A client who has been physically aggressive arrives at the emergency department for a psychiatric assessment. Which approach would be best for the nurse to use?
Use brief statements and questions to obtain information.
Provide close contact to increase the client's sense of safety.
Have a sense of humor to show a lack of fear.
Use open-ended questions so the client can elaborate.
The Correct Answer is A
Explanation: When dealing with a client who has been physically aggressive and is in distress, the best approach for the nurse is to use brief statements and questions to obtain essential information. This approach helps to keep the communication clear, focused, and non-threatening. The nurse should maintain a calm and assertive demeanor while avoiding lengthy discussions that may escalate the client's agitation.
Options not appropriate in this situation:
B. Providing close contact to increase the client's sense of safety may not be safe for the nurse or the client, especially when dealing with someone who has been physically aggressive. It is essential to maintain a safe distance and ensure the safety of everyone involved.
C. Having a sense of humor to show a lack of fear can be misinterpreted by the client and may not be appropriate or therapeutic in this context. The focus should be on establishing a professional and respectful rapport with the client, prioritizing their needs and safety.
Option D may not be the best approach because open-ended questions could lead to lengthy responses, which may not be suitable for a client who is in distress and potentially aggressive. The nurse should aim for concise and clear communication to ensure safety and facilitate a psychiatric assessment efficiently.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Objective data:
Blood pressure (can be measured by the nurse)
Cyanosis (can be observed by the nurse)
Petechiae (can be observed by the nurse)
So, the subjective data in this list is "Nausea." This is information that the client shares with the nurse about their symptoms or feelings.
The objective data includes A-"Blood pressure," B-"Cyanosis," and D-"Petechiae," which are findings that the nurse can measure or observe during the physical examination.
Correct Answer is ["260"]
Explanation
Step 1: Convert ½ cup of juice to mL. 1 cup = 240 mL ½ cup = 240 mL ÷ 2 = 120 mL Result: 120 mL
Step 2: Convert 3 oz of gelatin to mL. 1 oz = 30 mL 3 oz = 3 × 30 mL = 90 mL Result: 90 mL
Step 3: Convert 1 oz of an ice pop to mL. 1 oz = 30 mL 1 oz = 1 × 30 mL = 30 mL Result: 30 mL
Step 4: Ginger ale is already in mL. Result: 20 mL
Step 5: Add all the mL values together. 120 mL + 90 mL + 30 mL + 20 mL = 260 mL Result: 260 mL
The nurse should record the child’s fluid intake as 260 mL.
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