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
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Each evening: Turning the patient only once per day is insufficient to prevent pressure injuries.
B. Once every shift: This is also inadequate as it does not provide the frequent repositioning necessary to prevent pressure injuries.
C. Every 4 hours: While better than every shift, every 4 hours may still not be frequent enough to prevent pressure injuries in at-risk patients.
D. Every 2 hours: Frequent repositioning, such as every 2 hours, is essential for pressure injury prevention in bedfast patients.
Correct Answer is A
Explanation
A. Body image. Body image refers to an individual's perceptions, thoughts, and feelings about their physical appearance and bodily functions.
B. Role performance. Role performance relates to how individuals perceive their ability to fulfill various roles in their life, such as student, parent, or employee, rather than how they feel about their body functions.
C. Personal identity. Personal identity encompasses the sense of self as a unique individual, including values, beliefs, and goals, but does not specifically pertain to feelings about bodily functions.
D. Self-esteem. Self-esteem involves overall feelings of self-worth or self-value, which can be influenced by body image but is a broader concept.
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