While the nurse is conducting an admission assessment of a female client with bipolar disorder, the client suddenly begins to take off her clothes and throw them about the room. Which action should the nurse take first?

Leave the client's room so she can act out her anxiety.

State it is unacceptable to undress during the interview.

Ignore the client's inappropriate behavior.

Change to less anxiety-provoking questions.

Answer and Explanation

The Correct Answer is B

A: Leaving the client alone could increase the risk of harm to herself or others and does not address the immediate need for safety and boundaries.
B: Clearly stating that undressing is unacceptable sets immediate boundaries, which is essential in managing acute behavioral situations, ensuring the client's dignity, and maintaining a professional environment.
C: Ignoring the behavior does not provide any guidance or boundaries for the client, which could lead to escalation or reinforce the inappropriate behavior.
D: While changing to less anxiety-provoking questions may be helpful, it does not directly address the behavior at hand, which could lead to further inappropriate actions or misunderstandings about acceptable behavior during the assessment.

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Correct Answer is D

Explanation

A. Improved visual acuity.
Pregabalin does not affect visual acuity. This medication is primarily used to manage neuropathic pain.

B. Granulating tissue in foot ulcer.
While important, this is not directly related to the effectiveness of pregabalin, which is prescribed for neuropathic pain, not wound healing.

C. Full volume of pedal pulses.
This reflects peripheral circulation but is not an indicator of the effectiveness of pregabalin for neuropathic pain.

D. Reduced level of pain.
This is the correct answer because pregabalin is used to treat neuropathic pain associated with diabetic peripheral neuropathy, and a reduction in pain indicates the medication is effective.

A. Determine type of chemical exposure. B. Call poison control emergency number. C. Assess child for altered sensorium. D. Obtain equipment for gastric lavage.

Correct Answer is A

Explanation

A. Determining the type of chemical exposure is critical as it guides subsequent treatment and interventions. Different chemicals require different management strategies, including whether to induce vomiting or administer activated charcoal.

B. Calling poison control is important but should occur after identifying the specific chemical involved, as the poison control guidelines often depend on the substance the child was exposed to.

C. Assessing for altered sensorium is important, but the immediate priority is to identify the type of chemical exposure to implement appropriate interventions.

D. Obtaining equipment for gastric lavage may be necessary in certain cases, but this is based on the type of chemical ingested and the child's condition. Identifying the chemical exposure must occur first to determine if gastric lavage is appropriate.

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While the nurse is conducting an admission assessment of a female client with bipolar disorder, the client suddenly begins to take off her clothes and throw them about the room. Which action should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with diabetic peripheral neuropathy has been taking pregabalin for 4 days. Which finding indicates to the nurse that the medication is effective?

Correct Answer is D

Explanation

Correct Answer is A

Explanation

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