The mental health nurse observes that a female client with delusional disorder carries some of her belongings with her because she believes that others are trying to steal them. Which nursing action will promote trust?

Explain that these beliefs are related to her illness.

Explain that distrust is related to feeling anxious.

Initiate short, frequent contacts with the client.

Offer to keep the belongings at the nurse's desk.

Answer and Explanation

The Correct Answer is C

(A) Explain that these beliefs are related to her illness: While it is important to educate the client about their illness, directly challenging their delusions may increase distrust and anxiety. This approach might make the client feel misunderstood and less likely to trust the nurse.

(B) Explain that distrust is related to feeling anxious: This explanation might not be well-received by the client and could be perceived as dismissive of their concerns. It may not effectively address the client’s immediate need for trust and reassurance.

(C) Initiate short, frequent contacts with the client: This approach helps build trust through consistent and reliable interactions. It allows the nurse to establish a rapport without overwhelming the client, thereby promoting a sense of safety and trust. Regular, brief interactions can help the client feel more comfortable and secure.

(D) Offer to keep the belongings at the nurse’s desk: This action might be perceived as an attempt to take control of the client’s belongings, which could reinforce their delusions and decrease trust. It is important to respect the client’s need to keep their belongings close to them.

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Correct Answer is A

Explanation

A) Reviewing serum creatinine is the most critical laboratory finding prior to initiating lithium therapy. Lithium is primarily excreted through the kidneys, and any existing renal impairment can increase the risk of lithium toxicity. Ensuring normal kidney function is vital for safe lithium administration and monitoring throughout the treatment.

B) While blood glucose levels can be relevant in the context of overall health and any potential metabolic syndrome concerns, they are not as directly related to lithium therapy as renal function. Blood glucose levels do not significantly impact the safety or effectiveness of lithium.

C) A white blood count (WBC) can be important in assessing for potential infections or hematological disorders, but it is not the primary focus when starting lithium. Lithium does not typically have a direct effect on white blood cell levels, making this finding less critical compared to renal function.

D) Alkaline phosphatase levels are primarily related to liver function and bone health. While monitoring liver function is important in general, it is not as directly pertinent to the initiation of lithium therapy as assessing renal function through serum creatinine levels. Therefore, this laboratory finding is less of a priority in this context.

A. Tell me what you think should happen. B. Call for transportation to the hospital. C. How serious was the collision D. What do you think you should do?

Correct Answer is B

Explanation

A) Asking the employee what she thinks should happen may put additional pressure on her during an extremely distressing moment. In a crisis, individuals often struggle to think clearly, and this response may not provide the immediate support she needs.

B) Calling for transportation to the hospital is the best response. This action demonstrates immediate support and concern for her well-being and allows her to prioritize reaching her child. It provides practical assistance in a moment of crisis and helps ensure she can get to her child as quickly as possible.

C) Asking how serious the collision was may seem relevant, but it could increase anxiety for the employee. She may not have this information, and discussing the severity of the situation could lead to further distress when she is already overwhelmed.

D) Asking what she thinks she should do could also add pressure to make a decision at a time when she is likely feeling helpless and confused. In a crisis, offering direct support and assistance is typically more effective than seeking input from the individual.

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The mental health nurse observes that a female client with delusional disorder carries some of her belongings with her because she believes that others are trying to steal them. Which nursing action will promote trust?

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Naxlex Comprehensive Predictor Exams

The healthcare provider prescribes lithium carbonate for a client diagnosed with bipolar, manic depression. It is most important for the nurse to review which laboratory finding prior to beginning the drug therapy?

Correct Answer is A

Explanation

The occupational health nurse is working with a female employee who was just notified that her child was involved in a motor vehicle collision and taken to the hospital. The employee states, 1 can't believe this. What should I do? Which response is best for the nurse to provide in this crisis?

Correct Answer is B

Explanation

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