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Questions 158

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Question 1 of 5

In client teaching, the nurse should emphasize that fetal damage occurs more frequently with ingestion of drugs during:

Correct Answer: A

Rationale: The first trimester is the period of organogenesis, when the fetus is most susceptible to teratogenic effects of drugs.

Question 2 of 5

A 30-year-old client has been admitted to the psychiatric service with the diagnosis of schizophrenia. He tells the nurse that when the woman he had been dating broke up with him, the CIA had replaced her with an identical twin. The client is experiencing:

Correct Answer: B

Rationale: There are no indications that the client's thoughts reflect special powers or talents characteristic of grandiosity. The client's thought content is fixed, false, persecutory, and suspicious in nature, which is characteristic of paranoid delusions. (C,
D) The client is not demonstrating a sensory experience.

Question 3 of 5

A schizophrenic client who is experiencing thoughts of having special powers states that 'I am a messenger from another planet and can rule the earth.' The nurse assesses this behavior as:

Correct Answer: D

Rationale: Clients experiencing ideas of reference believe that information from the environment (e.g., the television) is referring to them. Clients experiencing delusions of persecution believe that others in the environment are plotting against them. Clients experiencing thought broadcasting perceive that others can hear their thoughts. Clients experiencing delusions of grandeur think that they are omnipotent and have superhuman powers.

Question 4 of 5

A client who was started on antipsychotic medication 2 weeks ago is preparing for discharge from the hospital. Compliance with the medication regimen is important despite the mild side effects encountered. In order to increase the likelihood of medication compliance, the nurse would:

Correct Answer: A

Rationale: This answer is correct. If the client is well informed about what reactions to expect from her medication, she is more likely to follow the treatment regimen. This answer is incorrect. There are many side effects that are reversible by medication, and these must be reported to the nurse or physician. There are also more severe side effects, such as neuroleptic malignant syndrome, characterized by fever, tachycardia, and diaphoresis, which can be life threatening. This answer is incorrect. There is no need for weekly blood tests if the drug regimen has been followed properly. This answer is incorrect. The client should continue the medication until the physician recommends any change in the drug regimen. Symptoms will usually reappear if medication is discontinued.

Question 5 of 5

The client is admitted with a diagnosis of ectopic pregnancy. Which symptom is most characteristic of this condition?

Correct Answer: A

Rationale: Ectopic pregnancy often presents with sudden sharp abdominal pain due to tubal stretching or rupture. Painless bleeding is more typical of placenta previa and fever or edema are not characteristic.

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