The nurse is caring for a client diagnosed with Severe Intellectual Disability. Which of the following characteristics should the nurse recognize to be associated with Severe Intellectual Disability?

Other than possible coordination problems, the client's psychomotor skills are not affected.

The client communicates wants and needs by "acting out behaviors.”

The client can perform some self-care activities independently.

The client has advanced speech development.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Other than possible coordination problems, the client's psychomotor skills are not affected. Severe Intellectual Disability (ID) is characterized by significant limitations in intellectual functioning as well as adaptive behaviors. Coordination problems are not a primary characteristic of severe ID. The main focus is on cognitive and adaptive deficits.

Choice B rationale:

The client communicates wants and needs by "acting out behaviors." Severe ID can lead to challenges in effective communication. "Acting out behaviors" such as tantrums, aggression, or other disruptive actions might be the client's way of expressing themselves when they are unable to communicate verbally or effectively due to their cognitive limitations.

Choice C rationale:

The client can perform some self-care activities independently. Severe ID typically involves significant impairments in adaptive functioning, which includes self-care activities. The ability to perform some self-care activities independently is not consistent with the characteristics of severe ID.

Choice D rationale:

The client has advanced speech development. Severe ID is associated with delayed or impaired speech and language development. Advanced speech development would be contradictory to the diagnosis of severe ID, as this condition is characterized by substantial limitations in communication skills.

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Correct Answer is B

Explanation

The correct answer is Choice B.

Choice A rationale: Worrying about a pimple, while significant for self-esteem, does not indicate an immediate risk. Addressing more serious concerns first is crucial, although self-esteem issues should be considered subsequently.

Choice B rationale: Expressing feelings of social isolation and dislike towards peers can indicate underlying mental health concerns, such as depression or anxiety. Addressing these feelings is a priority to provide support and prevent potential escalation.

Choice C rationale: Feeling that parents treat them like a baby can be part of normal adolescent development and is not typically a priority concern unless it significantly impacts the child's well-being.

Choice D rationale: Concerns about not having started menstruation are common and usually not immediately alarming unless accompanied by other signs of developmental delay. Reassurance and providing information can address this issue effectively.

A. Ask the client direct questions about the hallucination. B. Act to the client as if the hallucination is real. C. Tell the client to go to their room and they should go away. D. Instruct the client to argue with the voices that are a part of the hallucination.

Correct Answer is A

Explanation

The correct answer is choice A. Ask the client direct questions about the hallucination.

Choice A rationale:

Asking direct questions about the hallucination helps the nurse understand the client’s experience and assess the content and intensity of the hallucinations. This approach also allows the nurse to provide appropriate support and interventions.

Choice B rationale:

Acting as if the hallucination is real can reinforce the client’s distorted perception of reality, which is not therapeutic. The nurse should acknowledge the client’s experience without validating the hallucination as real.

Choice C rationale:

Telling the client to go to their room and that the hallucinations should go away is dismissive and does not address the client’s immediate needs. It is important to engage with the client and provide support rather than dismiss their experience.

Choice D rationale:

Instructing the client to argue with the voices can increase the client’s distress and is not a recommended therapeutic approach. Instead, the nurse should help the client find ways to cope with and manage the hallucinations.

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The nurse is caring for a client diagnosed with Severe Intellectual Disability. Which of the following characteristics should the nurse recognize to be associated with Severe Intellectual Disability?

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Explanation

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