NCLEX-RN
NCLEX RN Exam Review Answers Questions
Extract:
Question 1 of 5
A client on an acute mental health unit reports hearing voices that are stating, "kill your doctor"?. Which of the following actions should the nurse take first?
Correct Answer: B
Rationale: When a client experiences command hallucinations, such as being told to harm someone, the priority is ensuring the safety of the client and others. Initiating one-to-one observation allows for close monitoring and intervention to prevent harm. Encouraging participation in group therapy may not be appropriate or safe at this time. Focusing the client on reality may not be effective when experiencing hallucinations, and notifying the provider should come after immediate safety measures have been taken.
Question 2 of 5
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Question 3 of 5
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Question 4 of 5
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Question 5 of 5
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