A full bladder can help improve the quality of an abdominal ultrasound by pushing the intestines out of the way and providing a clearer view of the uterus and baby.

The therapist's statement shows a lack of remorse or guilt for committing Medicare fraud. The statement suggests that the therapist does not see anything wrong with overbilling Medicare and taking advantage of the government. This lack of remorse or guilt is a common trait seen in individuals who engage in fraudulent behaviour.

Schizophrenia is a severe mental illness associated with an increased risk of suicide. Individuals with schizophrenia are at a higher risk of suicide due to the presence of symptoms such as depression, hopelessness, and social isolation. Unemployment is also a risk factor for suicide as it can contribute to financial and social stress.

The other options do have some risk factors, but not as high as the individual in option c. Alcohol use and being independent-minded are not necessarily significant risk factors for suicide, and being active in church can be a protective factor. While depression is a significant risk factor for suicide, it is not the only factor, and having two best friends may be a protective factor. Diabetes, in and of itself, is not a risk factor for suicide.

Borderline personality disorder is a serious mental illness characterized by instability in mood, behaviour, and self-image. Patients with borderline personality disorder are at a high risk of self-harm, suicide, and impulsive behaviours. Therefore, the nurse's priority assessment should be to identify any suicidal or homicidal ideations, as these can be life-threatening emergencies. Once identified, appropriate interventions should be initiated, such as suicide precautions, crisis management, and referral to mental health professionals for further evaluation and treatment.

While sleep patern changes, impulsive behaviours, and support systems are also important aspects to assess in patients with borderline personality disorder, they are not the priority when compared to suicidal or homicidal ideations.

Therapeutic communication involves actively listening to the client, demonstrating empathy, and using open-ended questions to encourage the client to express their thoughts and feelings.

Reflecting (option a) and listening attentively (option b) are both examples of effective therapeutic communication techniques as they demonstrate active listening and empathy.

However, offering advice (option c) is a barrier to therapeutic communication because it implies that the nurse knows what is best for the client and can solve their problems for them.

This can create a power dynamic in the nurse-client relationship and may discourage the client from expressing their true thoughts and feelings. Giving information (option d) can be an important aspect of therapeutic communication, but it should be done in a way that respects the client's autonomy and involves collaboration rather than giving directives.

a. Initiate one to one constant supervision around the clock: A client who has attempted suicide is at high risk for further harm, and close monitoring is necessary to prevent further attempts. Initiation of one-to- one constant supervision around the clock ensures that the client is continuously monitored, and any signs of suicidal ideation or behavior can be immediately addressed.

e. Check the environment for possible hazards: It is important to check the client's environment for potential hazards, such as sharp objects, cords, or other items that could be used to harm oneself. This step helps to ensure the client's safety and prevent further attempts.

The other options are not appropriate or necessary in this situation:

b. Ensure the client's hands are always visible: This action may be necessary if the client has a history of self-harm or aggressive behavior, but it is not specifically related to preventing suicide attempts.

c. Tuck bedcovers over client's hands and arms: This action may be necessary if the client has a history of self-harm, but it is not specifically related to preventing suicide attempts.

d. Inspect the client's personal belongings: While it may be important to inspect the client's personal belongings for any items that could be used for self-harm, this action is not as urgent as initiating constant supervision and checking the environment for hazards.

f. Assign the client to a private room: While a private room may be beneficial for the client's comfort and privacy, it is not specifically related to preventing suicide attempts.

g. Place only plastic utensils on the client's meal tray: This action is not specifically related to preventing suicide attempts, unless there is concern that the client may harm themselves with utensils.

This statement by the patient suggests that they may be projecting their feelings, thoughts, and attitudes toward their parents and uncle onto the therapist. This projection is a common phenomenon in therapy and is known as transference. Transference occurs when a patient transfers emotions, desires, and expectations from one person to another, usually the therapist. It can be positive or negative and can affect the therapeutic relationship.

Therefore, the statement "Talking to you feels like talking to my parents and uncle" is a clear indication of transference and should be carefully considered by the therapist in the ongoing therapy sessions. The therapist should explore the patient's feelings and experiences with their parents and uncle to better understand the nature of the transference and how it may be affecting the therapeutic process.

a. “I can see that you feel sad about this situation”.

e. “The loss of your parent should be very painful for you.”

These responses by the nurse show empathy and validate the patient’s feelings. They also encourage the patient to continue expressing their emotions and facilitate communication.

Option b. “Don’t be sad, everyone has to pass for something like this in the life” is not a helpful response

because it minimizes the patient’s feelings and may make them feel like their emotions are not valid.

Option c. “I felt very sad when my mother died, it was horrible!” is not a helpful response because it shifts the focus of the conversation away from the patient and onto the nurse’s personal experience.

Option d. “Let’s talk about something else. this subject is upsetting you, don’t worry about this” is not a helpful response because it dismisses the patient’s emotions and may make them feel like they are not allowed to express their feelings.

The ethical principle of justice refers to the fair and equal treatment of all individuals. In this situation, the nurse is concerned about whether the team is behaving ethically by using different approaches to prevent self-mutilation in two patients. The nurse is questioning whether the team is treating both patients fairly and equally.

Option a. Veracity refers to the principle of truth-telling and honesty.

Option b. non-maleficence refers to the principle of doing no harm.

Option c. Autonomy refers to the principle of respecting an individual’s right to make their own decisions.

This client is experiencing auditory hallucinations and may be at risk for self-harm or suicide. The nurse should prioritize visiting this client first to assess their safety and provide appropriate interventions.

Option a. A client who recently burned her arm by accident while using a hot iron at home may require wound care and education on safety, but this situation is not as urgent as the client experiencing auditory hallucinations.

Option b. A client who tells the nurse he experienced manifestations of severe anxiety before and during a job interview may benefit from interventions to manage anxiety, but this situation is not as urgent as the client experiencing auditory hallucinations.

Option c. A client who requests that her antipsychotic medication be changed due to some new adverse effects may require medication adjustment and monitoring for side effects, but this situation is not as urgent as the client experiencing auditory hallucinations.

During the termination phase of the nurse-client relationship, the nurse should focus on making appropriate referrals to ensure that the client continues to receive the care and support they need after the relationship with the nurse has ended.

Option a. Developing realistic solutions is an important task during the working phase of the nurse-client relationship, when the nurse and client work together to identify and implement solutions to the client’s problems.

Option b. Building rapport and trust is an important task during the orientation phase of the nurse-client relationship, when the nurse and client get to know each other and establish a therapeutic relationship.

Option d. Identifying expected outcomes is an important task during the planning phase of the nursing process, when the nurse and client work together to set goals and develop a plan of care.

This response acknowledges the client's request for the forms while also addressing the need to discuss the client's decision to leave treatment. It provides an opportunity for the nurse to explore the client's reasons for wanting to leave, discuss the potential consequences of leaving against medical advice, and address any concerns or fears the client may have about continuing treatment.

Option b is not appropriate because it does not address the potential risks associated with leaving treatment against medical advice.

Option c is also not appropriate because it does not acknowledge the client's request and is potentially misleading.

Option d is not appropriate because it does not address the client's reasons for wanting to leave or the potential consequences of leaving against medical advice.

a. Substance abuse disorder

b. Schizophrenia

c. Age greater than 55 years old

f. Male gender

h. Previous suicide attempt.

Option a. Substance abuse disorder can increase the risk of suicide because it can exacerbate underlying mental health conditions and impair judgment.

Option b. Schizophrenia is a mental health condition that can increase the risk of suicide due to symptoms such as delusions and hallucinations.

Option c. Age greater than 55 years old is a risk factor for suicide because older adults may experience social isolation, chronic health conditions, and loss of independence.

Option f. Male gender is a risk factor for suicide because men are more likely to die by suicide than women. Option h. Previous suicide attempt is a strong predictor of future suicide attempts and completed suicides. Option d. Female gender is not a known risk factor for suicide.

Option e. Being currently married is not a known risk factor for suicide. Option g. Having a bachelor’s degree is not a known risk factor for suicide.

False imprisonment is the unlawful restraint of a person against their will. In this situation, the nurse’s actions of placing the client in seclusion overnight because the unit is short-staffed and the client frequently fights with other clients may be considered false imprisonment if the client did not consent to being placed in seclusion and if there were no legal grounds for doing so.

Option a. Invasion of privacy refers to the violation of a person’s right to privacy.

Option b. Battery refers to the intentional and harmful or offensive touching of another person without their consent.

Option d. Assault refers to the intentional act of causing another person to fear immediate harm or offensive contact.

Russell’s sign is a physical symptom that is associated with bulimia nervosa. It refers to the presence of calluses on the knuckles or back of the hand that are caused by repeated self-induced vomiting.

Option a. Very low BMI is not typically associated with bulimia nervosa. People with bulimia nervosa may have a normal or above-normal BMI.

Option b. Decreased size of parotid glands is not associated with bulimia nervosa. In fact, people with bulimia nervosa may have an enlarged parotid gland due to repeated vomiting.

Option d. Fluid and electrolyte overload is not typically associated with bulimia nervosa. People with bulimia nervosa may experience fluid and electrolyte imbalances due to repeated vomiting and laxative abuse.

Generalized anxiety disorder (GAD) is a type of anxiety disorder characterized by excessive and persistent worry about a variety of different things, including health, work, relationships, and everyday situations. People with GAD may experience physical symptoms, such as fatigue, muscle tension, and restlessness.

Option a is not a typical finding associated with GAD. Sudden unexplained loss of vision may be a symptom

of a neurological or ophthalmologic condition, but not specifically related to GAD.

Option c describes a condition called body dysmorphic disorder (BDD), which is a type of obsessive- compulsive disorder characterized by an excessive preoccupation with a perceived physical flaw. BDD is not typically associated with GAD.

Option d does not describe a typical finding associated with GAD. While physical health issues can contribute to anxiety, the need for surgeries within the last three months is not necessarily indicative of GAD.

Therefore, the correct option is b. Constant worry about the undiagnosed presence of an illness for more than 6 months. People with GAD often worry about their health and the possibility of having an undiagnosed illness, even when there is no evidence of a problem. This worry may persist for six months or more and can interfere with daily life.

Denial is a defense mechanism where an individual refuses to accept or acknowledge the existence of a problem or a reality that causes anxiety or distress. In this scenario, the client is denying that their coughing is related to their lung cancer, and instead attributing it to a common cold that everyone is getting. This denial may be a way for the client to avoid facing the reality of their illness and the potential consequences of smoking.

Option b, reaction formation, is a defense mechanism where an individual expresses feelings or behaviors that are the opposite of their true feelings to reduce anxiety.

Option c, sublimation, is a defense mechanism where an individual channels their unacceptable impulses into more acceptable or socially appropriate behaviors.

Option d, suppression, is a defense mechanism where an individual consciously pushes down or avoids their thoughts or feelings. None of these defense mechanisms are being exhibited in the scenario described.

The child is striving for independence.” The behaviors described by the parent are typical for a child who is 26 months old. At this age, children are beginning to develop a sense of autonomy and independence, and they may resist direction and assert their own will. Toilet training can also be a challenging process for both children and parents, and it is not uncommon for children to resist or refuse toilet training at first.

Option a. “The child needs more control. You have been weak” is not a helpful response because it places blame on the parent and does not provide any useful information or guidance.

Option b. “Some undesirable attitudes are developing currently. A child psychologist can help you develop a remedial plan” may be an appropriate response if the child’s behaviors were significantly outside the norm for their age or if they were causing significant distress or disruption. However, based on the information provided by the parent, this does not appear to be the case.

Option d. “There may be developmental problems. Most children are toilet trained by age 2 years and a half” is not a helpful response because it may cause unnecessary worry or concern for the parent. While many children are toilet trained by age 2 and a half, there is a wide range of normal variation in when children achieve this milestone.

A systolic blood pressure of 62 mm Hg indicates severe hypotension and is a medical emergency. This is a life-threatening situation that requires immediate hospitalization for stabilization and treatment. Clients with eating disorders are at risk of electrolyte imbalances, cardiac complications, and other medical complications due to malnutrition and dehydration. While the other options are also abnormal findings, they are not as severe as the critically low blood pressure measurement. Therefore, the priority for hospitalization would be the client with severe hypotension.

Manipulative behavior is not acceptable in any situation, and it is important for the nurse to set clear boundaries and expectations with the client. Allowing manipulation can enable the client's behavior and reinforce it. Avoiding discussing past or present manipulative behaviors with the client may not effectively address the issue and could potentially worsen the behavior. Bargaining with the client can also reinforce manipulative behavior.

Therefore, instituting consequences for manipulative behavior is the most appropriate intervention to include in the plan of care. This could involve setting clear limits on what is acceptable behavior and consistently enforcing consequences when those limits are exceeded. The consequences should be communicated clearly to the client, and the nurse should work with the client to identify more appropriate ways to communicate their needs and concerns.

When caring for a client with obsessive-compulsive disorder (OCD), it is important for the nurse to understand that the client’s compulsive behaviors are a way for them to manage their anxiety and distress. Rather than trying to confront or eliminate these behaviors, the nurse should work with the client to develop a schedule that allows time for their rituals while also incorporating other activities and treatments.

Option a. Confront the client about the senseless nature of repetitive behaviors is not a helpful intervention because it may increase the client’s anxiety and distress.

Option b. Isolate the client for a period of time is not a helpful intervention because it does not address the underlying causes of the client’s compulsive behaviors.

Option d. Set very strict limits on the behaviors so that the client can conform to the unit rules and schedules is not a helpful intervention because it may increase the client’s anxiety and distress and may interfere with their ability to participate in treatment.

Refeeding syndrome is a potentially life-threatening complication that can occur when a person with anorexia nervosa or other forms of malnutrition begins to eat again after a period of starvation. It is characterized by electrolyte imbalances and fluid shifts that can lead to cardiovascular dysfunction, including heart failure and arrhythmias. Therefore, when caring for a patient with anorexia nervosa who is being refed, it is important for the nurse to closely monitor the patient’s cardiovascular system for signs of dysfunction.

Option a. Endocrine system dysfunction can occur in patients with anorexia nervosa, but it is not typically associated with refeeding syndrome.

Option b. Respiratory system dysfunction can occur in patients with anorexia nervosa, but it is not typically associated with refeeding syndrome.

Option c. Musculoskeletal system dysfunction can occur in patients with anorexia nervosa, but it is not typically associated with refeeding syndrome.

Option a. Clients diagnosed with anorexia nervosa often see themselves as overweight is true. Anorexia nervosa is characterized by a distorted body image and an intense fear of gaining weight. Even when they are severely underweight, individuals with anorexia nervosa may perceive themselves as being overweight.

Option b. Anorexia Nervosa has the highest mortality of all mental disorders is true. Anorexia nervosa is a serious mental illness that can have severe physical and psychological consequences, including death.

Option c. Clients diagnosed with anorexia nervosa often see themselves as emaciated and underweight is not true. As mentioned above, individuals with anorexia nervosa often have a distorted body image and may perceive themselves as being overweight even when they are severely underweight.

Option d. Clients diagnosed with anorexia nervosa are self-indulgent is not true. Anorexia nervosa is a complex mental illness that is not caused by self-indulgence.

Option e. Adolescent females are most affected is true. While anorexia nervosa can affect individuals of any gender and age, it is most diagnosed in adolescent females.

Diarrhea, vomiting, and drowsiness are potential signs of lithium toxicity, which can be a serious and potentially life-threatening condition. If a client who is being treated with lithium carbonate develops these symptoms, the nurse should notify the health care provider immediately and hold the next dose of medication until new orders are received from the provider.

Option a. Hold the medication and refuse to administer additional doses for 3 days is not an appropriate action because it does not involve notifying the health care provider or obtaining new orders.

Option b. Notify the health care provider immediately and give 4 liters of fluids is not an appropriate action because it involves administering fluids without obtaining orders from the health care provider.

Option d. Document the client’s symptoms and continue with medication as prescribed is not an appropriate action because it does not involve notifying the health care provider or holding the next dose of medication.

Rationalization is a defence mechanism in which a person attempts to justify or explain their behavior or actions in a way that makes them seem more acceptable or reasonable. In this case, the client is using rationalization by attributing their alcohol abuse to their job and the need to drink with clients at parties.

Option a. Compensation is a defense mechanism in which a person attempts to make up for a perceived weakness or deficiency by excelling in another area.

Option b. Suppression is a defense mechanism in which a person consciously chooses to avoid thinking about or dealing with unpleasant thoughts or feelings.

Option d. Reaction-formation is a defense mechanism in which a person behaves in a way that is opposite to their true feelings or desires.