A client is agitated and pacing in the hall near the nurses' station and swearing loudly. What response is the best for the registered nurse to provide?
Select one:
Others are being distracted; Please, quiet down and go to your room.
You seem pretty upset. Tell me about it
Please go to your room to get control of yourself.
What’s going on? Be quiet.
The Correct Answer is B
This response acknowledges the client's distress and opens the opportunity for the client to express their feelings and concerns. It also demonstrates empathy and a willingness to listen, which can help deescalate the situation and build trust between the nurse and client.
Option a ("Others are being distracted; Please, quiet down and go to your room") is dismissive of the client's feelings and may further escalate the situation.
Option c ("Please go to your room to get control of yourself") is directive and may be perceived as confrontational, potentially increasing the client's agitation.
Option d ("What's going on? Be quiet") is insensitive and dismissive of the client's distress and may further agitate the client.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Lorazepam belongs to a class of drugs called benzodiazepines, which are central nervous system (CNS) depressants.
Taking other CNS depressants such as opioids or sedatives along with lorazepam can lead to increased sedation, respiratory depression, and other serious side effects. It is crucial for patients to avoid these medications while taking lorazepam.
Reporting insomnia is important, but it is not the most critical teaching for this medication. Eating a tyramine-free diet is not relevant to lorazepam use.
Adjusting the dose and frequency based on anxiety level is not recommended as it can lead to misuse or dependence on the medication. It is important to take lorazepam only as prescribed by a healthcare provider.
Correct Answer is C
Explanation
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.
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