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: Keeping the environment warm can help prevent the vasoconstriction that can exacerbate PAD symptoms.

Choice B reason: Resting with the legs above heart level is not typically recommended for PAD as it can reduce arterial blood flow to the legs.

Choice C reason: Applying a heating pad is not recommended for clients with PAD because they may have decreased sensation and could suffer burns.

Choice D reason: Wearing antiembolic stockings during the day can help improve circulation, which is beneficial for clients with PAD.

A. Auditory hallucinations B. Free-floating anxiety C. Flashbacks D. Delusions of grandeur

Correct Answer is C

Explanation

Choice A reason: Auditory hallucinations involve hearing voices or sounds that are not present, which does not match Audrey's experience of visual perceptions.

Choice B reason: Free-floating anxiety is a general feeling of unease that is not tied to a specific situation, whereas Audrey's anxiety is triggered by a specific scenario reminiscent of past trauma.

Choice C reason: Flashbacks are vivid, often distressing, memories of past traumatic events that feel as though they are happening in the present. Audrey's experience is indicative of flashbacks related to her military service.

Choice D reason: Delusions of grandeur involve beliefs of inflated worth, power, or identity, which is not described in Audrey's situation.

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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

A nurse is reinforcing discharge teaching with an older adult client who has peripheral artery disease (PAD). Which of the following instructions should the nurse include in the teaching?

Correct Answer is A

Explanation

Audrey is a veteran who served in Afghanistan. She finds it very difficult to drive through a parking ramp because she perceives that "There are people hiding behind the pillars! They have guns! Be careful." Audrey is most likely experiencing which of the following?

Correct Answer is C

Explanation

A nurse overhears a client who has schizophrenia talking to herself. The client keeps stating, "The muxtranks are coming. The muxtranks are coming." The nurse correctly recognizes the client's use of the word "muxtranks" as an example of which of the following alterations in speech?

During general surgery, a nurse observes tachycardia, muscle rigidity, respiratory acidosis, and hyperthermia in a patient. Which complication of surgery does the nurse suspect?

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A nurse is collecting data from a client who has histrionic personality disorder. Which of the following findings should the nurse expect?

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A patient who repeats a word or part of a word over and over might be said to have which of the following symptoms?

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