The nurse is completing an admission assessment for a client with a known history of depression and multiple, unexplained fractures. Which action should the nurse delegate to the unlicensed assistive personnel (UAP)?

Screen the client for domestic violence.

Determine the client's risk for suicide.

Ask client to state a chief complaint for admission.

Obtain a baseline set of vital signs.

Answer and Explanation

The Correct Answer is D

Choice A rationale: Screening the client for domestic violence requires a more comprehensive assessment and interpretation of findings, which is beyond the scope of practice for the UAP.

Choice B rationale: Determining the client's risk for suicide involves complex judgment and should be assessed by a licensed healthcare provider, not a UAP.

Choice C rationale: Asking the client to state a chief complaint for admission involves initial communication and assessment skills, which should be performed by licensed nursing staff.

Choice D rationale: Obtaining a baseline set of vital signs is a routine task that can be delegated to the UAP. It is a non-complex and standard part of the admission process.

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Correct Answer is D

Explanation

A: While eating nutritious meals is important for recovery, it is not the highest priority because it addresses a physical need without directly addressing the underlying psychological issues.
B: Positive self-esteem is crucial for the recovery from anorexia nervosa. It addresses the core psychological challenges of the disorder, helping the client to develop a healthier self-image and relationship with food.
C: Communication of love and concern by the family is supportive, but it does not directly facilitate the client's personal development of self-esteem and self-worth, which are essential for long-term recovery.
D: Family therapy is beneficial for systemic healing and support, but the individual's self-esteem needs to be established as a priority to empower personal change and recovery.

A. Altruism. B. Regression. C. Compartmentalization. D. Egocentrism.

Correct Answer is A

Explanation

Choice A rationale: Altruism involves addressing one's own needs through meeting the needs of others, and caring for the husband's aging parents is an example of this coping mechanism.

Choice B rationale: Regression involves reverting to an earlier stage of development, which is not evident in the scenario.

Choice C rationale: Compartmentalization is the defense mechanism of separating conflicting thoughts or feelings, which is not clearly identified in the scenario. Choice D rationale: Egocentrism involves seeing the world from only one's own perspective, which is not the primary issue in the scenario.

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The nurse is completing an admission assessment for a client with a known history of depression and multiple, unexplained fractures. Which action should the nurse delegate to the unlicensed assistive personnel (UAP)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which goal has the highest priority for an adolescent client who is hospitalized for weight loss related to anorexia nervosa?

Correct Answer is D

Explanation

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Correct Answer is A

Explanation

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