*NURSING > HESI > HESI Fundamental Version 3 / Latest Questions and Complete Solutions / GRADED A (All)

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HESI Fundamental Version 3 / Latest Questions and Complete Solutions / GRADED A

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A nurse on the psychiatric unit of the hospital has been assigned four clients for the shift. The assignment includes an 84-year-old client who is severely depressed, a 73-year-old client who is being... discharged, a 53-year-old client who was admitted for lithium toxicity, and a 48-yearold client who has panic attacks. Which client should the nurse evaluate first after receiving report? 1 84-year-old client 2 73-year-old client Correct3 53-year-old client 4 48-year-old client The 53-year-old client should be evaluated first because of the severity of adaptations associated with lithium toxicity. A severely depressed client has a low energy level and is not at the greatest risk at this time. A client who is stable enough to be discharged does not need immediate attention. Clients with panic attacks usually seek immediate attention when it is needed. A young female client admitted to the trauma center after being sexually assaulted continues to talk about the rape. Toward what goal should the primary nursing intervention be directed? 1 Getting her involved with a rape therapy group 2 Remaining available and supportive to limit destructive anger 3 Exploring her feelings about men to promote future relationships Correct4 Providing a safe environment that permits the ventilation of feelings The client needs to be able to express her current feelings. Providing an environment in which she feels safe will encourage this expression of feelings. It is too soon after the assault to discuss this topic in a group. Although the nurse should be available and supportive, feelings of anger are usually not the initial response. It is too soon after the assault to discuss her feelings about men and future relationships. [Show More]

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