A young man with malaria spikes a temperature of 105°F (40.5°C) and begins to hallucinate. How should the nurse assess this?

Delirium

Psychotic break

Possible stroke

Anxiety disorder

Answer and Explanation

The Correct Answer is A

A. Delirium: Delirium is characterized by acute confusion, disorientation, and altered mental status often due to severe infection or high fever.

B. Psychotic break: While hallucinations are a symptom, a psychotic break is generally a chronic mental health condition rather than an acute response to infection.

C. Possible stroke: Stroke symptoms usually involve sudden onset of neurological deficits rather than fever and hallucinations.

D. Anxiety disorder: Anxiety disorders do not typically cause such high fevers or acute hallucinations.

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Free Nursing Study Resources

Correct Answer is B

Explanation

A. The darker the patient's skin, the easier it is to assess for color change. Darker skin can make it more challenging to assess color changes, such as pallor or cyanosis.
B. To assess rashes and skin inflammation in dark-skinned individuals, the nurse should rely on palpation. Palpation can help detect changes in texture and warmth, which might be less visible on darker skin.
C. Pallor in black-skinned individuals will appear as a pale pink color. Pallor in dark-skinned individuals often appears as an ashen or gray color, not pink.
D. Baseline skin color should be assessed in areas with the most pigmentation. Baseline skin color should be assessed in normally less pigmented areas like palms and soles for accurate assessment.

A. The drug is addictive. B. The drug causes flashbacks. C. The drug stimulates drug-seeking behavior. D. The drug sets off hypertensive episodes.

Correct Answer is B

Explanation

A. The drug is addictive. LSD is not typically considered addictive as it does not cause physical dependence.
B. The drug causes flashbacks. One of the greatest problems with LSD is the occurrence of flashbacks, where the person re-experiences aspects of the drug effects long after use.
C. The drug stimulates drug-seeking behavior. While this can be an issue, it is not the most significant problem with LSD use.
D. The drug sets off hypertensive episodes. Hypertension is not a common or primary issue with LSD use.

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A young man with malaria spikes a temperature of 105°F (40.5°C) and begins to hallucinate. How should the nurse assess this?

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Naxlex Comprehensive Predictor Exams

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