An 80-year-old client visits the mental health clinic with her daughter. During the assessment process, the client tells the nurse that she is taking an antidepressant, an antibiotic, and an occasional aspirin. Which question would be most important for the nurse to ask?

Correct Answer: A

Rationale: The correct answer is A: "How much grapefruit juice do you drink on a daily basis?" This is because grapefruit juice can interact with certain medications, including antidepressants, antibiotics, and aspirin, leading to potentially serious side effects. Grapefruit juice inhibits the enzyme CYP3A4, which can increase the concentration of these medications in the bloodstream, causing adverse effects. Therefore, it is crucial for the nurse to ask about grapefruit juice consumption to assess the risk of drug interactions. Choices B, C, and D are incorrect because orange juice, tomato juice, and grape juice do not have significant interactions with the mentioned medications. While it is important to consider overall dietary habits, grapefruit juice specifically has a known interaction with many medications, making it the most critical question to ask in this scenario.

Correct Answer: A

Rationale: The correct answer is A because it promotes cognitive-behavioral techniques to manage anger effectively. By helping the patient identify triggering thoughts, evaluate their validity, and replace them with reality-based thinking, nurses can assist in changing the patient's response to anger. This intervention encourages self-awareness and empowers the patient to develop healthier coping mechanisms. Choice B is incorrect as it promotes punitive measures, which can escalate aggression and undermine trust between the patient and healthcare provider. Choice C is incorrect as aversive conditioning methods like popping a rubber band on the wrist are not evidence-based and can be harmful. Choice D is incorrect as medication should not be the first-line intervention for managing anger without violence.

Correct Answer: A

Rationale: The correct answer is A because a client placed in restraints due to aggressive behavior poses an immediate safety concern that requires urgent assessment to prevent harm to the client or others. Assessing this client first ensures their immediate well-being. Choice B may indicate a potential health issue but does not pose an immediate safety threat, so it can be assessed after addressing the client in restraints. Choice C, a client receiving PRN medication for anxiety, may require assessment but does not present the same level of urgency as a client in restraints. Choice D, a client receiving ECT treatment, is important but not as urgent as the client in restraints. It can be assessed after addressing the immediate safety concern.

Correct Answer: D

Rationale: The correct answer is D (ages 18 to 24 years Women) because young women in this age group are statistically at the highest risk of being stalked. Factors such as increased social media use, dating relationships, and independence make them vulnerable. They may also be more likely to encounter obsessive behaviors from current or former partners. Choice A (Boys and young men) is less likely as stalking affects women more frequently. Choice B (ages 12 to 21 years Men) is less likely as younger age groups are generally at a lower risk. Choice C (ages 24 to 28 years) is less likely as the risk tends to decrease slightly as individuals get older.

Correct Answer: A

Rationale: The correct answer is A: Lithium (Eskalith). Lithium is known to cause fluid and electrolyte imbalances by affecting sodium and water reabsorption in the kidneys. Patients on lithium therapy should be closely monitored for signs of dehydration, hyponatremia, and other electrolyte disturbances. Clozapine, Diazepam, and Amitriptyline do not typically cause significant fluid and electrolyte imbalances. Monitoring is still important, but not as critical as with lithium.