In conducting the initial assessment of a preoperative client, the nurse notes that the client's home medications include the monoamine oxidase (MAO) inhibitor phenelzine. Because of this client's medication history, which assessment finding is most important for the nurse to monitor?

Urinary output.

Blood pressure.

Respiratory rate.

Temperature

Answer and Explanation

The Correct Answer is B

A.   Urinary output might be important in some contexts but is not the priority related to the use of MAO inhibitors.
B.   MAO inhibitors like phenelzine can affect blood pressure significantly; monitoring BP is crucial due to the risk of hypertensive crisis when certain foods or medications are taken.
C.   Respiratory rate might be a consideration in some situations but is not directly affected by MAO inhibitors.
D.   Temperature is not typically a primary concern related to MAO inhibitor use; blood pressure monitoring is more crucial due to potential interactions.

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Correct Answer is A

Explanation

A. Returning to a previous level of functioning is essential for someone hospitalized due to an overdose as it ensures their safety and stability.
B. Identifying personal traits might be a part of therapy but is not the primary goal immediately after an overdose.
C. While exercise can be beneficial, it's not the primary concern right after a suicide attempt.
D. Discussing relationship needs is important but not the immediate priority after a suicide attempt.

A. Isolate the client from other clients. B. Administer a PRN sedative. C. Escort the client to a private area. D. Avoid recognizing the behavior.

Correct Answer is C

Explanation

A. Isolating the client might exacerbate feelings of social exclusion and isn't the best approach for managing echolalia.
B. Administering a sedative should not be the initial response to echolalia unless the behavior poses immediate harm to the client or others.
C. Escorting the client to a private area can help reduce the annoyance to other clients without isolating or punishing the individual.
D. Avoiding recognition of the behavior doesn't address the issue and might negatively impact the therapeutic relationship.

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In conducting the initial assessment of a preoperative client, the nurse notes that the client's home medications include the monoamine oxidase (MAO) inhibitor phenelzine. Because of this client's medication history, which assessment finding is most important for the nurse to monitor?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A female college student is admitted to the mental health unit following a drug overdose. The student tells the nurse that she took the overdose following the end of a romantic relationship. Which is the primary goal for hospitalization that should be included in this client's plan of care?

Correct Answer is A

Explanation

A client with schizophrenia is demonstrating echolalia, which is becoming annoying to other clients on the unit. Which intervention is best for the nurse to implement?

Correct Answer is C

Explanation

The nurse is assessing a client who reports using cocaine several times in the past week.Which observations should the nurse expect on assessment?

The nurse is preparing the physical environment to interview a new client for admission to the mental health unit. Which environmental setting facilitates the best outcome of the interview?

The nurse documents that a male client with schizophrenia is delusional. Which statement by the client confirms this assessment?

A client with borderline personality disorder tells the nurse, "You are the best nurse on the unit! The other nurses don't care about me the way you do." Which response should the nurse provide to this client?

Following the visit, what are appropriate actions for the nurse? Select all that apply.

A client with post-traumatic stress disorder (PTSD) is admitted to the psychiatric unit. Which intervention is most important for the nurse to include in this client's plan of care?