A nurse is caring for a client on a psychiatric unit.

Exhibits

For each potential action, click to specify if the action is indicated or contraindicated for the client.

Ask the client about the content of their hallucinations.

Instruct the client on expected hygiene practices.

Allow the client to watch TV at a high volume.

Assess the client for suicidal ideation.

Place the client in a room near the activity

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"B"}}

Potential action	Indicated	Contraindicated
Ask the client about the content of their hallucinations.	✓
Instruct the client on expected hygiene practices.	✓
Allow the client to watch TV at a high volume.		✓
Assess the client for suicidal ideation.	✓
Place the client in a room near the activity		✓

Rationale

Ask the client about the content of their hallucinations: Indicated
- Understanding the content of hallucinations can help in assessing the severity and nature of the client's condition, and in planning appropriate interventions.
Instruct the client on expected hygiene practices: Indicated
- Encouraging and educating the client about personal hygiene is important for their overall well-being and social interactions.
Allow the client to watch TV at a high volume: Contraindicated
- High volume and excessive stimulation can exacerbate symptoms of schizophrenia, such as hallucinations and agitation.
Assess the client for suicidal ideation: Indicated
- Regular assessment for suicidal thoughts is crucial, even if the client initially denies them, as their mental state can change.
Place the client in a room near the activity: Contraindicated
- A quieter environment is generally more beneficial for clients with schizophrenia to reduce overstimulation and stress.

Nursing Test Bank

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Free Nursing Study Resources

Correct Answer is A

Explanation

A. Spotting or painless vaginal bleeding is a hallmark sign of placenta previa.

B. A board-like abdomen is associated with placental abruption, not placenta previa.

C. Nausea is not a typical symptom of placenta previa.

D. Delayed menses is unrelated to placenta previa and indicates a different condition.

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Explanation

Answers: Hypoxemia; Oxygen saturation

Rationale:

Hypoxemia: The client’s oxygen saturation is 88% on room air, which is below the normal range (≥ 95%). Hypoxemia is the most immediate and life-threatening concern as it affects oxygen delivery to vital organs.

Oxygen saturation: Low oxygen saturation is a direct indicator of impaired gas exchange, commonly seen in conditions like pneumonia. The priority intervention is to improve oxygenation, as outlined in the provider's prescription to administer oxygen at 2 L/min via nasal cannula.

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A nurse is caring for a client on a psychiatric unit. Exhibits For each potential action, click to specify if the action is indicated or contraindicated for the client.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has a placenta previa. Which of the following findings should the nurse expect?

Correct Answer is A

Explanation

A nurse working in the emergency department (ED) is admitting a client. Exhibits Complete the following sentence by using the lists of options. The nurse should first address the client's ___1___ evidenced by the client's ___2___.

Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}

Explanation

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A nurse is caring for a client on a psychiatric unit.

Exhibits

For each potential action, click to specify if the action is indicated or contraindicated for the client.