A male college student brings his roommate to the clinic because the roommate has been talking to someone who is not present. The client tells the practical nurse (PN) that the voices are saying, "Kill, kill.”. Which question should the PN ask the client next?

The correct answer is Choice A:

"Are you planning to obey the voices?.”. Choice A rationale:

The PN should ask the client if he plans to obey the voices because it helps assess the potential risk of harm to himself or others. If the client indicates an intention to follow the voices' commands to harm someone, it indicates a serious concern for safety and may require immediate intervention to protect the client and others.

Choice B rationale:

While asking if the client believes the voices are real is important for understanding the client's perception of the situation, it may not immediately address the risk of harm that the client or others might be facing.

Choice C rationale:

Asking if the client has taken any hallucinogens is relevant to explore possible substance- induced psychosis, but this question should be asked later in the assessment process. The priority is to assess immediate safety concerns related to the client's compliance with the voices' instructions.

Choice D rationale:

Inquiring about when the voices began is important, but it is not the most urgent question in this situation. Although the onset of the symptoms is relevant, addressing the potential for harmful actions should be prioritized.

The correct answer is choice A. Consecutive evening serum glucose greater than 260 mg/dL.

Choice A rationale:

A consecutive evening serum glucose greater than 260 mg/dL indicates persistent hyperglycemia. Inadequate NPH insulin dosage may lead to consistently high blood glucose levels, which can result in various complications.

Choice B rationale:

The complaint of cold feet and numbness is not a specific indicator of inadequate insulin dosage. Neuropathy and circulation issues can occur with poorly controlled diabetes, but they are not solely indicative of inadequate insulin.

Choice C rationale:

Nausea in the morning, even with the ability to eat breakfast, does not necessarily point to inadequate insulin dosage. It could be due to various factors, including dietary choices or other medical conditions.

Choice D rationale:

The wound on the ankle that starts to drain and becomes painful is not a specific sign of inadequate insulin dosage. Poorly controlled diabetes can lead to delayed wound healing, but it does not necessarily indicate that the current insulin dosage is insufficient.