A nurse is assisting with the care of a client who has schizophrenia and auditory hallucinations. Which of the following responses should the nurse make?
"I'm sure the voices will go away soon."
"Let's talk about what the voices are saying to you."
"You should talk to your counselor about the voices."
"Tell me what medications you are taking."
The Correct Answer is B
This response acknowledges the client's experience and shows a willingness to understand and address their concerns.
It opens up a dialogue about the hallucinations, allowing the nurse to gather more information and assess the client's current mental state. It also demonstrates empathy and support, which can help build trust between the nurse and the client.
Offering to discuss the voices with the client can also help in developing coping strategies and exploring potential interventions to manage the hallucinations effectively.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
a.Ferrous sulfateworks best when you take it on an empty stomach. However, taking ferrous sulfate on an empty stomach can actually increase the risk of gastrointestinal side effects, such as nausea. It is often recommended to take it with food to reduce nausea, even though absorption is best on an empty stomach. Thus, this statement does not indicate proper understanding.
b.Black stools are a common side effect of taking iron supplements and are usually not a cause for concern unless they are tarry or associated with other symptoms, which could indicate gastrointestinal bleeding. Reporting black stools to the doctor is typically not necessary unless the stool is tarry and has other concerning symptoms like abdominal pain or bleeding. This statement reflects a misunderstanding of common side effects.
c.Mixing ferrous sulfate elixir with a full glass of water is advisable because it helps dilute the medication, making it easier to swallow and reducing the risk of gastrointestinal irritation. This practice also ensures that the medication is taken completely. This statement indicates a correct understanding of how to take the medication properly.
d.While staying hydrated can help manage constipation, milk is not recommended with iron supplements because calcium in milk can interfere with the absorption of iron. Instead, increasing water intake, eating a high-fiber diet, and considering other dietary measures would be better advice for preventing constipation.
Correct Answer is A
Explanation
When administering eye drops to a child, the nurse should apply gentle pressure to the lacrimal punctum (the small opening in the inner corner of the eye) after administering the drops. This can help prevent the medication from draining into the tear duct and being absorbed into the bloodstream, which can reduce systemic side effects.
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