Edited Text
A client with borderline personality disorder reported to the nurse in the clinic that they feel empty and anxious. The client wants to cut their arms. The nurse should first:

Assist the client to identify the triggering situation and choose a coping strategy.

Send the client to the crisis intervention unit for 23 hours of observation.

Restrain the client to prevent self-harm.

Advise the client to take an anxiolytic to decrease their anxiety level.

Answer and Explanation

The Correct Answer is A

Choice A Reason: Assist the client to identify the triggering situation and choose a coping strategy

This is the correct answer. Assisting the client to identify the triggering situation and choose a coping strategy is a therapeutic approach that empowers the client to understand and manage their emotions. This intervention helps the client develop skills to cope with distressing feelings and reduces the likelihood of self-harm. It is essential to address the underlying issues and provide support in a constructive manner.

Choice B Reason: Send the client to the crisis intervention unit for 23 hours of observation

While sending the client to a crisis intervention unit may be necessary in some cases, it is not the first step. Immediate therapeutic intervention to help the client understand and manage their emotions is crucial. Observation alone does not address the underlying issues or provide the client with coping mechanisms.

Choice C Reason: Restrain the client to prevent self-harm

Restraint should be a last resort and only used when there is an immediate risk of harm that cannot be managed through other means. It is important to first attempt less restrictive interventions that help the client manage their emotions and behaviors.

Choice D Reason: Advise the client to take an anxiolytic to decrease their anxiety level

While medication can be part of the treatment plan, it should not be the first intervention. Addressing the client’s immediate emotional needs and helping them develop coping strategies is crucial. Medication can be considered as part of a comprehensive treatment plan but should not replace therapeutic interventions.

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Free Nursing Study Resources

Correct Answer is ["2"]

Explanation

Step 1: Identify the dosage required and the concentration available.

Required dosage: 40 mg
Available concentration: 20 mg/mL

Step 2: Calculate the volume to be administered.

Volume to be administered = Required dosage ÷ Available concentration
Volume to be administered = 40 mg ÷ 20 mg/mL

Step 3: Perform the division.

Volume to be administered = 40 ÷ 20
Volume to be administered = 2 mL

Step 4: Round the answer to the nearest whole number (if necessary).

Volume to be administered = 2 mL (no rounding needed)

The nurse should administer 2 mL.

A. Expect hyperactivity as a common adverse effect. B. Give the dose in the morning to help prevent insomnia. C. Avoid crowds due to the increased risk for infection. D. Limit caloric intake to prevent excessive weight gain.

Correct Answer is B

Explanation

The correct answer is b.

Choice A Reason:

Expect hyperactivity as a common adverse effect. This statement is incorrect. Atomoxetine is a non-stimulant medication used to treat ADHD and does not typically cause hyperactivity. Instead, it helps improve attention and reduce hyperactivity and impulsiveness. Common side effects of atomoxetine include nausea, vomiting, upset stomach, constipation, dry mouth, loss of appetite, mood changes, feeling tired, dizziness, urination problems, or impotence.

Choice B Reason:

Give the dose in the morning to help prevent insomnia. This statement is correct. Atomoxetine should be taken in the morning to help prevent insomnia, as taking it later in the day can interfere with sleep. The medication can be taken with or without food, and if a second dose is prescribed, it is typically taken in the late afternoon or early evening.

Choice C Reason:

Avoid crowds due to the increased risk for infection. This statement is incorrect. Atomoxetine does not increase the risk of infection, and there is no need to avoid crowds while taking this medication3. Common side effects do not include an increased risk of infection.

Choice D Reason:

Limit caloric intake to prevent excessive weight gain. This statement is incorrect. Atomoxetine is more likely to cause weight loss rather than weight gain. It can decrease appetite, which may lead to weight loss in some patients. Therefore, limiting caloric intake is not necessary while taking atomoxetine.

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Edited TextA client with borderline personality disorder reported to the nurse in the clinic that they feel empty and anxious. The client wants to cut their arms. The nurse should first:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer fluoxetine 40 mg PO daily. The amount available is fluoxetine 20 mg/mL. How many mL should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["2"]

Explanation

A nurse is teaching the parents of a school-age child who has ADHD about atomoxetine. Which of the following instructions should the nurse include in the teaching?

Correct Answer is B

Explanation

The nurse is observing a family member administer eye drops to the patient as part of medication teaching. Which action(s) indicate the family member is performing the skill correctly? (SELECT ALL THAT APPLY)

A client with major depressive disorder has been taking fluoxetine, an SSRI, for 5 weeks. During the first outpatient visit, the client smiles and states, “I feel like a great weight is off my chest.” How should the nurse interpret this behavior change?

A client diagnosed with bipolar disorder is experiencing a severe depressive episode. Which client behavior would alert the nurse to the highest priority intervention? The client:

The nurse is providing discharge instructions to the client taking disulfiram. Which of the following items should the nurse teach the client to avoid?

The nurse observes dental deterioration when assessing a client diagnosed with Bulimia Nervosa. Which best explains this assessment finding?

The nurse assesses that medication teaching about tricyclic antidepressants was understood when the client states:

A client who is prescribed lithium carbonate is being discharged from inpatient care. Which medication information should the nurse teach this client?

A client with bipolar disorder is refusing to take mood stabilizers due to weight gain. To increase the patient’s adherence to a medication regimen, what measures could the nurse teach the client? (SELECT ALL THAT APPLY)

Edited Text
A client with borderline personality disorder reported to the nurse in the clinic that they feel empty and anxious. The client wants to cut their arms. The nurse should first: