The nurse notes that a client with schizophrenia sits in a chair rocking back and forth for long periods of time. The nurse should characterized this behavior as which of the following?
A) A side effect of medication
B) Catatonic stupor
C) Catatonic excitement
D) A sign of anxiety
Ans: C
Feedback:
In catatonic excitement, clients may show uncontrolled and aimless motor activity. They may engage in repetitive stereotypic movements with no apparent purpose, such as rocking back and forth for hours. Clients also may manifest normal mannerisms out of context, such as grimacing for no reason.
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Which of the following ambulatory aids could a nurse suggest to assist a client who has weakness in one side of his body?
A) Cane B) Walker C) Axillary crutch D) Forearm crutch
The nurse is educating a client who has been diagnosed with stress incontinence. The nurse should include which of the following in the teaching care plan? Standard Text: Select all that apply
1. The client should maintain an ideal body weight. 2. The client should limit fluid intake to 4 glasses a day. 3. The client should try to void on a regular schedule. 4. The client should perform pelvic muscle strengthening exercises. 5. The client should increase fiber intake.
Which of the following methods of documenting client data is least likely to hold up in court if a case of negligence is brought against a nurse?
A) Problem-oriented medical record B) Charting by exception C) PIE charting system D) Focus charting
Pulse rates should be reported to your immediate supervisor if they
A) are less than 97 or greater than 100. B) are less than 60 or more than 100. C) are between 72 and 80. D) are greater than 28 or less than 14.