A nurse is assisting with the care of a client.

The nurse is collecting data from the client.

Select words from the choices to fill in each blank in the following sentence

The nurse should identify that

and

Indicate manifestations of borderline personality disorder

Answer and Explanation

The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"B"}

Fear of abandonment: Clients with borderline personality disorder (BPD) often have an intense fear of abandonment, leading to unstable relationships and emotional outbursts. The client’s fluctuating behavior towards the nurse (from anger to admiration) suggests this pattern.

Emotional instability: BPD is characterized by rapid mood changes and intense emotional reactions. The client displays aggression, impulsivity, and mood shifts, as seen in their outbursts and sudden praise for the nurse.

Incorrect:

Elevated body temperature: Fever is not a characteristic of BPD. It is more commonly associated with infections or inflammatory conditions.

Tactile hallucinations: Hallucinations are more common in psychotic disorders or substance withdrawal rather than BPD.

Increased heart rate: Tachycardia is a physiological response to stress, anxiety, or substance use but is not a defining feature of BPD.

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Correct Answer is C

Explanation

A) "I get nervous when I'm in a large group": This statement indicates social anxiety or discomfort, which is common among adolescents. While it may affect the client's well-being, it does not suggest an immediate risk for suicide.

B) "My partner and I had our first argument last night": While relationship issues can cause stress, this statement by itself does not indicate suicidal ideation. Arguments in relationships are a normal part of adolescent development and are not typically associated with a suicide risk unless other risk factors are present.

C) "I am not interested in anything anymore.": This is a concerning statement, as it suggests anhedonia, a hallmark symptom of depression. A lack of interest in activities once enjoyed, especially in adolescents, can be a significant risk factor for suicide and warrants further evaluation and intervention.

D) "I'm not sleeping much because of all the homework I have.": Although sleep disturbances can be a sign of stress, especially related to academic pressure, this is not an immediate indication of suicidal thoughts. Sleep issues can often be managed with lifestyle changes or stress management techniques.

A. Two diarrhea stools in the last day B. Chemotherapy treatments C. Clear rhinorrhea D. Medications for a cardiac anomaly

Correct Answer is B

Explanation

A) Two diarrhea stools in the last day: Diarrhea, especially if it is mild and without other severe symptoms, is not a contraindication for receiving a varicella vaccine. The child may still be able to receive the immunization if they are otherwise well. However, if the diarrhea is accompanied by fever, vomiting, or other signs of illness, the vaccine may be delayed.

B) Chemotherapy treatments: Chemotherapy treatments are a contraindication for the varicella vaccine. Chemotherapy can suppress the immune system, making the child more vulnerable to infections, including the risk of contracting varicella from the live vaccine. Immunocompromised patients should not receive live vaccines unless approved by their healthcare provider.

C) Clear rhinorrhea: Clear rhinorrhea, or a runny nose, typically indicates a mild upper respiratory condition like a cold. This is not a contraindication for receiving the varicella vaccine unless other symptoms are more severe or the child has a fever or signs of a more serious illness.

D) Medications for a cardiac anomaly: Medications for a cardiac anomaly do not generally interfere with the safety of the varicella vaccine. These medications may require careful monitoring for other reasons, but they are not contraindications to receiving the immunization, as long as the child is not immunocompromised from other causes

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A nurse is assisting with the care of a client. The nurse is collecting data from the client. Select words from the choices to fill in each blank in the following sentence The nurse should identify that ____ and ____ Indicate manifestations of borderline personality disorder

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data from an adolescent during an annual physical examination. Which of the following statements by the client indicates that they are at risk for suicide?

Correct Answer is C

Explanation

A nurse is reviewing the medical record for a child who is scheduled to receive a varicella immunization. Which of the following findings in the client's record should the nurse recognize as a contraindication?

Correct Answer is B

Explanation

A nurse is reinforcing teaching with an adolescent who has ADHD and a new prescription for methylphenidate. Which of the following actions by the adolescent should the nurse identify as a potential barrier is communication?

A nurse is collecting data for a client who is receiving enteral tube feeding. They should identify that which of the following findings is a manifestation of fluid overload?

A nurse is providing change-of-shift report for a client. Which of the following information should the nurse include in the report?

A nurse is assisting in the care of a newly admitted client. Which of the following findings should the nurse report immediately to the provider? Select all that apply

The nurse is reviewing the client's medical record. The nurse is assisting with the care the client prior to a blood transfusion Which of the following actions should the nurse take? Select all that apply.

A nurse is assisting with the care of a client who is receiving a spinal epidural to treat a herniated disc. Which of the following findings should the nurse identify as an indicator of unrelieved pain?

A nurse in a clinic is collecting data from a client. The client reports that they do not believe in receiving immunizations. Which of the following questions should the nurse ask the client?

A nurse is reinforcing teaching with a client who is to have plaster cast applied to his right arm. Which of the following information should the nurse include the teaching?

A nurse is assisting with the care of a client.

The nurse is collecting data from the client.

Select words from the choices to fill in each blank in the following sentence

The nurse should identify that

and

Indicate manifestations of borderline personality disorder