A patient was placed in restraints after punching a staff member. Which statement by the patient requires the nurse’s immediate attention?
“I’m thirsty, give me a drink of water.”
“I punched him because he’s rude to us.”
“I’m going to report you because this is an illegal use of restraints.”
“If I say I’m sorry, would you let me out of here?”
The Correct Answer is A
A: This statement requires immediate attention because it indicates a basic need that must be addressed to ensure the patient’s well-being while in restraints.
B: This statement reflects the patient’s justification for their behavior but does not require immediate attention.
C: This statement indicates the patient’s intention to report the use of restraints but does not require immediate attention.
D: This statement reflects the patient’s attempt to negotiate release from restraints but does not indicate an immediate need.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","C","D","E"]
Explanation
A: Providing a detailed account of school work is not typically associated with ADHD, as children with ADHD often have difficulty with sustained attention and organization.
B: Talking excessively and interrupting are common behaviors in children with ADHD due to impulsivity and hyperactivity.
C: Blurting out responses or thoughts is a characteristic behavior of ADHD, reflecting impulsivity.
D: Fidgeting and squirming in the chair are signs of hyperactivity, which are common in children with ADHD.
E: Being easily distracted is a hallmark symptom of ADHD, indicating difficulty with sustained attention.
Correct Answer is B
Explanation
A: Impulsivity refers to acting on urges without considering consequences, which is a feature of borderline personality disorder but not the best description of the scenario.
B: Emotional lability, or rapid and intense mood swings, accurately describes the client’s behavior in the scenario.
C: Reaction formation involves behaving in a way that is opposite to one’s true feelings, which is not depicted in the scenario.
D: Splitting involves viewing people or situations as all good or all bad, which can be a feature of borderline personality disorder but is not the primary feature shown in the scenario.
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