A mental health nurse is caring for a schizophrenic client. The nurse observes the client laughing about the recent death of her father. The nurse would correctly document this mood as which of the following?
A) Blunted
B) Inappropriate
C) Flat
D) Labile
Ans: B
The correct answer is inappropriate affect or lack of harmony between one's voice and movements with one's speech or verbalized thoughts. Blunted affect is a severe reduction or limitation in the intensity of one's affective responses to a situation. Flat affect describes absence or near absence of any signs of affective responses. Labile affect is the abnormal fluctuation of one's expressions.
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a. Parkinsonism. b. Cerebral palsy. c. Cerebellar ataxia. d. Muscular dystrophy.
The nurse is applying a hydrocolloid dressing to a client's wound, which measures 2 inches by 3 inches. The nurse would cut the dressing to which dimensions?
1. 3.5 inches by 4.5 inches 2. 2 inches by 3 inches 3. 1 1/2 inches by 2 1/2 inches 4. 1 inch by 1 1/2 inches
Over 50 million adults in the US have hypertension. Which of the following could be reduced if hypertension were controlled? (Select all that apply.)
a. disseminated intra-vascular coagulation d. myocardial infarction b. stroke e. heart failure c. deep vein thrombosis (DVT) f. syncope
The nurse instructs the client about the continent urinary diversion in the postoperative period and states that the stoma does not need a pouch. Which does the nurse use to explain the reason for the statement?
1. A gauze pad over the stoma collects draining urine. 2. All urine drains from the remaining healthy ureter. 3. Stoma has a muscular closure to prevent leakage. 4. Initially, a urinary diversion does not drain urine.