A client with schizophrenia is demonstrating echolalia, which is becoming annoying to other clients on the unit. Which intervention is best for the nurse to implement?

Isolate the client from other clients.

Administer a PRN sedative.

Escort the client to a private area.

Avoid recognizing the behavior.

Answer and Explanation

The Correct Answer is C

A.   Isolating the client might exacerbate feelings of social exclusion and isn't the best approach for managing echolalia.
B.   Administering a sedative should not be the initial response to echolalia unless the behavior poses immediate harm to the client or others.
C.   Escorting the client to a private area can help reduce the annoyance to other clients without isolating or punishing the individual.
D.   Avoiding recognition of the behavior doesn't address the issue and might negatively impact the therapeutic relationship.

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Correct Answer is B

Explanation

A. Familial history of mental illness is important but might not directly impact the initiation of sertraline treatment.
B. Medication history is the most important information to obtain before starting sertraline. This includes any current medications the client is taking, especially other antidepressants, anticoagulants, or medications that may interact with sertraline. Sertraline is a selective serotonin reuptake inhibitor (SSRI), and it can interact with other medications, such as monoamine oxidase inhibitors (MAOIs) or other serotonergic drugs, leading to serious side effects like serotonin syndrome.

C. While current weight may be important for monitoring side effects such as weight gain, it is not as immediately critical as understanding the client’s medication history, particularly regarding potential drug interactions.

D. A history of heart disease is relevant to the overall health assessment, but sertraline is generally considered safe for most individuals with heart disease. However, the medication history is more crucial because of potential drug interactions.

A. Expected, as the client is attempting to reduce anxiety by regressing to a state of lesser anxiety. B. Should be encouraged as representative of the client's non-destructive method of fear expression. C. Unacceptable, and limits should be set to encourage the client to maintain her independence. D. Should be accepted by staff as the first step the client must experience in the grieving process. E. Should be accepted by staff as the first step the client must experience in the grieving process.

Correct Answer is A

Explanation

A. This behavior can be seen as a regression aimed at reducing anxiety during a stressful time, which is a relatively common psychological response to stress or trauma.
B. While it may be a way for the client to cope, encouraging dependency might not necessarily be the best approach to fostering independence.
C. While independence is important, setting rigid limits might not address the underlying emotional needs during a period of distress.
D. Acknowledging and understanding the client's behavior as a coping mechanism within the grieving process can help the staff provide appropriate support and care.

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A client with schizophrenia is demonstrating echolalia, which is becoming annoying to other clients on the unit. Which intervention is best for the nurse to implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Prior to initiating a treatment regimen with the antidepressant sertraline, it is most important for the nurse to obtain which information?

Correct Answer is B

Explanation

Correct Answer is A

Explanation

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