A nurse is caring for a client who becomes extremely agitated and asks if they can go to a separate room to be alone for an hour.
The nurse should document which of the following de-escalation techniques in the client's medical record?.

A nurse is reinforcing behavior management techniques with the parent of a school-age child who has conduct disorder.
Which of the following statements by the parent indicates an understanding of the redirection technique? .

A nurse is collecting data from a client who has schizophrenia.
Which of the following client statements indicates that the client is experiencing a command hallucination? .

The nurse has reviewed the nurses' notes, provider's note, and vital signs at 0400.

Nurses' Notes 0205: Client brought to the ED by police after being found wandering on the street.

Client able to provide identity to police but not able to identify place or time.

Family notified.

0230: Client confused and agitated.

Appearance is disheveled.

Mucous membranes dry.

Lungs clear and equal, heart rhythm regular.

During data collection, the client states, "Can you ask that person to leave my room?" Client is pointing to an empty chair.

The client's adult child arrived at the ED and went to the client's room.

The client identified the family member.

The client is pacing and agitated and states, "I don't understand why I am here.”. The adult child asks the nurse to talk outside of the room and states, "I don't know why they are so confused.

They are not normally like this.”. The adult child.

Which of the following interventions should the nurse include in the client's care? Select the 3 interventions the nurse should implement.

Approach client slowly.

Alternate nursing staff daily.

Maintain a low stimulation environment.

Reorient client to person, place, and time frequently.

Provide the client with limited information about the diagnosis.

A nurse is collecting data from a client who is experiencing opioid withdrawal.
Which of the following manifestations should the nurse expect?.

A nurse is reinforcing teaching with a client who has bipolar disorder and has a new prescription for lithium.
To address possible adverse effects, the nurse should include that which of the following laboratory values will be monitored while the client is taking this medication? .

The nurse has reviewed the nurses' notes, provider's note, and vital signs at 0400.

For each potential provider prescription, click to specify if the prescription is expected or unexpected for the client.

A nurse in a mental health clinic is collecting data from a client to determine the client's risk for suicide.
Which of the following findings should the nurse identify as a risk factor for suicide? (Select all that apply.) .

A nurse is reinforcing teaching with a newly licensed nurse about client confidentiality.
Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?.

A nurse is reinforcing teaching with a client who started taking haloperidol decanoate 125 mg IM 1 month ago.
Which of the following statements by the client should the nurse address?.

A nurse is contributing to the plan of care for a client who has bipolar disorder and whose admission was voluntary.
For which of the following interventions should the nurse confirm that the client has given informed consent?.