A novice nurse is beginning work on a behavioral health unit and states to the preceptor, "What if I encounter a client that is sexually aggressive? Which is the appropriate response by the preceptor?

"Set firm limits and boundaries for the client."

“Tell the client that you are going to report to the director of the unit.”

"Walk away and have someone else take care of the client."

"It happens frequently so just ignore it they will stop."

Answer and Explanation

The Correct Answer is A

When encountering a client who is sexually aggressive, it is important for the nurse to establish firm limits and boundaries to ensure the safety and well-being of both the client and the healthcare team. This response promotes the maintenance of a therapeutic environment and helps prevent potential harm to the client, staff, and other patients.

the other choices are incorrect:

1. "Tell the client that you are going to report to the director of the unit." While it is important to report any concerning behaviors or incidents to the appropriate personnel, simply informing the client about reporting to the director may not be the most effective initial response. Prioritizing immediate actions to ensure safety and setting boundaries is crucial before involving higher-level staff.

2. "Walk away and have someone else take care of the client." Leaving the situation and passing the responsibility to someone else without addressing the issue directly is not an appropriate response. It is the nurse's responsibility to provide care and manage challenging situations within their scope of practice and training. Collaboration and support from the healthcare team may be sought, but abandoning the client is not an acceptable approach.

3. "It happens frequently, so just ignore it; they will stop." Ignoring sexually aggressive behavior is not an appropriate response. Such behavior should be taken seriously and addressed promptly to ensure the safety and well-being of everyone involved. Ignoring the behavior may enable its continuation and potentially lead to further harm or escalation of the situation.

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Correct Answer is D

Explanation

While all members of the interdisciplinary team play important roles in the care of a client started on antidepressant medication, the psychiatric nurse typically takes a leading role in monitoring the medication's effectiveness and side effects.

1. Pharmacist: The pharmacist plays a crucial role in ensuring the safe and accurate dispensing of medications. They provide important information about the medication, its dosing, and potential drug interactions. However, they may not be directly involved in monitoring the client's response to the medication or assessing for specific side effects.

2. Psychiatrist: The psychiatrist is responsible for prescribing the antidepressant medication and determining the appropriate treatment plan for the client. While they may periodically review the client's progress and adjust the medication as needed, their role may focus more on the overall management of the client's mental health condition rather than continuous monitoring of the medication's effectiveness and side effects.

3. Psychologist: The psychologist typically focuses on providing therapy and counseling services to the client. While they may have knowledge about the effects of antidepressant medication, their primary role is not to monitor its effectiveness or side effects.

4. Psychiatric nurse: The psychiatric nurse is often at the forefront of medication monitoring and management. They closely observe the client for changes in symptoms, assess the client's response to the antidepressant medication, and monitor for any potential side effects or adverse reactions. The psychiatric nurse may collaborate with the psychiatrist and other team members to adjust the medication regimen and provide ongoing support and education to the client about their medication.

Correct Answer is ["1.25"]

Explanation

To calculate the dose of Lasix (furosemide) in milliliters (ml), we can set up a proportion using the available concentration and the prescribed dose.

The available concentration is 80 mg/2 ml, which means there are 80 mg of Lasix in 2 ml of solution.

The prescribed dose is 50 mg.

Setting up the proportion:

80 mg / 2 ml = 50 mg / x ml

Cross-multiplying:

80 mg * x ml = 2 ml * 50 mg

80x = 100

Dividing both sides by 80:

x = 100 / 80

x = 1.25

Therefore, the dose of Lasix 50 mg IV would be approximately 1.25 ml.

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A novice nurse is beginning work on a behavioral health unit and states to the preceptor, "What if I encounter a client that is sexually aggressive? Which is the appropriate response by the preceptor?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client has been started on antidepressants. Which interdisciplinary team member is most responsible for monitoring effectiveness and side effects of this new medication?

Correct Answer is D

Explanation

Lasix 50 mg IV. The available vial contains 80mg/2ml. What is the dose in ml?

Correct Answer is ["1.25"]

Explanation

Order: cephalexin (Keflex) 0.5 gp.o. qid. Available: cephalexin (Keflex) 250 mg capsules. How many capsules will the nurse administer?

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he nurse observes the client experiencing a panic attack in the day room in the behavioral health unit. Which is the priority action by the nurse?

A nurse is discussing culturally competent care at a nursing staff inservice. Which of the following information should the nurse include when discussing clients' cultures?

During the assessment, the nurse asks the client to describe the client's problems. The purpose of this question is to obtain information about what?

A nurse is assisting a client who is working on the technique of systematic desensitization. Which statement made by the nurse best uses the principle of technique?

The nurse working in the ED of an urban hospital notifies the manager that there are several clients with mental health disorders still present in the ED that have been there over 48 hours. Which issue related to this phenomenon does the nurse discuss with the manager?

The nurse is preparing a client for a magnetic resonance imaging (MRI). Which statement(s) by the client would require the nurse to notify the health care provider to cancel the procedure? Select all that apply. (Select All that Apply.)