A nurse is caring for a client who expresses anxiety about an upcoming surgery. Which of the following actions should the nurse take?

Ask the client to describe their feelings.

Discuss the competency of the surgeon with the client.

Inform the client that others have had the procedure without problems.

Ask the client why they are experiencing anxiety.

Answer and Explanation

The Correct Answer is A

A. Ask the client to describe their feelings. Encouraging the client to express their emotions allows the nurse to assess their concerns and provide appropriate support. This is a key principle of therapeutic communication.

B. Discuss the competency of the surgeon with the client. While the surgeon's competency may help reassure the client, the nurse should not comment on the surgeon’s skill. Instead, the nurse should focus on the client's emotions and provide factual information about the procedure if needed.

C. Inform the client that others have had the procedure without problems. This response dismisses the client’s concerns rather than addressing their feelings. Each client’s experience is unique, and reassurance should be based on listening and providing accurate information.

D. Ask the client why they are experiencing anxiety. Asking “why” can make the client feel defensive. Instead, the nurse should use open-ended questions, such as "Can you tell me more about your concerns?", which encourages discussion without judgment.

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Correct Answer is B

Explanation

A. "Hold your breath for 6 seconds after inhaling the medication." – The correct recommendation is to hold the breath for at least 10 seconds to allow maximum medication absorption in the lungs.

B. "Inhale the medication deeply for 5 seconds." – A slow, deep inhalation (3-5 seconds) allows the medication to reach the lower airways effectively.

C. "Do not shake the medication in the inhaler." – Most metered-dose inhalers (MDIs) need to be shaken before use to ensure proper mixing of medication. Exceptions include dry powder inhalers (DPIs), which should not be shaken.

D. "Hold the inhaler 3 inches away from your mouth." – The correct distance is 1 to 2 inches (2-4 cm) from the mouth, or the mouthpiece can be placed directly into the mouth with lips sealed around it.

A. Pull the fire alarm. B. Close the fire doors. C. Evacuate the room. D. Extinguish the fire.

Correct Answer is C

Explanation

A. Pull the fire alarm. While activating the alarm is crucial, the immediate priority is client safety, meaning evacuation comes first.

B. Close the fire doors. Closing doors helps contain the fire, but ensuring client safety is the priority.

C. Evacuate the room. According to the RACE (Rescue, Alarm, Contain, Extinguish) protocol, the first step is to Rescue clients in immediate danger, then pull the alarm.

D. Extinguish the fire. Attempting to put out the fire is only appropriate if the fire is small and manageable. If the fire is significant, evacuating clients takes precedence.

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A nurse is caring for a client who expresses anxiety about an upcoming surgery. Which of the following actions should the nurse take?

Nursing Test Bank

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