A client who has coronary artery disease tells the nurse he is afraid of dying from a heart attack. Which of the following responses should the nurse make?

Choice A rationale:

Seclusion may be considered for a school-age client who repeatedly bites staff as a method of last resort to ensure the safety of both the client and staff.

It's important to exhaust other interventions first, such as verbal de-escalation, redirection, and medication.

If seclusion is used, it should be implemented under strict guidelines, with close monitoring and frequent reassessment to determine its effectiveness and necessity.

Choice B rationale:

Seclusion may be considered for an older adult client who is manic and agitated due to overstimulation, as it can provide a safe and quiet environment to reduce sensory input and promote calming.

However, it's crucial to carefully assess the client's physical and cognitive status, as seclusion can exacerbate confusion and disorientation in older adults.

Close monitoring and reassessment are essential.

Choice C rationale:

Seclusion may be considered for an adolescent client who throws objects at other clients to maintain safety and prevent harm to others.

It's important to first attempt other interventions, such as verbal de-escalation, redirection, and limit-setting.

If seclusion is used, it should be brief and implemented with therapeutic goals in mind, such as promoting self-regulation and problem-solving skills.

Choice D rationale:

Seclusion is contraindicated for an adult client after an interrupted suicide attempt.

This is because seclusion can increase isolation, hopelessness, and despair, which are significant risk factors for suicide.

It can also hinder close observation and monitoring of the client's mental state, potentially leading to further suicide attempts.

Instead, the focus should be on providing supportive, one-to-one contact, ensuring safety, and establishing therapeutic rapport to address the underlying issues that led to the suicide attempt.

The correct answer is choice d. “St. John’s wort can reduce the effectiveness of oral contraceptives.”

Choice A rationale:

St. John’s wort is commonly used to treat mild to moderate depression. It has been shown to be effective in alleviating symptoms of depression, likely due to its impact on neurotransmitters like serotonin.

Choice B rationale:

There is no evidence to suggest that St. John’s wort can lower prostate-specific antigen (PSA) levels. PSA levels are typically monitored for prostate health, and St. John’s wort does not have an impact on these levels.

Choice C rationale:

St. John’s wort does not increase estrogen levels in the body. It primarily affects neurotransmitters and has no known effect on hormone levels.

Choice D rationale:

St. John’s wort can indeed reduce the effectiveness of oral contraceptives. It induces certain liver enzymes that can increase the metabolism of contraceptive hormones, thereby reducing their effectiveness and increasing the risk of unintended pregnancy.