A nurse is caring for a newly admitted client who has schizophrenia. Which of the following actions is the nurse's priority?
Determine if the client is experiencing command hallucinations.
Arrange for the client to have consistent staff assignments.
Administer lorazepam to the client.
Use the client's name when talking to him.
The Correct Answer is A
Choice A rationale:
Assessing for the presence of command hallucinations is a priority, as they can pose a risk to the client's safety and the safety of others.
Choice B rationale:
Consistent staff assignments can be important for clients with schizophrenia, but immediate safety concerns should take precedence.
Choice C rationale:
Administering medication is not the priority action unless there is a specific reason to do so based on the assessment.
Choice D rationale:
Using the client's name is respectful and helpful, but it is not the priority action in this scenario.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
Warm water can help soothe the lesions and decrease painful urination, providing relief to the client.
Choice B rationale:
The client with genital herpes can still shed the virus and potentially transmit it to others even when there are no visible lesions, so this statement is incorrect.
Choice C rationale:
Genital herpes is a viral infection, and antibiotics are not effective in treating viral infections. Antiviral medications are used to manage genital herpes outbreaks.
Choice D rationale:
Soaking in a bubble bath can potentially irritate the lesions and worsen discomfort. It is not recommended for individuals with genital herpes.
Correct Answer is B
Explanation
Choice A rationale
Omeprazole is a proton pump inhibitor used to reduce stomach acid production and is not typically used for treating bloody stools in inflammatory bowel disease.
Choice B rationale:
Infliximab is used to treat inflammatory bowel disease and can help manage symptoms such as bloody stools by suppressing the inflammatory response.
Choice C rationale:
Ondansetron is an antiemetic used for nausea and vomiting, not related to bloody stools.
Choice D rationale:
Metoclopramide is used to treat nausea, vomiting, and gastrointestinal motility disorders, not specifically indicated for bloody stools.
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