What is the priority finding to report to the provider for a client who has schizophrenia and is taking clozapine?

Sore throat

Heart rate 104/min

Nausea

Random blood glucose 130 mg/dL

Answer and Explanation

The Correct Answer is A

This finding could indicate agranulocytosis, a potentially life threatening adverse effect of clozapine that causes a severe decrease in white blood cells and increases the risk of infection. The other findings are also important to monitor, but they are not as critical as sore throat.

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Correct Answer is B

Explanation

The nurse should respect the client's privacy and confidentiality and obtain their consent before disclosing any information to their employer or anyone else who is not directly involved in their care. Contacting the legal department, the provider, or the client's family may be appropriate in some situations, but they are not necessary or ethical actions without the client's permission.

A. Role model healthy ways to express anger. B. Suggest the client make a list of things that make him angry. C. Assist the client to explore techniques to reduce stress. D. Ask the client if he intends to harm others.

Correct Answer is D

Explanation

The priority for the nurse is to ensure safety for the client and others in the facility. Asking the client about his or her intentions can help the nurse determine the level of risk and plan appropriate interventions, such as setting limits, providing supervision, or initiating seclusion or restraint if necessary.

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What is the priority finding to report to the provider for a client who has schizophrenia and is taking clozapine?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has schizophrenia. The client's employer calls to discuss the client's condition. Which of the following is the appropriate nursing action?

Correct Answer is B

Explanation

A nurse in a mental health facility is caring for a client who is being aggressive toward other clients. Which of the following actions is the priority for the nurse to take?

Correct Answer is D

Explanation

A nurse in an in-patient facility is caring for a client who has an anxiety disorder. Which of the following actions should the nurse take while the client is experiencing an acute panic attack?

A nurse in an alcohol rehabilitation facility is creating a discharge plan for a client who has alcohol use disorder. Which of the following recommendations should the nurse include in the plan?

A home health nurse visits a client who lost their partner 2 years ago. Which of the following behaviors by the client indicates a maladaptive grief response?

A nurse in a provider's office is assessing a school-age child who has a spiral fracture. The parent of the child provides different accounts of the cause of the injury. Which of the following actions should the nurse take first?

A nurse is preparing for an interprofessional team meeting regarding a newly admitted client who has major depressive disorder. Which of the following findings obtained during the initial assessment is the priority to report to other disciplines?

A nurse is planning to conduct a support group for adolescents who have cancer. Which of the following actions should the nurse include during the orientation phase?

A nurse is caring for a client who reports that he is angry with his partner because she thinks he is just trying to gain attention. When the nurse attempts to talk to the client, he becomes angry and tells her to leave. Which of the following defense mechanisms is the client demonstrating?