Ability to focus on interactions with the team is highly impaired in a client with schizophrenia. A current client has cognitive disturbances of distractibility, attention deficit, and difficulty in remembering recent events
The client also has a history of suicide attempts. The nurse conducting an assessment interview states, "Don't you trust me?" How does this question affect the client? A) It is therapeutic and values the client's feelings.
B) It clarifies what the client can expect from the team.
C) It contributes to the client's sense of low self-worth.
D) It reinforces the client's need to prevent self-harm.
C
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The nurse is caring for a patient diagnosed with blood clots in the right lower extremity. The admitting physician orders bed rest. The patient tells the nurse, "I usually exercise three times a week. It helps me go to the bathroom."
The nurse determines that the patient may have difficulty with bowel movements. Which nursing diagnosis statement accurately reflects the nurse's concern? a. Constipation related to bed rest as manifested by hard, dry stools. b. Perceived constipation resulting from patient's expectation manifested by patient statement. c. Risk for constipation related to immobility as manifested by verbal complaint. d. Risk for constipation related to insufficient physical activity.
The nurse is concerned that an older patient has a problem related to regular alcohol consumption. What did the nurse assess in this patient? Select all that apply.
1. Anxiety 2. Malnutrition 3. Social isolation 4. Bruises from falling 5. Dependence on family members
The client with a diagnosis of major depression tells the nurse that multiple generations of women in her family also suffered from depression. She states, "I guess it is a family tradition to have problems dealing with stress."
The nurse tells the client: A) There is no evidence to suggest a familial occurrence of mood disorders. B) Mood disorders do seem to have some basis in heredity, among other contributing factors. C) There is evidence to suggest that genotype is not influenced by stress. D) There is probably a shared stressful environment.
The patient is afraid to have a thoracentesis at the bedside. The nurse sits with the patient and asks about the fears. During the procedure, the nurse stays with the patient, explaining each step and providing encouragement. What is the nurse displaying?
a. Providing touch b. Providing a presence c. Providing family care d. Providing a listening ear