NCLEX PN Final for Knott - Fall 2023, Complete Solutions

NCLEX PN Final for Knott - Fall 2023, Complete Solutions A client recently admitted to an inpatient unit for treatment of alcoholism says to the nurse, "I only came here to get away from my nagging spouse. Sometimes I ...

NCLEX PN Final for Knott - Fall 2023, Complete Solutions A client recently admitted to an inpatient unit for treatment of alcoholism says to the nurse, "I only came here to get away from my nagging spouse. Sometimes I think my spouse is the one who should be here. I can stop drinking any time I want." The nurse recognizes that the client is exhibiting which of the following defense mechanisms? Denial and projection The nurse is conducting a seminar for parents of adolescents about health issues common to this age group. Which parent's statement indicates that the adolescent may have bulimia nervosa? I found several empty boxes in my child's waste basket The nurse is reinforcing information to a client in preparation for discharge from the hospital when the client breaks down crying, saying "the health care provider thinks I am crazy because I was diagnosed with a functional disorder." Which statement would be the best reply to this client? Functional disorder is a diagnosis for a genuine medical issue that the medical science does not fully understand The nurse is reinforcing information to a client in preparation for discharge from the hospital when the client breaks down crying, saying "the health care provider thinks I am crazy because I was diagnosed with a functional disorder." Which statement would be the best reply to this client? Encourage the client to talk about the trauma A client comes to the community mental health clinic seeking treatment for severe anxiety associated with a recent job promotion that requires a 30-minute commute via train. The nurse recognizes that this client most likely suffers from which psychological disorder? Agoraphobia The nurse is caring for a 10-year-old diagnosed with attention-deficit hyperactivity disorder (ADHD). In addition to the 3 core symptoms of ADHD (hyperactivity, impulsiveness, and inattention), which of the following would the nurse expect to find? Low self esteem and impaired social skills Which findings support a diagnosis of post-traumatic stress disorder? Select all that apply. Difficulty concentrating feeling detached from others flashbacks of traumatic experience persistent angry, fearful mood Which actions would the nurse expect to be included in the care plan for a client hospitalized for bipolar disorder, acute manic episode? Select all that apply. Assign the client a private room Choose clothing for client Schedule client for physical activity for a staff member The nurse is reviewing the records of an adolescent client. Which findings suggest that the client may need referral for depression screening? Select all that apply. client has had school disciplinary issues and absenteeism due to outbursts Client has lost 8 lbs over the last 3 weeks w/o trying Client is often found sleeping during class Client quit sports, despite receiving athletic awards The nurse is caring for a client newly admitted with an acute manic episode of bipolar disorder. The nurse identifies which dinner selection as the most appropriate to promote client nutrition? cheeseburger, apple and vanilla milkshake A client recently diagnosed with schizophrenia is hospitalized. The client appears distraught and says to the nurse, "The voices are bad today...they are so angry with me." Which of the following is the best response by the nurse? What are the voices saying to you? The nurse provides teaching for a client newly prescribed disulfiram for alcohol abstinence. Which information is the priority for the nurse to include? List of everyday items that contain alcohol The nurse is participating in a staff presentation to review risk factors for skin cancer. Which of the following risk factors should the nurse include? Select all that apply. Family history of skin cancer High number of moles Immunosuppressant meds Outdoor occupation The practical nurse is collaborating with the registered nurse to develop a care plan for a homeless client just brought into the emergency department with frostbite to the fingers and toes. The client is experiencing numbness, and assessment shows mottled skin. Which interventions should be included in the client's plan of care? Select all that apply. Elevate affected extremities after rewarming Provide adequate analgesics Provide continuous warm water soaks The nurse assists with a community skin cancer screening program. Which finding would be most concerning? Client with a flat, 1cm lesion on the neck that is black and brown A nurse is reinforcing education to an adolescent client on skin cancer prevention with special focus on melanoma. Which statements should the nurse include? Select all that apply. Apply broad spectrum sunscreen before and during activities reapply sunscreen after swimming sunburns can occur even on overcast days An elderly client with a history of stable chronic obstructive pulmonary disease, alcohol abuse, and cirrhosis has a serum theophylline level of 25.8 mcg/mL (143 μmol/L). Which clinical manifestation associated with theophylline toxicity should worry the nurse most? seizure activity A client with type 2 diabetes, coronary artery disease, and peripheral arterial disease developed hospital-acquired pneumonia (HAP) and has been receiving intravenous (IV) antibiotics for 4 days. Which parameter monitored by the nurse best indicates the effectiveness of treatment? White blood count A client's arterial blood gases (ABGs) are shown in the exhibit. The nurse would expect which finding to demonstrate that the client is compensating for the ABGs? Increase in respiratory rate The nurse reinforces safety precautions of home oxygen use to a client with chronic obstructive pulmonary disease (COPD) being discharged with a nasal cannula and portable oxygen tank. Which client statement indicates the need for further teaching? Select all that apply. I can apply vasoline when my nostrils feel dry I can cook on my gas stove I can increase my oxygen from 2 to 6 liters when I feel short of breath The intensive care nurse is caring for a client who has just been extubated. Which interventions are appropriate at this time? Select all that apply. Administer warm humidified oxygen via face mask provide mouth care with oral sponges start the client on the incentive spirometer The nurse reinforces teaching about strategies to prevent community-acquired pneumonia. Which statement made by the client indicates the need for further instruction? I got the one time pneumonia shot, so I don't need it again Which teaching instructions should the nurse reinforce to a client with advanced chronic obstructive pulmonary disease? Select all that apply.