which therapeutic technique can the nurse use when an anxious client exhibits pressured and rambling speech which therapeutic technique can the nurse use when an anxious client exhibits pressured and rambling speech
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Psychosocial Integrity NCLEX Questions

1. Which therapeutic technique can the nurse use when an anxious client exhibits pressured and rambling speech?

Correct answer: Focusing

Rationale: Focusing is the appropriate therapeutic technique to use when an anxious client exhibits pressured and rambling speech. By focusing on one specific aspect, the intended meaning is easier to understand and helps the client stay on track. Touch is not recommended in this scenario as it can invade the client's personal space and potentially increase anxiety. Silence may allow the client to continue rambling without addressing the underlying concerns. Summarizing requires the identification and exploration of the client's concerns, which may be challenging when the speech is pressured and disorganized.

2. The major difference between a grand mal and petit mal seizure is that a person with a grand mal seizure will have _______________ and the person with a petit mal seizure will not.

Correct answer: convulsive movements

Rationale: The major difference between a grand mal and petit mal seizure is the presence or absence of convulsive movements. Grand mal seizures are characterized by convulsive movements, including jerking of limbs and loss of consciousness. In contrast, petit mal seizures, also known as absence seizures, typically involve brief episodes of staring or eye blinking without convulsive movements. Therefore, choice A, 'convulsive movements,' is the correct answer. Choices B, 'sleep apnea,' and D, 'flaccidity,' are incorrect as they are not associated with the characteristics of grand mal or petit mal seizures. Choice C, 'atonic movements,' is also incorrect as petit mal seizures do not involve atonic movements, but rather absence behaviors such as staring spells.

3. A client has started sweating profusely due to intense heat. His overall luid volume is low and he has developed electrolyte imbalance. This client is most likely suffering from:

Correct answer: Heat exhaustion

Rationale: Heat exhaustion occurs when a person has enough diaphoresis that he becomes dehydrated. Intense sweating can cause both luid and electrolyte imbalances. Untreated heat exhaustion can lead to heat stroke, which results in organ damage, loss of consciousness, or death.

4. The nurse is comparing the concepts of religion and spirituality. Which statement describes an appropriate component of one’s spirituality?

Correct answer: A connection with something larger than oneself and belief in transcendence

Rationale: Spirituality refers to a connection with something larger than oneself and a belief in transcendence. The other responses do not apply to spirituality. Choice A, 'Belief in and worship of God or gods,' and choice C, 'Attendance at a specific church or place of worship,' are more aligned with religious practices. Choice B, 'Being closely tied to one’s ethnic background,' is not a defining aspect of spirituality or religion as it pertains more to cultural identity rather than spiritual beliefs.

5. When teaching the client with tuberculosis about follow-up home care, the nurse should emphasize that a laboratory appointment for which of the following lab tests is critical?

Correct answer: Liver function

Rationale: The nurse should emphasize the importance of monitoring liver function tests in clients taking INH due to the risk of hepatocellular injury and hepatitis associated with this medication. Regular assessment of liver enzymes can help detect liver damage early. Monitoring kidney function, blood sugar levels, or cardiac enzymes is not specifically required for clients taking INH and tuberculosis treatment.

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