When setting limits with patients with personality disorders, the consequences of violating those limits should be set at which time?

Just before the nurse anticipates the behavior

When the behavior is done

When the staff or family complains about the behavior

When the limit is set

Answer and Explanation

The Correct Answer is D

Choice A reason: Setting consequences just before the behavior occurs does not provide clear expectations and boundaries for the patient.

Choice B reason: Setting consequences after the behavior is done may not effectively prevent the behavior and can lead to inconsistent enforcement.

Choice C reason: Waiting for complaints before setting consequences can lead to a reactive rather than proactive approach to care.

Choice D reason: Consequences should be clearly communicated when the limit is set to establish clear boundaries and expectations, which is essential in managing patients with personality disorders.

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Correct Answer is A

Explanation

Choice A reason: Dehiscence refers to the separation of layers of a surgical wound, which may be partial or complete.

Choice B reason: Evisceration is a more severe complication where the wound opens and internal organs may protrude.

Choice C reason: Gaping refers to a wound that is open but does not necessarily indicate the layers have separated, as in dehiscence.

Choice D reason: Distention generally refers to swelling or enlargement of an organ or area, not specifically to the opening of a wound.

A. The client breathes only when their oxygen levels climb above a certain point. B. The client breathes only when their carbon dioxide levels climb above a certain point. C. The client doesn't notice they need to breathe. D. The client breathes only when their oxygen levels dip below a certain point.

Correct Answer is D

Explanation

Choice A reason: This statement is incorrect because it suggests that higher oxygen levels trigger breathing, which is not the case in hypoxic drive.

Choice B reason: While carbon dioxide levels do influence breathing, this statement is not accurate in the context of hypoxic drive, which is specifically about oxygen levels.

Choice C reason: This choice is incorrect because the client does notice the need to breathe, but the trigger is low oxygen rather than high carbon dioxide levels.

Choice D reason: This is correct. In clients with COPD, chronic high levels of carbon dioxide can lead to a reliance on low oxygen levels to stimulate breathing.

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When setting limits with patients with personality disorders, the consequences of violating those limits should be set at which time?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The sudden bursting open of the wound's edges is known as:

Correct Answer is A

Explanation

A client with COPD should receive only 1-2 liters per minute of oxygen, if needed, or they may lose their hypoxic drive. Which of the following statements is correct about hypoxic drive?

Correct Answer is D

Explanation

The mental health status examination includes (select all that apply):

Ms. T complains of headaches and body pains whenever her husband mentions that the house needs to be cleaned. This has been a recurring problem for more than 6 months. Ms. T probably is suffering from what kind of disorder?

A nurse is assisting with the plan of care for a client who is newly diagnosed with borderline personality disorder. Which of the following interventions is the nurse's priority?

When setting limits with patients with personality disorders, the consequences of violating those limits should be set at which time?

The nurse is providing care for a patient after an above-the-knee amputation due to diabetes complications. Which nursing care is essential for promoting ambulation?

A nurse is collecting data from a client who has anemia due to excessive blood loss during surgery. Which of the following findings should the nurse expect?

Marie has just learned that she has failed her mental health nursing class. She tells her friends, "I knew that instructor was going to fail me. She has never liked me and has just been looking for an excuse to fail me all along." Marie's behavior is an example of which defense mechanism?