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Questions 158

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Extract:


Question 1 of 5

The health team needs to realize that the compulsive concern with cleanliness that a client with severe anxiety exhibits is most likely an attempt to:

Correct Answer: A

Rationale: These behaviors are attempts to relieve anxiety, as compulsive actions often serve as a coping mechanism for severe anxiety.

Question 2 of 5

The nurse is caring for a client with a history of a hiatal hernia who is receiving Propulsid (cisapride). The nurse should monitor the client for:

Correct Answer: A

Rationale: Cisapride can prolong the QT interval, risking arrhythmias, requiring cardiac monitoring. Hypotension, constipation, and weight gain are not primary side effects.

Question 3 of 5

The nurse is teaching a client with a history of type 2 diabetes about foot care. The nurse should tell the client to:

Correct Answer: A

Rationale: Daily foot inspection helps detect early signs of injury or infection in type 2 diabetes, preventing complications like ulcers.

Question 4 of 5

In admitting a client to the psychiatric unit, the nurse must explain the rules and regulations of the unit. A client with antisocial personality disorder makes the following remark, 'Forget all those rules. I always get along well with the nurses.' Which nursing response to him would be most effective?

Correct Answer: B

Rationale: This answer is incorrect. A nurse should be an appropriate role model. Threats are not appropriate. No limit setting was stated. This answer is correct. The nurse made a positive statement followed by a simple, clear, concise setting of limits. This answer is incorrect. It appears to have a negative connotation. There was no limit setting. This answer is incorrect. The nurse obviously responded in a negative manner. Learning takes place more readily when one is accepted, not rejected. No limits were set.

Question 5 of 5

A client is a victim of domestic violence. She is now receiving assistance at a shelter for battered women. She tells the nurse about the cycle of violence that she has been experiencing in her relationship with her husband of 5 years. In the 'tension-building phase,' the nurse might expect the client to describe which of the following?

Correct Answer: C

Rationale: This description is characteristic of the 'tension-building' phase prior to the volatile discharge of tension found in the battering phase.

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