The nurse suspects that a male client may become violent. Which verbal cue might have indicated this? The client:
1. Receives news that his wife is filing for divorce and begins sobbing inconsolably.
2. Demands, "Give me my medicine now or you'll be sorry."
3. Begins pacing the hall exhibiting clenched jaw and fists.
4. States, "I don't know why people seem afraid of me."
2
Rationale: Threats or demands are verbal cues that indicate potential for violence. Crying is not a violence risk factor. Pacing and exhibiting clenched fists and jaws are behavioral, not verbal, cues of risk for violence. Nothing in the client's statement of concern about others' fears is indicative of impending violence.
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a. "Beer and martinis have the same alcohol and calorie content." b. "Only beer drinkers are considered alcoholics if they overindulge." c. "The alcohol in 4 martinis is equal to about 11 cans of regular beer." d. "People who drink martinis may consume a smaller amount of alcohol but can still be considered alcoholics."
When preparing nutritional instruction, which pregnant patient would the nurse consider the highest priority?
1. 40-year-old gravida 2 2. 22-year-old primigravida 3. 35-year-old gravida 4 4. 15-year-old nulligravida
Prioritize the steps in developing a concept map
a. Develop the basic diagram. d. Place all the data on the concept map in an organized manner. b. Develop interventions to address the client's condition or the chosen disease. e. Choose a client, a disease, or main theme around which the concept map is developed. c. Prioritize the main concepts of the client, disease, or theme. f. Draw lines to show the relationship between the data.
To detect this complication, what will be the focus of your ongoing assessment?
What will be an ideal response?