A nurse on an acute care mental health unit is examining the belongings of a client who is being admitted following a suicide attempt. Which of the following belongings should the nurse ask the client's partner to take back home? (Select All that Apply.)
Nylon socks
Glass framed picture of the client's partner
Lace-up tennis shoes
Cotton underwear
Necklace
Correct Answer : B,C,E
Rationale:
A. Nylon socks are generally not considered a risk for self-harm and can be safely kept with the client.
B. A glass-framed picture presents a risk as the glass could be broken and used for self-harm. This item should be taken home.
C. Lace-up tennis shoes have long laces that could be used for self-harm, making them unsafe for a client at risk of suicide.
D. Cotton underwear does not pose a significant risk for self-harm and can be kept with the client.
E. A necklace could be used for self-harm, such as strangulation, and should be taken home to ensure the client's safety.
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Correct Answer is C
Explanation
Rationale:
A. Amphetamines can cause agitation and psychosis but are less commonly associated with delirium.
B. Antihistamines, particularly those with sedative properties, can contribute to delirium, but they are not the primary culprit.
C. Benzodiazepines, especially when used in high doses or in older adults, can cause delirium. They have sedative effects and can impair cognitive function, leading to confusion and delirium, particularly in vulnerable populations.
D. Sertraline, a selective serotonin reuptake inhibitor (SSRI), is generally not associated with causing delirium, though any medication can contribute to altered mental status depending on the patient’s overall health.
Correct Answer is A
Explanation
Rationale:
A. Taking bronchodilators before meals can help improve breathing, which is essential for eating comfortably, so it is better to take them before meals rather than after.
B. Resting before eating helps conserve energy and can make eating easier for individuals with COPD.
C. Eating small, frequent meals is beneficial for managing COPD because it prevents large meals that can lead to respiratory discomfort.
D. Choosing non-gas-forming foods can help reduce abdominal distention and discomfort during meals for individuals with COPD.