This topic contains a solution. Click here to go to the answer
« previous next »

Author Question: A patient's care plan includes monitoring for auditory hallucinations. Which assessment findings ... (Read 65 times)

chandani

  • Hero Member
  • *****
  • Posts: 541
on: Jul 19, 2018
A patient's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating?
 
  a. Detachment and overconfidence
  b. Darting eyes, tilted head, mumbling to self
  c. Euphoric mood, hyperactivity, distractibility
  d. Foot tapping and repeatedly writing the same phrase

Question 2

Which hallucination necessitates the nurse to implement safety measures? The patient says,
 
  a. I hear angels playing harps.
  b. The voices say everyone is trying to kill me.
  c. My dead father tells me I am a good person.
  d. The voices talk only at night when I'm trying to sleep.


Related Topics

Need homework help now?

Ask unlimited questions for free

Ask a Question
Marked as best answer by a Subject Expert

Jmfn03

  • Sr. Member
  • ****
  • Posts: 323
Reply #1 on: Jul 19, 2018
Answer to Question 1

ANS: B
Clues to hallucinations include eyes looking around the room as though to find the speaker, tilting the head to one side as though listening intently, and grimacing, mumbling, or talking aloud as though responding conversationally to someone.

Answer to Question 2

ANS: B
The correct response indicates the patient is experiencing paranoia. Paranoia often leads to fearfulness, and the patient may attempt to strike out at others to protect self. The distracters are comforting hallucinations or do not indicate paranoia.


chandani

  • Hero Member
  • *****
  • Posts: 541
Reply #2 on: Jul 19, 2018
TY


Jmfn03

  • Sr. Member
  • ****
  • Posts: 323
Reply #3 on: Jul 19, 2018
Happy to Help


« previous next »
 

Did you know?

There are major differences in the metabolism of morphine and the illegal drug heroin. Morphine mostly produces its CNS effects through m-receptors, and at k- and d-receptors. Heroin has a slight affinity for opiate receptors. Most of its actions are due to metabolism to active metabolites (6-acetylmorphine, morphine, and morphine-6-glucuronide).

Did you know?

When blood is deoxygenated and flowing back to the heart through the veins, it is dark reddish-blue in color. Blood in the arteries that is oxygenated and flowing out to the body is bright red. Whereas arterial blood comes out in spurts, venous blood flows.

Did you know?

Adults are resistant to the bacterium that causes Botulism. These bacteria thrive in honey – therefore, honey should never be given to infants since their immune systems are not yet resistant.

Did you know?

The calories found in one piece of cherry cheesecake could light a 60-watt light bulb for 1.5 hours.

Did you know?

Looking at the sun may not only cause headache and distort your vision temporarily, but it can also cause permanent eye damage. Any exposure to sunlight adds to the cumulative effects of ultraviolet (UV) radiation on your eyes. UV exposure has been linked to eye disorders such as macular degeneration, solar retinitis, and corneal dystrophies.

Patients should be encouraged to bring to their health care visit all the substances that they take, Patients should be encouraged to bring to their health care visit all the substances that they take,
Critical thinking model for safety assessment Critical thinking model for safety assessment
Patient teaching: vascular assessment Patient teaching: vascular assessment
All messages must be documented and placed in the patient's chart. All messages must be documented and placed in the patient's chart.
Progression Graph: Fitness Plan Progression Graph: Fitness Plan
Develop a Patient Teaching Handout About Stress Develop a Patient Teaching Handout About Stress
Video: Gastrin (gastric emptying) & Secretin (buffering gastric acid)

For a complete list of videos, visit our video library