A nurse on a mental health unit is caring for four clients. Which of the following clients should the nurse see first?
A client who has schizophrenia and exhibits apathy
A client who has an anxiety disorder and appears restless
A client who has major depressive disorder and reports hopelessness
A client who has bipolar disorder and exhibits provocative behavior
The Correct Answer is C
A. A client with schizophrenia exhibiting apathy may require attention, but it may not be an immediate priority unless there are signs of deterioration or safety concerns.
B. A client with an anxiety disorder appearing restless may be experiencing distress, but it is not necessarily indicative of an immediate safety or crisis situation.
C. A client with major depressive disorder reporting hopelessness raises significant concern, as it may indicate an increased risk of self-harm or suicide. Clients expressing hopelessness should be assessed promptly to determine the level of risk and implement appropriate interventions.
D. A client with bipolar disorder exhibiting provocative behavior may pose a potential risk, but the level of urgency is typically higher for a client expressing hopelessness and depressive
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Initiate a 24-hr urine collection for a client who has end-stage kidney disease:
While a 24-hour urine collection is important for assessing kidney function, it is not an urgent task and can be scheduled at a later time without compromising the client's immediate well-being.
B. Change the dressing for a client who has a decubitus ulcer:
Changing the dressing for a decubitus ulcer is important for wound care, but it is not as urgent as addressing respiratory distress in a client with COPD.
C. Administer an antibiotic for a client who has methicillin-resistant Staphylococcus aureus:
Administering an antibiotic for a client with a methicillin-resistant Staphylococcus aureus (MRSA) infection is important, but it is not as immediately critical as ensuring adequate oxygenation in a client with COPD. Respiratory issues take precedence in the hierarchy of priorities.
D. Initiate oxygen therapy via nasal cannula for a client who has COPD.
The priority should be given to tasks that address immediate threats to the client's well-being or safety. In this scenario, initiating oxygen therapy for a client with COPD is a priority because it addresses respiratory distress and hypoxia, which are critical concerns in individuals with COPD. Respiratory interventions take precedence to ensure adequate oxygenation.
Correct Answer is ["38"]
Explanation
To calculate the IV flow rate in drops per minute (gtt/min), you can use the following formula:
Flow Rate (gtt/min)=(Volume (mL)/Time (min)) × Drop Factor (gtt/mL)
In this case:
Flow Rate = (150 mL/hr / 60 min/hr) × 15 gtt/mL
Flow Rate=37.5gtt/min
Therefore, the nurse should set the IV flow rate to deliver approximately 38 gtt/min for the dextrose 5% in water IV infusion at 150 mL/hr, rounded to the nearest whole number.
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