Podcast
Questions and Answers
What is an appropriate intervention for a client with paranoid delusions who refuses to eat?
What is an appropriate intervention for a client with paranoid delusions who refuses to eat?
Which pediatric client demonstrates signs of abuse that may necessitate mandatory reporting?
Which pediatric client demonstrates signs of abuse that may necessitate mandatory reporting?
What is the best response by the nurse when a spouse becomes upset about a hospital bed for a client with Huntington disease?
What is the best response by the nurse when a spouse becomes upset about a hospital bed for a client with Huntington disease?
What upsets you about having a hospital bed?
Which statement indicates that ondansetron was effective in a client?
Which statement indicates that ondansetron was effective in a client?
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Which client should the nurse see first?
Which client should the nurse see first?
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How should the care of an unaccompanied 16-year-old girl with severe abdominal pain and vomiting be handled?
How should the care of an unaccompanied 16-year-old girl with severe abdominal pain and vomiting be handled?
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Which statement by the parents indicates effective teaching regarding weaning from breastfeeding?
Which statement by the parents indicates effective teaching regarding weaning from breastfeeding?
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What is the most appropriate intervention when a client's adult child requests to override the DNR code status?
What is the most appropriate intervention when a client's adult child requests to override the DNR code status?
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What should the nurse ask a client diagnosed with schizophrenia who looks away and grimaces?
What should the nurse ask a client diagnosed with schizophrenia who looks away and grimaces?
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What priority information should be included during the initial prenatal visit for a 15-year-old primigravid client?
What priority information should be included during the initial prenatal visit for a 15-year-old primigravid client?
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Which question helps determine a client's risk for sexually transmitted infections?
Which question helps determine a client's risk for sexually transmitted infections?
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What is the nurse's priority action when a client's chest tube drainage system is dislodged?
What is the nurse's priority action when a client's chest tube drainage system is dislodged?
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What stage of burn is indicated by an area that is red, moist, and covered in shiny, fluid-filled vesicles?
What stage of burn is indicated by an area that is red, moist, and covered in shiny, fluid-filled vesicles?
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Which client should the nurse see first in the emergency department?
Which client should the nurse see first in the emergency department?
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Which client statement indicates that the client is not currently at risk for suicide?
Which client statement indicates that the client is not currently at risk for suicide?
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What is the best response by the nurse for a client taking escitalopram who reports no improvement?
What is the best response by the nurse for a client taking escitalopram who reports no improvement?
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Study Notes
Mental Health and Nursing Interventions
- For clients with paranoid delusions refusing food, providing unopened, individually packaged food is appropriate to ensure safety and trust.
- It is crucial to recognize signs of abuse in children, such as a 5-year-old with multiple fractures, which may require mandatory reporting.
End-of-Life and Advance Directives
- Engaging clients' families about care needs in terminal stages can be sensitive; asking about their feelings regarding care items like hospital beds helps in understanding their emotional state.
- If a client with DNR status stops breathing, explaining the client's wishes to a family member who changes their mind is essential.
Medication Administration and Assessment
- The effectiveness of ondansetron for nausea can be indicated when a client reports improvement, such as feeling "a lot better."
- In emergency scenarios, recognizing a client’s vital condition—like a 16-year-old with abdominal pain and a fever—should prompt continued care until guardians are reached.
Pediatric Health and Development
- When reinforcing weaning from breastfeeding, parents should be informed that cow's milk is an acceptable substitute.
- Consistent prenatal care is essential for pregnant clients, particularly those in their first trimester.
Sexual Health Assessment
- Inquiring about barrier methods during sexual encounters helps assess risk for sexually transmitted infections in clients reporting same-sex relations.
Emergency Care and Prioritization
- In case of chest tube dislodgment, the immediate action is to cover the insertion site with a clean, gloved hand to prevent air entering the pleural space.
- Identifying critical conditions, such as a client with myasthenia gravis experiencing fever and swallowing difficulties, is vital for timely intervention.
Behavioral Assessment and Safety
- Clients who express plans for future events, like attending a grandchild's graduation, often indicate reduced suicidal risk.
- Monitoring medication adherence and discussing lack of improvement, such as with escitalopram, encourages a focus on the client's experience and medication management.
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Description
This quiz consists of flashcards designed to help nursing students prepare for the NCLEX-PN exam. It includes scenarios involving patient care interventions, particularly in mental health and pediatric settings. Each card presents a situation followed by an appropriate nursing response, reinforcing critical thinking and knowledge application in nursing practice.
