A nurse is preparing to give change-of-shift report to the oncoming nurse. Which of the following information should the nurse include?

Medical diagnosis.

Number of visitors.

Routine care.

Expected laboratory results.

Answer and Explanation

The Correct Answer is A

A. Medical diagnosis:
This provides context for the patient’s condition and guides the next nurse in understanding care priorities.

B. Number of visitors:
This is not essential clinical information for continuity of care.

C. Routine care:
Routine care (like scheduled hygiene or linen changes) is generally not included unless there was a deviation or issue.

D. Expected laboratory results:
Only actual or pending critical results should be reported. “Expected” values are not useful unless they have been received and are relevant.

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Correct Answer is C

Explanation

Collaborate with the client to develop a daily physical exercise routine. This intervention can help reduce aggression and impulsivity in schizophrenia by providing an outlet for frustration, enhancing self-esteem, and improving mood. Physical exercise can also improve physical health and reduce the risk of metabolic syndrome associated with antipsychotic medications.

Choice A is wrong because warning the client that the staff will use seclusion as a consequence if there are repeated reports of hallucination is punitive and threatening. This can increase the client’s anxiety, paranoia, and hostility, and may worsen the psychotic symptoms. Seclusion should only be used as a last resort when the client poses a serious danger to self or others, and not as a punishment or coercion.

Choice B is wrong because keeping the facility’s security personnel constantly visible to the client throughout treatment is intimidating and stigmatizing. This can also increase the client’s fear, distrust, and resentment, and may trigger aggressive behavior. Security personnel should only be involved when there is an imminent risk of violence, and not as a routine measure.

Choice D is wrong because agreeing that the hallucinations are real if the client exhibits aggressive behavior toward other clients is reinforcing the delusional belief and rewarding the aggression. This can also confuse the client and undermine the therapeutic relationship.

The nurse should acknowledge the client’s experience of hallucinations, but not endorse them as reality. The nurse should also set clear limits on aggressive behavior and use de-escalation techniques to calm the client.

A. “Perform the self-examination every 3 months.” B. “Examine your testicles after a warm shower.” C. “Palpate both testicles firmly with your fingertips.” D. “Apply a cool compress to the scrotum prior to examination.”

Correct Answer is B

Explanation

Examine your testicles after a warm shower.

This is because a warm shower will relax the scrotum and the muscles holding the testicles, making an exam easier. You should gently roll the scrotum with your fingers to feel the surface of each testicle and check for any lumps, bumps, swelling, hardness or other changes.

Choice A is wrong because you should perform the self-examination every month, not every 3 months.

This will help you notice any changes over time.

Choice C is wrong because you should not palpate both testicles firmly with your fingertips. You should use a gentle touch and avoid squeezing or pressing too hard.

Choice D is wrong because you should not apply a cool compress to the scrotum prior to examination. This will make the scrotum contract and tighten, making an exam more difficult.

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A nurse is preparing to give change-of-shift report to the oncoming nurse. Which of the following information should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is contributing to the plan of care for a newly-admitted client who has schizophrenia and a history of aggressive behavior. Which of the following interventions should the nurse include in the initial plan?

Correct Answer is C

Explanation

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Correct Answer is B

Explanation

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