During a manic episode a newly admitted client who is displaying hyperactive, restless, and
disorganized behavior goes into the dining room and begins to throw food and dishes. Verbal
intervention is ineffective.
The client's behavior is determined to pose a substantial risk of harm to
others. Seclusion is instituted for the primary purpose of
a. maintaining a safe milieu for other clients.
b. reducing environmental stimuli that negatively affect the client.
c. reinforcing limit setting, enabling the client to learn to follow unit rules.
d. protecting the client's biological integrity until medication can take effect.
B
Seclusion is used when less restrictive measures have failed to help the client maintain control. One
of its benefits is to reduce overwhelming environmental stimuli affecting an extremely distractible
individual.
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Which of the following factors influence normal lung volumes and capacities? Choose all that apply
1) Age 2) Race 3) Body size 4) Activity level
A nurse notes that a patient voices shame and socially isolates. The nurse will most likely interpret this behavior as:
a. unrelated to serious mental illness. b. likely representing learned behaviors. c. associated with secondary symptoms of serious mental illness. d. a coincidental response that has little relationship to the illness.
Place the steps for changing a sterile surgical dressing in the appropriate order.A) Apply clean gloves and remove the old dressing.B) Apply sterile gloves.C) Create a sterile field.D) Assess the incision area for erythema, edema, or drainage.E) Replace sterile dressing.F) Clean the incision using sterile saline.
Fill in the blank(s) with the appropriate word(s).
During which phase of the nurse-patient relationship can the nurse anticipate that identified patient issues will be explored and resolved?
a. Preorientation b. Orientation c. Working d. Termination