NUR 202 Exam 3 Latest Update - Exam with 270 Questions and 100% Verified Correct Answers Guaranteed A+
A 16-year-old-client with paranoid schizophrenia experiences command hallucination to harm others, and has been admitted for trying to jump off a building because he felt the voice of God told him to do so. His parents ask the nurse, "What is it that makes him hear voices?" Which is the appropriate nursing response?A.) "Psychosis is correlated with excessive dopamine levels in certain parts of the brain." B.) "Hallucinations are caused by medication interactions." C.) "Too little serotonin is to blame for delusions and hallucinations." D.) "Changes in hormones during puberty have been shown to cause the voices." - CORRECT ANSWER: A.) "Psychosis is correlated with excessive dopamine levels in certain parts of the brain."
A 16-year-old-client with paranoid schizophrenia experiences command hallucination to harm others, and has been admitted for trying to jump off a building because he felt the voice of God told him to do so. His parents ask the nurse, "What is it that makes him hear voices?" Which is the appropriate nursing response?A.) "Tell him to stop discussing the voices or sels you will conclude the visit." B.) "Ignore what he is saying and attempt to talk over him." C.) "Neither confirm nor deny the voices, but try to focus on reality." D.) "Tell him that the voices are not real and that he is going to have to stop talking about them." - CORRECT ANSWER: C.) "Neither confirm nor deny the voices, but try to focus on reality."
A client developed a number of compulsive washing rituals over the years and has sought the help of a psychiatrist, who diagnosed obsessive-compulsive disorder (OCD).What purpose does the nurse recognize that the behavioral rituals serve?A.) Blocking delusions and hallucinations from awareness B.) Providing temporary and partial relief from her anxiety 1 / 4
C.) Drawing attention and approval from significant others
D.) Increasing the inhibitory powers of her superego - CORRECT ANSWER: B.)
Providing temporary and partial relief from her anxiety
A client has been feeling increasingly overwhelmed. He is enrolled full time in a nursing program and works full time to support his wife and two young children. He missed clinical this week because he overslept, and he also failed a test. This evening, his wife found him in the garage assembling a noose. When she questioned him, he began to cry. She immediately brought him to the emergency department. What is the nurse's goal of crisis intervention for the client?A.) Adjust his type A personality traits to more adaptive ones.B.) Cease either full-time school or work.C.) Examine how childhood events led to his overachieving orientation.D.) Return to his previous level of functioning with some modifications and supports in place. - CORRECT ANSWER: D.) Return to his previous level of functioning with some modifications and support in place.
A client has been feeling increasingly overwhelmed. He is enrolled full time in a nursing program and works full time to support his wife and two young children. He missed clinical this week because he overslept, and he also failed a test. This evening, his wife found him in the garage assembling a noose. When she questioned him, he began to cry. She immediately brought him to the emergency department. Which reflects the priority nursing diagnoses?A.) Ineffective coping B.) Anxiety C.) Risk for self-directed violence
D.) Ineffective role performance - CORRECT ANSWER: C.) Risk for self-directed
violence
A client on lifelong desmopressin or vasopressin therapy should be taught to monitor for which of the following symptoms as a sign that another dose of the medication is needed?A.) Polyuria and polyphasia B.) Polydipsia and dysphagia 2 / 4
C.) Polyuria and polydipsia
D.) Polyphagia and dysuria - CORRECT ANSWER: C.) Polyuria and polydipsia
A client who has schizophrenia receives a monthly injection of haloperidol decanoate (Haldol LA). Which of the following symptoms are expected to improve?A.) Meaningless imitation of movement B.) Inability to experience pleasure C.) Diminished facial expression D.) Extremities remail in fixed position - CORRECT ANSWER: A.) Meaningless imitation of movement
A client with chronic schizophrenia is seen monthly by a community mental health nurse for administration of fluphenazine (Prolixin Decanoate). The client refuses medication at one regularly scheduled monthly visit. Which nursing intervention is ethically appropriate?A.) Allow the client to decline taking the medication.B.) Inform the client that the medication must be taken to avoid hospitalization.C.) Arrange with a relative to add medication to the client's morning orange juice.D.) Call for help to hold the client down while the shot is administered. - CORRECT
ANSWER: A.) Allow the client to decline taking the medication.
A client with psychosis tells the nurse that he is hearing voices telling him to kill the president. Which nursing diagnosis is the most appropriate for this client?A.) Disturbed sensory perception B.) Altered thought processes C.) Self-care deficit
D.) Spiritual distress - CORRECT ANSWER: A.) Disturbed sensory perception
A client with schizoaffective disorder has been admitted for social skill training. Which skill will the nurse plan to teach?A.) Learning about the side effects of medications 3 / 4
B.) Practicing deep breathing techniques to decrease stress C.) Learning how to make eye contact when communicating by role-playing.D.) Performing hygiene and other activities of daily living. - CORRECT ANSWER: C.) Learning how to make eye contact when communicating by role-playing.
A client with schizophrenia approaches you with a look of distress and anguish on his face saying, "Can you hear him? It's the devil. He's telling me I'm going to hell." Which is the best nursing response?A.) "Did you take your medication this morning?" B.) "You are not going to hell. You are a good person." C.) "There is no such thing as the devil. It's all in your mind." D.) "The voices sound really distressing and scary, but I don't hear them." - CORRECT ANSWER: D.) "The voices sound really distressing and scary, but I don't hear them."
A client with schizophrenia has recently begun a new medication, clozapine (Clozaril).Of which potentially fatal side effect must the nurse be aware?A.) Agranulocytosis B.) Akathisia C.) Dystonia
D.) Akinesia - CORRECT ANSWER: A.) Agranulocytosis
A client with schizophrenia has recently begun a new medication, clozapine (Clozaril).Which blood test results for a potentially fatal side effect would the nurse expect?A.) WBC count >3000 mm3 and granulocyte >1500 mm3 B.) WBC count <3000 mm3 and granulocyte >1500 mm3 C.) WBC count >3000 mm3 and granulocyte <1500 mm3
D.) WBC count <3000 mm3 and granulocyte <1500 mm3 - CORRECT ANSWER: D.)
WBC count <3000 mm3 and granulocyte <1500 mm3
A client with schizophrenia is receiving risperdone (Risperdal) to treat both the positive (type I) and negative (type II) symptoms. Which positive (type I) symptoms would the
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