The nurse is caring for a client who has been admitted with recurring migraine headaches.
To assess the quality of the client's pain experienced from the migraine headache, which approach should the nurse use?

This is the correct answer because it is the most relevant and respectful question to ask the client next. Asking about the onset of the voices can help the practical nurse (PN) determine the possible causes and triggers of the client's hallucinations, which are sensory perceptions that occur without external stimuli. Hallucinations can be caused by various factors, such as mental disorders, substance abuse, medication side effects, physical illnesses, sleep deprivation, or stress. The PN should ask about the frequency, duration, and content of the voices, as well as the client's response to them. The PN should also assess the client's mood, behavior, cognition, and insight. The PN should use a calm, supportive, and nonjudgmental approach when communicating with the client who is experiencing hallucinations.

a) "Are you planning to obey the voices?"
This is not the correct answer because it is not a priority question to ask the client next. Asking about the client's intention to obey the voices can help the PN assess the risk of harm to self or others, which is an important aspect of safety. However, this question may also imply that the PN believes or validates the voices, which may reinforce the client's delusions or false beliefs. The PN should ask about the client's plan to obey the voices only after establishing rapport and trust with the client, and after assessing the nature and content of the voices.

b) "Have you taken any hallucinogens?"
This is not the correct answer because it is not a respectful question to ask the client next. Asking about the client's substance use can help the PN identify the possible causes of hallucinations, as some drugs such as LSD, psilocybin, or ketamine can induce hallucinogenic effects. However, this question may also sound accusatory or confrontational, which may offend or alienate the client. The PN should ask about the client's substance use in a sensitive and nonthreatening manner, and after obtaining informed consent and ensuring confidentiality.

d) "Do you believe the voices are real?"
This is not the correct answer because it is not a helpful question to ask the client next. Asking about the client's belief in the reality of the voices can help the PN assess the level of insight or awareness that the client has about their condition. However, this question may also challenge or invalidate the client's perception, which may cause defensiveness or resistance. The PN should avoid arguing or disagreeing with the client about their hallucinations, as this may damage the therapeutic relationship. The PN should acknowledge and accept the client's experience without endorsing or reinforcing it.

Choice A rationale:

A pH level of 7.35 to 7.45 and HCO3- level of 22 to 26 mEq/L indicate a resolution of ketoacidosis. The normal pH range for the body is 7.35 to 7.45, and a return to this range indicates that the body’s acid-base balance has been restored. The bicarbonate (HCO3-) level is a measure of the metabolic component of the body’s acid-base balance, and the normal range is 22 to 26 mEq/L. A return to this range indicates that the metabolic acidosis caused by the ketoacidosis has been resolved.

Choice B rationale:

A pH level of 7.25 to 7.35 and HCO3- level of 18 to 22 mEq/L would indicate that the client is still in a state of mild acidosis, as the pH is below the normal range and the bicarbonate level is also slightly low, indicating a metabolic acidosis.

Choice C rationale:

A pH level of 7.15 to 7.25 and HCO3- level of 14 to 18 mEq/L would indicate a moderate acidosis. Both the pH and bicarbonate levels are significantly below their normal ranges, indicating a significant disruption in the body’s acid-base balance.

Choice D rationale:

A pH level of 7.05 to 7.15 and HCO3- level of 10 to 14 mEq/L would indicate severe acidosis, which would be life-threatening if not corrected. Both the pH and bicarbonate levels are far below their normal ranges, indicating a severe disruption in the body’s acid-base balance. In conclusion, choice A is correct because it represents values within the normal ranges for both pH and bicarbonate, indicating a resolution of ketoacidosis.