A nurse is receiving a change-of-shift report about a group of assigned clients at a mental health facility. Which of the following clients should the nurse assess for risks related to sensory impairments?
A client who has conversion disorder
A client who has mild anxiety disorder
A client who has narcissistic personality disorder
A client who has severe obsessive-compulsive disorder
The Correct Answer is A
Choice A reason: This client experiences psychological stress that manifests as neurological symptoms, such as blindness, deafness, or paralysis, without an underlying medical cause. These deficits are real to the client, creating significant safety risks. The nurse must prioritize assessing their ability to navigate the environment safely to prevent falls or injuries related to these sudden sensory losses.
Choice B reason: Mild anxiety disorder typically does not involve sensory impairments. Anxiety may cause heightened awareness or sensitivity to stimuli but does not result in a loss of sensory function.
Choice C reason: Narcissistic personality disorder is characterized by patterns of grandiosity, need for admiration, and lack of empathy. It does not include sensory impairments as a symptom.
Choice D reason: While this client may engage in time-consuming rituals or repetitive behaviors that interfere with daily life, the disorder does not typically present with neurological or sensory impairments. Potential physical risks for these clients usually involve skin integrity issues from excessive washing or nutritional imbalances rather than the loss of primary senses like sight or hearing.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Providing detailed explanations to a client with moderate anxiety might overwhelm them and exacerbate their anxiety. While information is important, too much detail can be counterproductive in this context.
Choice B reason: Using short, simple sentences can help ensure that the client with moderate anxiety comprehends the information without becoming overwhelmed. This approach is conducive to learning and retention, especially when the client is anxious.
Choice C reason: Avoiding asking the client questions may seem like a way to reduce stress, but it can actually hinder engagement and understanding. Questions can help clarify the client's comprehension and provide them with a sense of involvement in their care.
Choice D reason: Showing a 30-minute teaching video might be informative, but it could be too lengthy for a client with moderate anxiety. The client may benefit more from interactive and personalized teaching methods that allow for breaks and questions as needed.
Correct Answer is C
Explanation
Choice A reason: While attending support group meetings can be beneficial for individuals with borderline personality disorder by providing a sense of community and shared experiences, it is not the immediate priority. Support groups can offer emotional support and coping strategies, but they do not directly address the urgent safety concerns that may arise with this disorder.
Choice B reason: Discussing the use of assertive behavior is an important aspect of therapy for individuals with borderline personality disorder, as it can help them express their needs and feelings in a healthy way. However, this is part of a long-term strategy for improving interpersonal relationships and communication skills, rather than an immediate safety concern.
Choice C reason: Implementing measures to prevent intentional self-inflicted injury is the priority when planning care for a client with borderline personality disorder. Due to the high risk of self-harm and suicidal behaviors associated with this disorder, ensuring the client's safety is the most critical and immediate concern. This may include creating a safe environment, developing a crisis plan, and closely monitoring the client.
Choice D reason: Assisting the client to maintain awareness of their thoughts and feelings is a key component of therapy for borderline personality disorder, as it can help them understand and manage their emotions more effectively. However, while this is important for long-term management, it is not the immediate priority when compared to ensuring the client's safety.
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