The nurse is caring for an assigned group of clients. Which client does the nurse identify as being at the highest risk for the development of delirium and will be closely monitored?

A client with a blood glucose level of 110 mg/dL (6.1 mmol/L).

A client who sustained a fractured femur in a motor vehicle crash.

An adult client being prepared for a laparoscopic cholecystectomy.

An older adult client with sepsis from a urinary tract infection.

Answer and Explanation

The Correct Answer is D

Choice A reason: This choice is incorrect. A blood glucose level of 110 mg/dL is within normal range and does not significantly increase the risk of delirium.

Choice B reason: While a fractured femur can be painful and stressful, it does not pose the highest risk for delirium compared to sepsis.

Choice C reason: Preparation for surgery can be a risk factor for delirium, but it is not as high a risk as sepsis in an older adult.

Choice D reason: This is the correct choice. Older adults with sepsis are at a high risk for delirium due to the systemic infection and its impact on overall health.

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Correct Answer is D

Explanation

Choice A reason: Separate personalities are not a characteristic of schizophrenia; this is a common misconception. The disorder involving separate personalities is more accurately associated with dissociative identity disorder.

Choice B reason: While mood swings and hostility can occur in schizophrenia, they are not defining features of the disorder. Schizophrenia is primarily characterized by psychosis, which includes delusions and hallucinations.

Choice C reason: Preoccupation with somatic symptoms is more commonly associated with somatic symptom disorder, not schizophrenia. Schizophrenia involves a range of symptoms including cognitive and emotional dysfunctions.

Choice D reason: Thought disturbances, such as disorganized thinking, and hallucinations, particularly auditory ones, are hallmark symptoms of schizophrenia and are often used in its assessment.

A. "Our child will sleep longer and could oversleep in the morning." B. "Our child may have some side eﬀects, like insomnia, loss of appetite, or weight loss." C. "Our child needs to take this medication once every 12 hours." D. "We'll bring our child in every week to get blood levels drawn."

Correct Answer is B

Explanation

Choice A reason: This choice is incorrect because stimulant medications used to treat ADHD are known to potentially cause insomnia rather than increased sleep duration.

Choice B reason: This is the correct choice. Common side eﬀects of stimulant medications for ADHD include insomnia, loss of appetite, and weight loss. These side eﬀects are well-documented and are important for parents to be aware of.

Choice C reason: This choice is incorrect. While the frequency of medication administration is important, the statement is too vague and does not reﬂect the common dosing schedule for ADHD stimulant medications, which can vary based on the specific medication and the individual's needs.

Choice D reason: This choice is incorrect. Routine blood level monitoring is not a standard requirement for ADHD stimulant medication therapy. Monitoring typically focuses on growth, blood pressure, heart rate, and the presence of any side eﬀects.

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The nurse is caring for an assigned group of clients. Which client does the nurse identify as being at the highest risk for the development of delirium and will be closely monitored?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Schizophrenia is most often characterized by which assessment finding?

Correct Answer is D

Explanation

A 9-year-old patient with atention deficit hyperactivity disorder (ADHD) has been prescribed a stimulant. The nurse knows that the teaching has been eﬀective when the patient's parents make which statement?

Correct Answer is B

Explanation

For a client diagnosed with obsessive-compulsive disorder (OCD), which strategy should the nurse include in the client's plan of care to address the challenge of coping eﬀectively with daily obsessions and compulsions?

The nurse is teaching relaxation techniques to a client with obsessive-compulsive disorder (OCD). When should the nurse teach relaxation techniques to the client?

When conducting a risk assessment for suicide, the nurse most likely identifies which client as having the greatest risk for completing suicide?

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Which goal is appropriate for the client being treated for obsessive-compulsive disorder with response prevention therapy?

The geriatrician has prescribed medication for an 80-year-old client to treat the client's dementia. Which teaching points should the nurse provide to the client's spouse about the new medication?

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