A patient reports that the voices he hears distract and sometimes frighten him. Which actions would be appropriate for the nurse to recommend? Select all that apply
a. Listen to music.
b. Take a short nap.
c. Read books aloud.
d. Spend time alone.
e. Say, "Go away, voices.".
f. Converse with others.
A, C, E, F
Activities which require concentration, provide distraction, involve competing auditory stimuli (e.g. music), or involve interaction with others tend to help persons who are hallucinating. Telling the "voices" to "go away" allows the patient to exert control over the experience and decreases his sense of powerlessness relative to the hallucinations. Solitary activities would reduce competing reality-based stimuli and reduce opportunities to participate in external, reality-based activities and as a result tend to worsen hallucinations. Napping would not be expected to help hallucinations, and it would probably be difficult for an actively hallucinating person to nap.
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A 6-month-old infant is due for routine immunizations. The parent reports the infant was exposed to pertussis 2 days ago. The nurse should:
a. give the 6 month immunizations as scheduled. b. hold the 6 month immunizations until the next visit. c. hold the 6 month immunizations for 3 weeks. d. notify the physician.
Modern parish nursing in the United States is attributed to
1. Dr. Sydney Rosenbaum. 2. Father Joseph McLaughton. 3. Jean Watson. 4. Reverend Granger Westberg. 5. Sister Mary Margaret Logan.
A pregnant woman is in her third trimester. She asks the nurse to explain how she can tell true labor from false labor. The nurse would explain that "true" labor contractions:
a. Increase with activity such as ambulation. b. Decrease with activity. c. Are always accompanied by the rupture of the bag of waters. d. Alternate between a regular and an irregular pattern.
Nursing diagnoses must meet specific criteria to reflect both the client's problem and the possible etiology involved. Which one of the following is an appropriate etiology for a nursing diagnosis?
a. Abnormal blood gas levels b. Myocardial infarction c. Increased airway secretions d. Cardiac catheterization