The nurse is preparing to start an IV for a client who is combative. What precautionary measure should the nurse take in order to avoid a needlestick?

Have the client placed in restraints.

Refuse to start the IV.

Give the client a sedative prior to starting the IV.

Ask for assistance.

Answer and Explanation

The Correct Answer is D

A. Have the client placed in restraints: Restraints should only be used as a last resort when the client poses a danger to themselves or others. They require a provider’s order and must follow strict guidelines. It is not the first step in managing a combative client.
B. Refuse to start the IV: Refusing care delays necessary treatment and does not address the issue of safety. The nurse has a duty to provide care using appropriate support and safety measures.
C. Give the client a sedative prior to starting the IV: Administering a sedative requires a provider's order and should not be done solely for ease of IV insertion. Sedation is not a routine intervention and must be clinically justified.
D. Ask for assistance: Having another trained staff member present increases safety and reduces the risk of needlestick injury. Assistance ensures proper restraint of movement without violating patient rights or safety protocols.

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Correct Answer is ["A","B","E"]

Explanation

A. Take all antipsychotic medications as directed: Adherence is critical for managing symptoms and preventing relapse. Antipsychotics must be taken consistently and exactly as prescribed to maintain therapeutic effectiveness and minimize side effects.
B. Notify the health care provider if you have hypertension or severe muscle stiffness: These symptoms may indicate serious adverse effects, such as neuroleptic malignant syndrome. Prompt reporting allows for early intervention and prevention of life-threatening complications.
C. Double the next dose if you forget one dose: Doubling the dose increases the risk of overdose and severe side effects. Clients should be instructed to take the next dose as scheduled and never compensate for missed doses.
D. Stop the medication for any side effects: Suddenly stopping antipsychotics can lead to symptom rebound or withdrawal effects. Side effects should be discussed with the provider, who can adjust the dose or switch medications safely.
E. Report any rhythmic, involuntary movements of the tongue, face, mouth, jaw, or extremities immediately: These are signs of tardive dyskinesia, a potentially irreversible side effect of long-term antipsychotic use. Early detection is essential to prevent progression and guide changes in therapy.

A. Eroded teeth enamel B. Younger onset than anorexia nervosa C. Denial of abnormal eating habits D. Overweight or normal weight E. Admits to purging and binging F. Appears thin but feels fat

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

Explanation

A. Eroded teeth enamel: Frequent vomiting in bulimia nervosa exposes teeth to stomach acid, leading to enamel erosion. This is a classic physical sign associated with purging behavior.
B. Younger onset than anorexia nervosa: Bulimia nervosa typically has a later onset than anorexia nervosa, often emerging in late adolescence or early adulthood. This statement is inaccurate for distinguishing between the two disorders.
C. Denial of abnormal eating habits: Clients with bulimia nervosa are often aware of their disordered eating behaviors and may express guilt or shame. Denial is more characteristic of anorexia nervosa.
D. Overweight or normal weight: Unlike individuals with anorexia, those with bulimia usually maintain a normal or slightly above-average weight, due to cycles of binge eating and purging rather than extreme caloric restriction.
E. Admits to purging and binging: Admission of binging and purging episodes is a key behavioral characteristic of bulimia nervosa. Clients may describe eating large amounts of food followed by self-induced vomiting or use of laxatives.
F. Appears thin but feels fat: This perception is more commonly associated with anorexia nervosa, where body image distortion is profound despite extreme thinness. Bulimia clients often have less severe weight loss.

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The nurse is preparing to start an IV for a client who is combative. What precautionary measure should the nurse take in order to avoid a needlestick?

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The nurse is providing discharge instructions to the client being prescribed antipsychotic medications. Which discharge instruction(s) should be included? Select all that apply.

Correct Answer is ["A","B","E"]

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A client is being evaluated for an eating disorder. Which nursing assessment finding(s) is most indicative of a client with bulimia nervosa? Select all that apply.

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

Explanation

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The nurse is preparing to start an IV for a client who is combative. What precautionary measure should the nurse take in order to avoid a needlestick?