<?xml version="1.0" encoding="utf-8"?>
<catalog>
<query>
<question type="1" nursingprocess="PL" humanfunction="7" clientneeds="Phi" clientneedschild="6">A patient is in a withdrawn catatonic state and exhibits waxy flexibility. During the initial phase of hospitalization for this patient, the nurse's first priority is to:</question>
<answer value="1">Watch for edema and cyanosis of the extremities.</answer>
<answer value="0">Encourage the patient to discuss concerns that led to the catatonic state.</answer>
<answer value="0">Provide a warm, nurturing relationship, with therapeutic use of touch.</answer>
<answer value="0">Identify the predisposing factors in the illness.</answer>
<rationale>Circulation may be severely impaired in a patient with waxy flexibility who tends to remain motionless for hours unless moved. Answer 2 is not the first priority. "Touch" is not used in this stage, as in Answer 3. Answer 4 is incorrect because the patient is mute and also because intellectual discussion of predisposing factors ignores the feelings of the patient.</rationale>
<hint>Note the key words: "first priority."</hint>
</query>
</catalog>