NCLEX-PN

48. The LPN is caring for a client who has a history of exhibiting inappropriate and dangerous behavior in brief episodes. The LPN is asked to suggest ways to adapt the client’s care plan to prevent these episodes. Which of the following are appropriate interventions? Select all that apply. A. Ensure the client has the same bedtime to promote adequate sleep.​ B. Change the client’s schedule daily to help the client adjust to unexpected changes.​ D. Allow the clients to participate in physical exercise to help decrease the client’s stress.​ E. Keep the client engaged in activities from wake up to bedtime to distract the client.

C. Promote appropriate socialization to ensure the client is having enough personal interaction.

A.​ B, C, D B.​ A, C

C.​ A, C, D D.​ B, D, E Correct Response: C

Explanation : The correct answer is (C) (A, C, D), as these interventions are appropriate for adapting the client’s care plan to prevent episodes of inappropriate and dangerous behavior in a client with a history of such episodes. Ensuring the client has the same bedtime to promote adequate sleep (A) contributes to a stable routine, which can reduce stress and potential triggers. Promoting appropriate socialization to ensure the client has enough personal interaction (C) helps address social needs and may prevent feelings of isolation or frustration. Allowing the client to participate in physical exercise to help decrease stress (D) is beneficial for overall well-being. These measures collectively provide a comprehensive approach to fostering a supportive and structured environment for the client, minimizing potential triggers for inappropriate behaviors. (B) is not appropriate, as changing the client’s schedule daily may introduce unnecessary stress and unpredictability, which could exacerbate the client's condition. (E) , while potentially useful in moderation, should be approached cautiously, as excessive engagement in activities may contribute to fatigue and stress.(See Empowering Self-Control: Strategies for Preventing and Managing Inappropriate Behavior ) 49. A client who is 3 hours post-op from a hysterectomy is ordered 7.5 mg morphine sulfate q 2 hr PRN for pain. The pharmacy sends a vial constituted of 5mg/10mL. How many mL will the nurse give?

A.​ 15mL B.​ 10mL C.​ 5mL D.​ 7.5 mL Correct Response: D Explanation : Available is 5mg/10ml but ordered is 7.5mg 5 mg/10 mL = 7.5 mg

75 mg = 5x 75 ÷ 5 = 15 So x = 15mL (See Calculation Formulas for Dosages )

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