A nurse in a primary care provider’s office is caring for a client.
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Nurses’ Notes
Today, 0900: Client returns for a follow-up examination after new onset of symptoms; client reports loss of appetite; reports sleeping most of the day; became teary when asked about plans for activities; questions reason to live if not working; auscultated lungs for a dry, nonproductive cough; breath sounds present bilaterally; experiences occasional muscle “aches and pains”; reports having no energy.
Client returns for a follow-up examination after new onset of symptoms
loss of appetite
sleeping most of the day
became teary when asked about plans for activities
questions reason to live if not working
experiences occasional muscle “aches and pains”
having no energy
The Correct Answer is ["A","B","C","D","E","F","G"]
The client’s return for a follow-up examination after new onset of symptoms indicates a change in their health status that requires immediate attention.
Loss of appetite can be a sign of various health issues, including depression and other mental health disorders1. It’s important to address this symptom promptly to ensure the client is receiving proper nutrition.
Excessive sleepiness can be a symptom of several conditions, including depression, sleep disorders, and certain medical conditions1. It’s important to investigate this symptom further to determine its cause.
Becoming teary when asked about plans for activities could indicate emotional distress or depression. Mental health is a critical aspect of overall health, and this symptom should be addressed promptly.
Questioning the reason to live if not working is a serious symptom that could indicate suicidal ideation
This requires immediate attention and intervention.
While a dry, nonproductive cough can be a symptom of a respiratory condition, since breath sounds are present bilaterally, it may not require immediate attention. However, any persistent cough should be evaluated.
Occasional muscle aches and pains can be a symptom of various conditions, including fibromyalgia, influenza, and other infections1. It’s important to investigate this symptom further to determine its cause.
Reporting no energy could be a symptom of conditions such as depression, chronic fatigue syndrome, or anemia. This symptom should be addressed promptly to determine its cause and appropriate treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason:
Listening carefully to the voices to hear what they're saying is not a recommended strategy for managing schizophrenia. Engaging with hallucinations can reinforce them and increase distress. Instead, clients are often taught to use distraction techniques or reality-testing strategies to manage auditory hallucinations. It is important for clients to recognize that the voices are a symptom of their condition and not something to be engaged with.
Choice B Reason:
Letting the counselor know if the client is having trouble sleeping is an important aspect of relapse prevention. Sleep disturbances can be an early warning sign of a potential relapse in schizophrenia. By informing their counselor, the client can receive timely interventions to address sleep issues and prevent a full-blown relapse. This proactive approach helps in managing symptoms and maintaining stability.
Choice C Reason:
Avoiding being around others if the client thinks they are having a relapse is not advisable. Social isolation can exacerbate symptoms and increase the risk of relapse. It is important for clients to stay connected with their support network and seek help if they notice signs of relapse. Engaging with others can provide emotional support and help in managing symptoms more effectively.
Choice D Reason:
Avoiding watching television when hearing voices is not a comprehensive strategy for managing hallucinations. While reducing exposure to certain stimuli can be helpful, it is more important for clients to use coping strategies and seek support from their healthcare team. Effective management of hallucinations involves a combination of medication, therapy, and support from mental health professionals.
Correct Answer is []
Explanation
Potential Condition The client is most likely experiencing b. Antisocial personality disorder. This is suggested by the client’s lack of remorse, impulsivity, deceitfulness, and aggressive behavior when denied something she wants.
Actions to Take To address this condition, the nurse should:
- a. Assess history of criminal behavior: This can provide insight into the severity and pattern of the client’s antisocial behavior.
- e. Establish clear and realistic boundaries regarding behavior: This can help manage the client’s impulsivity and aggressive behavior.
Parameters to Monitor To assess the client’s progress, the nurse should monitor:
- c. Aggressive and violent behavior: Any reduction in these behaviors can indicate improvement.
- e. Deceitfulness: A decrease in deceitful behavior can also signal progress.
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