An older adult client returns to the clinic for a follow-up visit with the healthcare provider for management of depression related to the death of a child, who was killed 6 months ago by a drunk driver. Which finding indicates to the practical nurse (PN) that the client is improving?

Misses the child every day.

Drinks 4 to 6 bottles of beer each evening.

Expresses that drunk driving is inexcusable.

Sleeps through the night often.

Answer and Explanation

The Correct Answer is D

A. Missing the child every day is a normal part of the grieving process but does not indicate improvement in managing depression.
B. Drinking 4 to 6 bottles of beer each evening suggests the client may be using alcohol as a coping mechanism, indicating poor management of depression.
C. Expressing that drunk driving is inexcusable shows the client has a strong opinion on the matter, but it does not necessarily indicate improvement in the client’s emotional health.
D. Sleeping through the night often indicates an improvement in the client’s ability to rest and manage depressive symptoms, suggesting a positive response to treatment.

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Correct Answer is []

Explanation

The child’s symptoms—drowsiness, thick yellow secretions, low respiratory rate, and fever—along with the chest x-ray showing consolidation consistent with pneumonia, indicate that he is experiencing respiratory insufficiency. Respiratory insufficiency occurs when the respiratory system fails to meet the body's oxygen needs or remove carbon dioxide effectively.

Actions to Take:

1. Perform oropharyngeal suctioning
Suctioning is necessary to clear the thick yellow secretions that can obstruct the airway and contribute to respiratory insufficiency. It helps maintain a patent airway and improves the child's ability to breathe.

2. Provide humidified supplemental oxygen
Humidified oxygen helps to maintain airway moisture and improve oxygenation, which is critical for managing respiratory insufficiency. It can also help loosen secretions and alleviate symptoms related to pneumonia.

Parameters to Monitor:

1. Oxygen Saturation
Monitoring oxygen saturation is essential to assess the effectiveness of supplemental oxygen and interventions for respiratory insufficiency. Low oxygen saturation indicates that the respiratory system is not meeting the oxygen demands of the body.

2. Temperature
Temperature monitoring is important to assess the effectiveness of fever management and to monitor for potential worsening of the infection. Elevated temperature can exacerbate respiratory insufficiency and indicate ongoing infection.

A. Take the child's pulse B. Place a cervical collar on the client C. Call child protective services D. Start a peripheral IV line E. Look for any open wounds F. Determine if the child's airway is clear

Correct Answer is A, F, E

Explanation

A. Take the child's pulse

Assessing the pulse is crucial to determine if the child has a heartbeat and to evaluate the effectiveness of CPR. This helps to determine the current cardiovascular status of the child and the urgency of further resuscitation efforts.

F. Determine if the child's airway is clear

Ensuring a clear airway is a priority in any emergency situation. A blocked airway can prevent effective ventilation and oxygenation, which is critical for a child who has experienced a near-drowning incident.

D. Start a peripheral IV line

Starting a peripheral IV line is important for administering fluids and medications that may be necessary for resuscitation and stabilization. It allows for rapid access to the child's circulatory system for necessary interventions.

E. Look for any open wounds

Checking for open wounds is necessary to identify any immediate sources of bleeding or potential infections that need to be addressed. It is part of a thorough initial assessment to ensure comprehensive care for the child.

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An older adult client returns to the clinic for a follow-up visit with the healthcare provider for management of depression related to the death of a child, who was killed 6 months ago by a drunk driver. Which finding indicates to the practical nurse (PN) that the client is improving?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Exhibits Complete the diagram by dragging from the choices area to specify which condition the client is most likely experiencing, two actions the practical nurse (PN) should take to address that condition, and two parameters the PN should monitor to assess the client's progress.

Correct Answer is []

Explanation

Exhibits Review H and P and nurse's note. Which are the first four actions that the practical nurse (PN) should do?

Correct Answer is A, F, E

Explanation

A preoperative client who has already signed the informed consent for a surgical procedure confides to the practical nurse (PN) of being really frightened and unsure about undergoing the surgery. Which priority action should the PN take?

Which foot care instruction is most important for the practical nurse (PN) to reinforce that minimizes a long-term complication for a client who is newly diagnosed with type 2 diabetes mellitus (DM)?

When the practical nurse (PN) attempts to assist an 18-year-old client with a mild mental disability to ambulate on the first postoperative day after an appendectomy, she becomes angry and yells at the PN, "Get out of here! I'll get up when I'm ready!" Which response is best for the PN to make?

The practical nurse (PN) is assessing an older adult client with left-sided heart failure (HF). Which intervention is most important for the PN to implement?

Exhibits The practical nurse (PN) notifies the healthcare provider that the client continues to have signs of fluid volume deficit. The health care provider prescribes a continuous infusion of isotonic fluids. Which fluid(s) is/are classified as isotonic? Select all that apply.

Which location should the practical nurse (PN) palpate to determine if a client's submandibular lymph nodes are enlarged?

The practical nurse (PN) is assisting with the plan of care for a client who is receiving the nonsteroidal anti-inflammatory drug ketorolac for painful muscle spasms of the back. Which intervention should the PN include in the client's plan of care?