A nurse is teaching the parent of an infant about the varicella virus vaccine. Which of the following statements by the parent indicates an understanding of the teaching?

"My child should not receive the vaccine if she is allergic to eggs."

"There is a series of three doses of the vaccine that my child will receive."

"My child should not take aspirin for 6 weeks following vaccination."

"The vaccine will be injected into the muscle of my child's upper arm."

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Allergic reactions to eggs are a concern with some vaccines, but the varicella vaccine is generally considered safe for children with egg allergies.

Choice B rationale:

The varicella vaccine is typically given in two doses, not three. Choice C rationale:

Children should avoid taking aspirin for about 6 weeks after receiving the varicella vaccine to reduce the risk of Reye's syndrome, a rare but serious condition associated with aspirin use during viral infections.

Choice D rationale:

The varicella vaccine is usually administered subcutaneously, not into the muscle.

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Correct Answer is ["A","C","D","E"]

Explanation

Choice A rationale:

Agitation is a common manifestation of delirium, as the client experiences a disturbance in attention, awareness, and cognition. The client may become restless, irritable, or aggressive due to the altered mental state.

Choice B rationale:

Slow, flat speech is not a manifestation of delirium, but rather a sign of depression or dementia. Clients with delirium may have rapid, incoherent, or slurred speech, depending on the cause and severity of the condition.

Choice C rationale:

Visual hallucinations are another manifestation of delirium, as the client may perceive things that are not there or misinterpret sensory stimuli. The client may also have auditory or tactile hallucinations, which can contribute to the agitation and confusion.

Choice D rationale:

Confusion is a hallmark manifestation of delirium, as the client has difficulty with orientation, memory, and reasoning. The client may not recognize familiar people or places, or may have fluctuating levels of consciousness. The confusion may worsen at night or in low-light settings, which is known as sundowning syndrome.

Choice E rationale:

Rapid mood swings are also a manifestation of delirium, as the client may exhibit emotional lability, anxiety, depression, fear, or anger. The mood changes may be unpredictable and inappropriate to the situation.

A. Replaces it with a different ritualistic behavior B. Reports auditory hallucinations C. Expresses relief from not having to perform the ritual D. Experiences panic-level anxiety

Correct Answer is D

Explanation

Choice A rationale:

Replacing the ritual with a different ritualistic behavior is possible, but it does not necessarily predict the initial response when the restriction is first imposed.

Choice B rationale:

Reporting auditory hallucinations is not a typical response to restricting ritualistic behavior in someone with OCD.

Choice C rationale:

Expressing relief from not having to perform the ritual is unlikely, as ritualistic behaviors in OCD are often driven by distress and anxiety.

Choice D rationale:

If ritualistic behavior is restricted in an individual with obsessive- compulsive disorder (OCD), they may experience panic-level anxiety due to their inability to engage in their usual coping mechanism. OCD rituals are often performed to reduce anxiety, and restricting them can lead to increased distress.

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A nurse is teaching the parent of an infant about the varicella virus vaccine. Which of the following statements by the parent indicates an understanding of the teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has delirium. Which of the following manifestations should the nurse expect? (Select all that apply.)

Correct Answer is ["A","C","D","E"]

Explanation

A nurse is caring for a newly admitted client who has obsessive-compulsive disorder and frequently performs ritualistic behaviors. The nurse should expect which of the following client responses if ritualistic behavior is restricted?

Correct Answer is D

Explanation

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