An adolescent client is seen in the emergency department with symptoms of dementia, tremors, and ataxia. The client had been sniffing glue with a friend. The nurse suspects the client's symptoms were caused by poisoning with which of the following?

Correct Answer: C

Rationale: The correct answer is C: Toluene. Toluene is a solvent found in glue and can cause symptoms of dementia, tremors, and ataxia when inhaled. Mercury (A), lead (B), and arsenic (D) are toxic substances but do not typically present with these specific symptoms after glue sniffing. Mercury poisoning can cause neurological symptoms, lead poisoning can lead to developmental delays, and arsenic poisoning can result in gastrointestinal symptoms. Toluene exposure is associated with neurological effects due to its impact on the central nervous system.

Correct Answer: D

Rationale: The correct answer is D because a client who had a cerebrovascular accident two days ago and needs help toileting can be safely assigned to an AP. This task does not require specialized nursing knowledge or assessment skills. The AP can assist with toileting safely under the supervision of the nurse. Choices A, B, and C require nursing assessment, intervention, or evaluation of the client's condition, which should be done by a nurse. Assigning these tasks to an AP could compromise client safety and proper care.

Correct Answer: C

Rationale: The correct answer is C: Toluene. Toluene is a solvent found in glue and can cause symptoms of dementia, tremors, and ataxia when inhaled. Mercury (A), lead (B), and arsenic (D) are toxic substances but do not typically present with these specific symptoms after glue sniffing. Mercury poisoning can cause neurological symptoms, lead poisoning can lead to developmental delays, and arsenic poisoning can result in gastrointestinal symptoms. Toluene exposure is associated with neurological effects due to its impact on the central nervous system.

Correct Answer: D

Rationale: The correct answer is D because assertive community treatment (ACT) is designed for individuals with severe mental illnesses, such as schizophrenia, who have difficulty managing their symptoms and functioning independently. This patient with schizophrenia and frequent hospitalizations would benefit from the intensive, community-based support provided by ACT teams. Choice A is incorrect as a phobic fear of crowded places does not typically require the level of intensive support provided by ACT. Choice B is incorrect as a single episode of major depressive disorder may not warrant the ongoing, comprehensive care offered by ACT. Choice C is incorrect as a catastrophic reaction to a tornado is likely a situational crisis that may be better addressed through crisis intervention or trauma-focused therapy, rather than ACT.

Correct Answer: D

Rationale: The correct response is D because it directly addresses the ambiguity in the patient's statement by seeking clarification on the term "stoned." By asking for an example, the nurse can better understand the specific content of the dream and its emotional impact on the patient. This open-ended question encourages the patient to elaborate and express their feelings, leading to a more meaningful conversation and a deeper understanding of the patient's concerns. Choices A, B, and C are incorrect because they do not directly address the ambiguity in the patient's statement or seek clarification on the term "stoned." Choice A assumes the patient was uncomfortable with the dream content, choice B only relates the nurse's experience without addressing the patient's specific situation, and choice C focuses on the quality of sleep rather than the content of the dream.