A client with somatic symptom disorder reports experiencing chest pain to the nurse. Which action should the nurse take?
Administer a PRN analgesic to the client.
Further assess the client's pain and vital signs.
Ask if the client to compare this pain to the pain in the past.
Remind the client that the symptoms are psychological in cause.
The Correct Answer is B
A) Administering a PRN analgesic may provide temporary relief but does not address the need for a comprehensive assessment of the client's condition. It is essential to understand the nature and cause of the chest pain before treating it.
B) Further assessing the client's pain and vital signs is the most appropriate action. This allows the nurse to gather important clinical information that can help determine whether the chest pain is related to a medical condition or is part of the somatic symptom disorder. A thorough assessment is critical in ensuring the client's safety and addressing any potential underlying health issues.
C) Asking the client to compare this pain to past pain can provide context but is not a priority action. The immediate focus should be on assessing the current situation rather than reflecting on past experiences.
D) Reminding the client that the symptoms are psychological in cause can be invalidating and may hinder the therapeutic relationship. It is crucial to approach the client with empathy and understanding, rather than dismissing their experience.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) Haloperidol is an antipsychotic that may be used for agitation or hallucinations, but it is not the first-line treatment for alcohol withdrawal symptoms. Administering haloperidol without addressing withdrawal may not be effective and could lead to further complications.
B) Lorazepam is a benzodiazepine and is the preferred medication for managing alcohol withdrawal symptoms, including agitation, anxiety, and hallucinations. It helps reduce the risk of severe withdrawal symptoms and seizures while providing sedative effects. Given the client’s symptoms of feeling bugs crawling on his body, which may indicate tactile hallucinations due to withdrawal, lorazepam would be the most appropriate choice.
C) Diphenhydramine is an antihistamine that can be used for allergic reactions or as a sedative, but it is not effective for managing alcohol withdrawal symptoms.
D) Thiamine is important to prevent Wernicke's encephalopathy in clients with a history of alcohol dependency, especially if there are signs of confusion or neurological deficits. However, it does not address the immediate symptoms of withdrawal the client is experiencing.
Correct Answer is D
Explanation
(A) Explains answers to open-ended questions:While explaining answers to open-ended questions indicates cognitive engagement, it does not directly address avolition, which is characterized by a lack of motivation to perform purposeful activities.
(B) Reports enjoyment from assigned activities:Reporting enjoyment from activities is a positive sign, but it does not necessarily indicate an improvement in the motivation to initiate and complete tasks independently.
(C) Shares a personal story with peers:Sharing personal stories can demonstrate social engagement, but it does not directly reflect an improvement in avolition, which involves the motivation to perform daily tasks.
(D) Performs activities of daily living:Performing activities of daily living (ADLs) demonstrates an improvement in avolition, as it shows the client is motivated to take care of themselves and engage in necessary daily tasks. This behavior directly aligns with the goal of improving avolition.
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