Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a young adult client who has somatic symptom disorder and is being evaluated for chest pain.
The client's laboratory results are all within the expected reference ranges, the ECG is unremarkable, and the client has no identified cardiac risk factors.
Which of the following actions should the nurse take?
A. Refer the client for flooding therapy.
Flooding therapy is not typically used for somatic symptom disorder.
B. Inform the client that the pain is not real.
Telling a client that their pain is not real can invalidate their experience and is not a recommended approach for somatic symptom disorder.
C. Provide reassurance to the client.
Providing reassurance to the client is a recommended approach when all tests are normal and there are no identified risk factors.
D. Encourage the client to request invasive cardiac testing.
Encouraging the client to request invasive cardiac testing is not typically recommended when all tests are normal and there are no identified risk factors.
This question is an excerpt from Nurse Dive's nursing test bank - Ati Rn Custom Nurs 120 Psychiatric Nursing Fa23 Proctored Exam 2. Take the full exam now
Full Explanation
Choice A rationale:
Flooding therapy is not typically used for somatic symptom disorder.
Choice B rationale:
Telling a client that their pain is not real can invalidate their experience and is not a recommended approach for somatic symptom disorder.
Choice C rationale:
Providing reassurance to the client is a recommended approach when all tests are normal and there are no identified risk factors.
Choice D rationale:
Encouraging the client to request invasive cardiac testing is not typically recommended when all tests are normal and there are no identified risk factors.
Similar Questions
A nurse is caring for a client who has been diagnosed with schizophrenia.
The client has been wearing the same clothes for the past week and appears unkempt and unbathed.
Which of the following statements should the nurse make to the client?
A. "Do you really think it is ok not to bathe? What is going on with you?".
This statement is confrontational and may make the client defensive.
B. "It is now time for you to bathe. Do you want to wear the red or green shirt?".
This statement provides the client with a choice, promoting autonomy and encouraging self-care.
C. "This is it! You are getting a bath! There are three of us here to bathe you!".
This statement is forceful and does not respect the client’s autonomy.
D. "I'm going to ignore your lack of self-care because it is an aspect of the disorder.”.
Ignoring the client’s lack of self-care does not address the issue and could potentially harm the client.
Full Explanation
Choice A rationale:
This statement is confrontational and may make the client defensive.
Choice B rationale:
This statement provides the client with a choice, promoting autonomy and encouraging self-care.
Choice C rationale:
This statement is forceful and does not respect the client’s autonomy.
Choice D rationale:
Ignoring the client’s lack of self-care does not address the issue and could potentially harm the client.
A nurse is reviewing abnormal laboratory values for four clients who have schizophrenia and take clozapine.
For which of the following clients should the nurse withhold the medication and notify the provider immediately to have clozapine therapy discontinued?
A. A client who has a BUN of 22 mg/dL.
A BUN of 22 mg/dL is slightly elevated but not a contraindication for clozapine.
B. A client who has a serum potassium of 3.3 mEq/L.
A serum potassium of 3.3 mEq/L is slightly low but not a contraindication for clozapine.
C. A client who has a hematocrit of 55%.
A hematocrit of 55% is high but not a contraindication for clozapine.
D. A client who has a WBC of 2,900 cells/mm².
A WBC of 2,900 cells/mm² is low and can indicate agranulocytosis, a potentially life-threatening condition. Clozapine should be discontinued.
Full Explanation
Choice A rationale:
A BUN of 22 mg/dL is slightly elevated but not a contraindication for clozapine.
Choice B rationale:
A serum potassium of 3.3 mEq/L is slightly low but not a contraindication for clozapine.
Choice C rationale:
A hematocrit of 55% is high but not a contraindication for clozapine.
Choice D rationale:
A WBC of 2,900 cells/mm² is low and can indicate agranulocytosis, a potentially life-threatening condition. Clozapine should be discontinued.
A nurse reviews the laboratory report for a client who is receiving lithium three times daily PO. The client's current blood lithium level is 1.8 mEq/L. The nurse identifies that this lab value indicates which of the following?.
A. The lithium level is within the therapeutic level for initial treatment.
A lithium level of 1.8 mEq/L is above the therapeutic level for initial treatment (0.8 to 1.4 mEq/L)3.
B. The lithium level is below the therapeutic treatment level.
A lithium level of 1.8 mEq/L is above, not below, the therapeutic treatment level.
C. The lithium level is at the toxic level.
A lithium level of 1.8 mEq/L is at the toxic level. A blood lithium level greater than 1.5 mEq/L indicates toxicity.
D. A blood lithium level of 1.8 mEq/L is not within the maintenance treatment level.
A lithium level of 1.8 mEq/L is not within the maintenance treatment level (0.4 to 1.3 mEq/L)3.
Full Explanation
Choice A rationale:
A lithium level of 1.8 mEq/L is above the therapeutic level for initial treatment (0.8 to 1.4 mEq/L)3.
Choice B rationale:
A lithium level of 1.8 mEq/L is above, not below, the therapeutic treatment level.
Choice C rationale:
A lithium level of 1.8 mEq/L is at the toxic level. A blood lithium level greater than 1.5 mEq/L indicates toxicity.
Choice D rationale:
A lithium level of 1.8 mEq/L is not within the maintenance treatment level (0.4 to 1.3 mEq/L)3.