2. A client who has been prescribed Chlordiazepoxide (Librium) has come into the clinic for a check-up. Which of the following behaviors indicates that the client has been taking the assigneddosage? a. Client feels energetic.b. Client gets easily confused.c. Client is always thirsty.d. Client complains of general fatigue.Rational: A common side effect of Chlordiazepoxide (Librium) is fatigue. The client should not feel energetic, get confused, or always be thirsty in relation to taking the prescribed dosage. 3. The nurse is caring for a patient with severe claustrophobia. What area of the hospital should the nurse avoid with the patient? Rational: A patient with claustrophobia has a fear of enclosed areas, such as elevators, small rooms, and closets. 4. The most important nursing action included in the care plan for the client taking morphine sulfate for pain is to: Rational: A patient taking morphine sulfate should control secretions by coughing and breathing deeply. The nurse should also encourage fluids for the patient, however the best answer is encouraging coughing and deep breathing. 5. The success of pericardiocentesis performed to treat cardiac tamponade is indicated by:
Rational: Cardiac tamponade is an acute pericardial effusion where fluid accumulates in the pericardium. Hypotension often occurs due to decreased stroke volume. When this fluid is removed during pericardiocentesis, normal stroke volume should resume, increasing blood pressure. 6. The client in the termination phase of the nurse-client relationship is being very confrontational. How should the nurse interpret this behavior? a. The nurse has done something to offend the client.b. The patient should be admitted to the hospital.c. The treatment should revisit the working phase.d. This behavior is common for a client in the termination phase.Rational: Confrontational behavior is very common for a client in the termination phase. The nurse should not assume that she offended the client, and further action in terms of therapy should not be addressed until completing the termination phase. 7. The nurse wishes to position the casted leg of a patient with a recent fracture. Which would be the appropriate action? Rational: The nurse should elevate the leg for 24 to 48 hours to reduce swelling and to allow fluid and blood to drain downhill to the patient's heart.
- Fall '18