Brian is seeking treatment for PTSD following his tour of duty in a combat zone. He reports to the assessment nurse that he has been smoking marijuana and drinking alcohol daily for the past 4 days because he just can't stand feeling depressed all the time. Which of these assessments is the nurse's highest priority?

Suicide risk assessment

Neurological assessment

Amount of current cannabis use

Marital status

Answer and Explanation

The Correct Answer is A

Choice A reason: Given Brian's recent substance use and expression of not being able to tolerate depressive feelings, a suicide risk assessment is the highest priority to ensure his immediate safety.

Choice B reason: While a neurological assessment may be relevant, it is not the highest priority when there is a potential risk of suicide.

Choice C reason: Assessing the amount of current cannabis use is important but secondary to evaluating the risk of suicide.

Choice D reason: Marital status may inform social support but is not the highest priority in the context of potential self-harm.

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

Explanation

Choice A reason: Urinary retention and constipation are not typically associated with tardive dyskinesia, which is characterized by involuntary movements.

Choice B reason: Fine hand tremors and pill rolling are more commonly associated with Parkinson's disease rather than tardive dyskinesia.

Choice C reason: Tongue thrusting and lip smacking are classic signs of tardive dyskinesia, often resulting from long-term use of antipsychotic medications.

Choice D reason: Facial grimacing and eye blinking are also indicative of tardive dyskinesia, reflecting involuntary facial movements.

Choice E reason: Involuntary pelvic rocking and hip thrusting movements can be manifestations of tardive dyskinesia, representing involuntary movements of the body.

A. "I think it is the shampoo and conditioner my child is using." B. "I have watched my child pull hair out and try to hide it." C. "I started losing some hair at a young age and think it's just shedding." D. "My child doesn't appear to be nervous or upset about anything."

Correct Answer is B

Explanation

Choice A reason: This statement suggests a possible external cause for the hair loss, which might not be related to a psychological issue.

Choice B reason: Observing the child pulling out hair and attempting to conceal it indicates trichotillomania, a disorder characterized by a compulsive urge to pull out one's hair.

Choice C reason: Genetic factors could contribute to hair loss, but the statement does not directly suggest a behavioral or psychological disorder.

Choice D reason: The lack of apparent nervousness or upset in the child does not rule out psychological reasons for hair loss, such as trichotillomania, which can sometimes be a covert behavior.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who was admitted with acute psychosis and is being treated with haloperidol. The nurse should suspect that the client may be experiencing tardive dyskinesia when the client exhibits which of the following? Select all that apply.

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

Explanation

Which of the following statements is associated with a client's child experiencing hair loss?

Correct Answer is B

Explanation

The nurse is leading a family therapy group with a client addicted to alcohol. Which statement made by the spouse indicates the need for additional education regarding alcoholism as a family illness?

A nurse is caring for a client who was admitted with acute psychosis and is being treated with haloperidol. The nurse should suspect that the client may be experiencing tardive dyskinesia when the client exhibits which of the following? Select all that apply.

A home-health nurse is assessing a client who has obsessive-compulsive disorder (OCD) and observes that the client engages in constant repetitive cleaning. The nurse knows that this behavior is an attempt to accomplish which of the following?

The nurse is talking with a client who grew up in a home where both parents were alcoholics. Which behaviors does the nurse identify when assessing this client that correlate with this home life? Select all that apply.

A nurse on an inpatient eating disorders unit is caring for a client who has anorexia nervosa with a body mass index (BMI) of 17.2. Which of the following actions should the nurse take? Select all that apply.

A nurse is providing care to a client with a situational phobia. Which techniques would the nurse most likely include as an intervention in the client's plan of care? (Select all that apply.)

The nurse observes a lack of hair on the eyebrows and hairline of a young adolescent. Which statement made by the parent demonstrates an understanding of the type of hair loss the child is experiencing?

The nurse is performing an assessment for a client brought in by a family member who states they think the client has dementia. When evaluating the assessment data, which finding indicates that the client may likely have delirium and not dementia?