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The nurse is performing a history and physical assessment for a client in the clinic with moderate dementia. The client becomes agitated when asked questions and inquires why so many questions are being asked. What are the best actions for the nurse to take to obtain the necessary data? Select all that apply.

Persistently ask the same question until answered.

Give the client ample time to answer the questions asked.

Ask simple questions instead of compound questions.

Provide simple explanations to the client as often as required.

Take frequent breaks during the interview process.

Answer and Explanation

Correct Answer : B,C,D,E

Choice A reason: Persistently asking the same question can increase agitation in clients with dementia.

Choice B reason: Allowing ample time for responses can reduce pressure and agitation in clients with dementia.

Choice C reason: Simple questions are easier for clients with dementia to understand and respond to.

Choice D reason: Providing simple explanations can help clients with dementia understand the purpose of the questions.

Choice E reason: Taking frequent breaks can help prevent fatigue and agitation during the assessment process.

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Correct Answer is B

Explanation

Choice A reason: This response is dismissive of the client's concerns and does not address her discomfort with a male nurse.

Choice B reason: This response is respectful of the client's wishes and offers a solution that could make her more comfortable.

Choice C reason: This response does not acknowledge the client's specific discomfort with a male nurse and does not offer an alternative.

Choice D reason: While this offers an alternative, it may not fully address the client's discomfort with having a male nurse responsible for her overall care.

A. Dialectical behavior therapy B. Behavioral contract C. Bibliotherapy D. Safety plan

Correct Answer is A

Explanation

Choice A reason: Dialectical behavior therapy (DBT) is a well-established treatment for borderline personality disorder, focusing on skills like mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness.

Choice B reason: While behavioral contracts can be part of treatment, they are not as central or evidence-based as DBT for borderline personality disorder.

Choice C reason: Bibliotherapy can be a supportive tool but is not a primary intervention for the complex needs of someone with borderline personality disorder.

Choice D reason: A safety plan is important, especially if there are concerns about self-harm or suicidal ideation, but it is not a comprehensive treatment approach like DBT.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A male nurse is assigned to care for a female client who was admitted to the hospital for treatment of injuries following a domestic abuse incident. The client expresses discomfort with a male nurse as her caregiver. Which response should the nurse manager provide?

Correct Answer is B

Explanation

A nurse is planning discharge for a client who has borderline personality disorder. Which of the following interventions should be included for this client?

Correct Answer is A

Explanation

During an assessment of family dynamics for a client with an eating disorder, which observed issue could indicate a reason for the client's eating disorder?

The nurse is caring for a client who delivered a newborn 2 days ago and states that they are experiencing crying spells, anxiety, and sadness that started the day after delivery. Which is the most therapeutic action by the nurse?

A nurse is caring for a client who was admitted with acute psychosis and is being treated with haloperidol. The nurse should suspect that the client may be experiencing tardive dyskinesia when the client exhibits which of the following? Select all that apply.

The nurse is providing a high-school prevention program for adolescents and parents about eating disorders. Which important preventative measures will the nurse educate the group regarding? (Select all that apply.)

The nurse is talking with the spouse of a client admitted for substance use disorder and overdose. Which statement(s) made by the spouse indicates that they are exhibiting enabling behaviors? Select all that apply.

A nurse is discussing postpartum depression with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of this condition?

The nurse is planning an approach that will be most effective in developing a therapeutic relationship with a client. Which disorder(s) will the nurse best employ a matter-of-fact approach with the client? (Select all that apply.)

A client with cognitive deficits is extremely suicidal and has not responded to antidepressants. The treatment team is considering electroconvulsive therapy (ECT). Which client information would impact the feasibility of this treatment option?