A nurse in a mental health facility is caring for a client who reports palpitations and a sense of impending doom. Which of the following actions should the nurse take first?

Administer an anti-anxiety medication.

Explore behaviors that have helped to reduce the client's anxiety in the past.

Minimize environmental stimuli in the client's surroundings.

Explain to the client that anxiety causes physical manifestations

Answer and Explanation

The Correct Answer is C

The client is experiencing palpitations and a sense of impending doom, which may indicate a heightened state of anxiety or a panic attack. Minimizing environmental stimuli can help create a calming and safe environment for the client. By reducing noise, bright lights, and other potentially distressing stimuli, the nurse can create a more soothing atmosphere that may help alleviate the client's anxiety.

While exploring behaviors that have helped to reduce the client's anxiety in the past and explaining to the client that anxiety causes physical manifestations are important actions, they may not provide immediate relief or address the client's immediate distress.

Administering an anti-anxiety medication may be considered if the client's symptoms persist or worsen, but it is not the first action to be taken. The nurse should prioritize non-pharmacological interventions and create a supportive environment before considering medication administration.

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Correct Answer is D

Explanation

This statement shows that the client understands the threshold for high blood pressure readings. A blood pressure reading of 140/90 mmHg or higher is considered elevated or hypertensive.

It is important for the client to be aware of this value and to seek medical attention or follow the prescribed management plan if their blood pressure exceeds this threshold.

The hand should be supported at the level of the heart or positioned comfortably during blood pressure measurement, but it does not need to be specifically 6 inches below the heart.

Consistency in the timing of blood pressure measurements is important for accurate monitoring. It is generally recommended to measure blood pressure at the same time each day to account for variations that can occur throughout the day.

The blood pressure cuff should be snug but not too tight around the upper arm. It should fit comfortably and securely to ensure accurate readings.

A. Improved respiratory function B. Decreased sodium excretion C. Improved absorption of vitamins B and C D. Reduced fat in the stools

Correct Answer is D

Explanation

a.Pancrelipase does not directly impact respiratory function. It is an enzyme replacement therapy used to aid digestion by compensating for the lack of pancreatic enzymes, not to improve lung function.

b.Cystic fibrosis affects sodium and chloride transport, leading to higher sodium levels in sweat. However, pancrelipase does not affect sodium excretion; it focuses on aiding digestion.

c.Pancrelipase helps with the digestion and absorption of fats and fat-soluble vitamins (A, D, E, K). Vitamins B and C are water-soluble and are not typically affected by the enzyme therapy used for fat digestion.

d.This is the correct answer. Pancrelipase contains enzymes (lipase, protease, and amylase) that help break down fats, proteins, and carbohydrates. In cystic fibrosis, pancreatic enzyme production is often insufficient, leading to malabsorption and steatorrhea (excessive fat in the stools). By providing the necessary enzymes, pancrelipase helps improve the digestion and absorption of dietary fats, reducing the fat content in the stools.

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A nurse in a mental health facility is caring for a client who reports palpitations and a sense of impending doom. Which of the following actions should the nurse take first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is D

Explanation

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