a nurse is caring for a client who is on a methadone maintenance program for opioid addiction what is the most important assessment to perform a nurse is caring for a client who is on a methadone maintenance program for opioid addiction what is the most important assessment to perform
Logo

Nursing Elites

HESI LPN

Mental Health HESI Practice Questions

1. A client is on a methadone maintenance program for opioid addiction. What is the most important assessment to perform?

Correct answer: C

Rationale: The most important assessment to perform for a client on a methadone maintenance program is to evaluate the client's respiratory status. Methadone can cause respiratory depression as a side effect, making it crucial to monitor the client's breathing to prevent potential complications. Monitoring for signs of withdrawal (choice A) is important but not the most critical in this scenario. Assessing for signs of methadone toxicity (choice B) is relevant, but respiratory status takes precedence due to the risk of respiratory depression. Checking the client's blood pressure regularly (choice D) is important for overall assessment but is not as crucial as monitoring respiratory status in this case.

2. A client on the psychiatric unit appears to imitate a certain nurse on the unit. The client seeks out this particular nurse and imitates the nurse's mannerisms. The nurse knows that the client is using which defense mechanism?

Correct answer: B

Rationale: The correct answer is (B) Identification. In this scenario, the client is imitating the nurse's mannerisms, which is a form of identification, a defense mechanism where an individual adopts the characteristics or behaviors of someone they admire or view as powerful. (A) Sublimation involves channeling unacceptable impulses into socially acceptable actions, not imitation. (C) Introjection is the internalization of external qualities or attributes, not imitation. (D) Repression is the unconscious exclusion of painful thoughts or memories from awareness, which is not demonstrated in this case.

3. The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). Which instruction should the LPN/LVN reinforce to the client to help manage their condition?

Correct answer: B

Rationale: Practicing pursed-lip breathing is an essential technique to help manage COPD as it can improve oxygenation by promoting better gas exchange. This technique helps to keep the airways open longer during exhalation, preventing air trapping and improving breathing efficiency. Increasing fluid intake can help thin secretions, which is beneficial, but it is not the primary instruction for managing COPD. Avoiding physical activity is not recommended as it can lead to deconditioning and worsen dyspnea in COPD patients. Using a peak flow meter is more commonly associated with monitoring asthma rather than COPD, so it is not the most relevant instruction for managing COPD.

4. A client post-coronary artery bypass graft (CABG) surgery is concerned about the risk of infection. What is the most important preventive measure the nurse should emphasize during discharge teaching?

Correct answer: D

Rationale: The correct answer is D: 'Keep the incision sites clean and dry.' After CABG surgery, maintaining the cleanliness and dryness of the incision sites is crucial to prevent infections. This practice reduces the risk of introducing harmful microorganisms to the surgical wound, promoting healing and preventing complications. Option A, while important, does not fully encompass the preventive measures necessary to avoid infections post-surgery. Option B is significant if antibiotics are prescribed, but ensuring cleanliness directly addresses infection prevention. Option C is reactive and focuses on addressing infection after it occurs, rather than proactively preventing it.

5. How should a healthcare provider address a child's concerns about a new medical diagnosis?

Correct answer: A

Rationale: Correct answer: Providing clear and age-appropriate information is crucial when addressing a child's concerns about a new medical diagnosis. Children often feel anxious and confused when faced with health issues, so offering them information in a way they can understand helps alleviate their fears and empowers them to cope better. Choice B is incorrect because avoiding discussing the diagnosis can lead to increased anxiety and uncertainty in the child. Choice C is incorrect as referring to a specialist immediately may not be necessary at the initial stage of addressing the child's concerns. Choice D is incorrect as suggesting alternative therapies without providing proper information about the medical diagnosis may not be suitable or effective.

Similar Questions

When performing cardiac chest compressions, what is a critical concept that the nurse must understand?
What dietary considerations must the nurse keep in mind for a patient who is an Orthodox Jew?
A client with osteoporosis is prescribed alendronate (Fosamax). What instruction should the LPN/LVN provide to the client?
A nurse is caring for an older adult client who is confused and continually grabs at the nurse. Which of the following is a nursing action?
During a tonic-clonic seizure, what is the nurse's priority intervention?

Access More Features

HESI Basic

HESI Basic