A nurse is receiving change-of-shift report for four clients.
Which of the following clients should the nurse see first?

A client who has bipolar disorder and is speaking loudly.

A client who has schizophrenia and is experiencing olfactory hallucinations.

A client who is taking clozapine and reports a sore throat.

A client who is taking lithium and reports weight gain.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

A client with bipolar disorder who is speaking loudly is displaying a manic symptom, which may require attention but is not the highest priority among the options. It does not pose an immediate risk to the client's physical health.

Choice B rationale:

A client with schizophrenia experiencing olfactory hallucinations may be distressed, but this is not an immediate physical health concern. It may require attention but is not the highest priority.

Choice D rationale:

Weight gain is a potential side effect of lithium, and while it should be monitored and addressed, it is not a critical finding that requires immediate attention.

Choice C rationale:

A client taking clozapine who reports a sore throat should be seen first. Clozapine is associated with a risk of agranulocytosis, a severe condition that can lead to a dangerously low white blood cell count. A sore throat can be an early sign of infection, and in the context of clozapine use, it is crucial to assess and monitor for agranulocytosis promptly. This condition is life-threatening and requires immediate attention to prevent complications. .

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is C

Explanation

Choice A rationale:

Justice refers to the fair and equitable distribution of resources and treatment, and it doesn't directly apply to the nurse supporting the client's refusal of medications.

Choice B rationale:

Beneficence involves the promotion of the client's well-being and may sometimes conflict with the client's autonomy when they refuse treatment. This choice doesn't apply to the situation where the nurse supports the client's decision to refuse medications.

Choice C rationale:

Autonomy is the ethical principle that supports an individual's right to make decisions about their own care, even if those decisions go against medical advice. In this scenario, the nurse is respecting the client's autonomy by supporting their choice to refuse medications.

Choice D rationale:

Veracity involves truth-telling and honesty in the nurse-client relationship. While it is essential, it is not the primary ethical principle being displayed when the nurse supports the client's refusal of medications.

A. The client reports following various cooking blogs. B. The client's potassium level is 3.2 mEq/L. C. The client states that she knows she can't be perfect. D. The client's current BMI is 14.

Correct Answer is C

Explanation

A nurse is assessing a client who has anorexia nervosa and began treatment 1 month ago. Which of the following findings indicates the client's adherence to the treatment plan? The correct answer is choice C: The client states that she knows she can't be perfect.

Choice A rationale:

The client reports following various cooking blogs. Following cooking blogs does not necessarily indicate adherence to an anorexia nervosa treatment plan. The client might still engage in disordered eating behaviors while having an interest in cooking.

Choice B rationale:

The client's potassium level is 3.2 mEq/L. A potassium level of 3.2 mEq/L is below the normal range (3.5-5.0 mEq/L) and indicates electrolyte imbalance. This finding suggests inadequate adherence to the treatment plan, as it may result from continued restrictive eating.

Choice D rationale:

The client's current BMI is 14. A BMI of 14 is significantly below the normal range and is indicative of severe malnutrition. It suggests non-adherence to the treatment plan and ongoing weight loss, which is common in anorexia nervosa.

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is receiving change-of-shift report for four clients.Which of the following clients should the nurse see first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has bipolar disorder and is refusing to take prescribed medications.Which of the following ethical principles is the nurse displaying when he supports the client's refusal of medications?

Correct Answer is C

Explanation

A nurse is assessing a client who has anorexia nervosa and began treatment 1 month ago. Which of the following findings indicates the client's adherence to the treatment plan?

Correct Answer is C

Explanation

A nurse is conducting an admission interview with a new client who tells the nurse, "My life is so stressful.I can't take it anymore.”. Which of the following responses should the nurse make first?

A nurse is caring for a client who reports that he is angry with his partner because she thinks he is just trying to gain attention. When the nurse attempts to talk to the client, he becomes angry and tells her to leave. Which of the following defense mechanisms is the client demonstrating?

A nurse in a mental health facility is reviewing the laboratory results of a client who is taking lithium carbonate.Which of the following findings places the client at risk for lithium toxicity?

A charge nurse is making room assignments for new client admissions. Which of the following clients should the nurse place closest to the nurse's station?

A nurse is assessing a client who has delirium.Which of the following findings requires immediate intervention by the nurse?

A nurse is providing behavioral therapy for a client who has obsessive-compulsive disorder. The client repeatedly checks that the doors are locked at night. Which of the following instructions should the nurse give the client when using thought stopping technique?

A nurse in a mental health facility is caring for a client who is being aggressive toward other clients.Which of the following actions is the priority for the nurse to take?

A nurse is planning to conduct a support group for adolescents who have cancer.Which of the following actions should the nurse include during the orientation phase?

A nurse is receiving change-of-shift report for four clients.
Which of the following clients should the nurse see first?