube can migrate or become dislodged after insertion. X-ray verification should be done initially and whenever there is doubt about the tube's position.
D. This is an incorrect action. Auscultating the lungs for adventitious breath sounds is not a specific method to confirm NG tube placement, as it can indicate other conditions such as pneumonia or pulmonary edema. It can also miss signs of respiratory complications due to NG tube misplacement, such as pneumothorax or bronchial obstruction.

A. Preeclampsia. B. Transverse fetal lie. C. Intrauterine growth restriction. D. Postterm pregnancy.

Correct Answer is B

Explanation

Choice A rationale:

Preeclampsia is not a contraindication for the administration of misoprostol for induction of labor. Misoprostol is a prostaglandin E1 analog used for cervical ripening and induction of labor. It is not contraindicated in patients with preeclampsia. However, its use should be carefully monitored in patients with hypertensive disorders of pregnancy due to the potential impact on blood pressure.

Choice B rationale:

Transverse fetal lie is a contraindication for the administration of misoprostol for induction of labor. Misoprostol should not be used when the baby is in a transverse position because it can lead to complications during delivery. Induction methods should be chosen carefully based on the fetal presentation to ensure a safe delivery process.

Choice C rationale:

Intrauterine growth restriction (IUGR) is not a contraindication for the administration of misoprostol for induction of labor. IUGR refers to a condition where a fetus does not grow at the expected rate inside the uterus. While the cause of IUGR needs to be addressed, misoprostol itself is not contraindicated in these cases. However, the healthcare provider should assess the overall fetal well-being before deciding on the induction method.

Choice D rationale:

Postterm pregnancy is not a contraindication for the administration of misoprostol for induction of labor. In postterm pregnancies, where the pregnancy has extended beyond 42 weeks, healthcare providers may consider inducing labor to prevent complications associated with prolonged gestation. Misoprostol is one of the options for induction in postterm pregnancies, although the choice of induction method may vary based on various factors.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse on an inpatient mental health unit is monitoring a visit between a client who has a history of aggressive behavior and the client's partner. Which of the following observations should the nurse identify as an indication for potential violence?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing for correct placement of a client's NG feeding tube prior to administering a bolus feeding. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

A nurse is reviewing the medical record of a client who has a prescription for misoprostol for induction of labor.Which of the following findings is a contraindication for administration of this medication?

Correct Answer is B

Explanation

A nurse is caring for a client who has a new prescription for clonidine. The nurse should inform the client that which of the following findings is an adverse effect of this medication?

A nurse is admitting a school-age child who has bacterial meningitis.Which of the following types of isolation precautions should the nurse initiate?

A nurse is caring for a client who has a magnesium level of 2.7 mEq/L. Which of the following interventions should the nurse plan to take?

A nurse in an emergency department is caring for a client who is unconscious and requires emergency medical procedures. The nurse is unable to locate members of the client's family to obtain consent. Which of the following actions should the nurse take?

A nurse is caring for a client who had abdominal surgery 24 hr ago. Which of the following actions is the nurse's priority?

A nurse is caring for a client who has a prescription for a continuous passive motion (CPM) machine following a total knee arthroplasty. Which of the following actions should the nurse take?

A nurse is caring for a 3-year-old toddler who has dehydration.Which of the following findings should the nurse report to the provider?