A nurse is caring for a client who reports acute, moderate anxiety. Which of the following is the priority nursing action?

Instruct the client to remember past coping mechanisms.

Provide a diverting activity.

Encourage verbalization of feelings.

Remain with the client.

Answer and Explanation

The Correct Answer is D

By remaining with the client, the nurse provides a sense of support and security. This presence can help alleviate the client's anxiety and provide reassurance. It also ensures that the nurse is available to assess the client's condition, offer therapeutic communication, and intervene if the anxiety escalates or the client becomes overwhelmed.

While the other options are also beneficial interventions for managing anxiety, they are not the priority in this situation. Instructing the client to remember past coping mechanisms (Option A) can be helpful, but the immediate presence of the nurse is more important to provide immediate support.

Providing a diverting activity (Option B) can be beneficial to distract the client from their anxiety, but it does not address the underlying anxiety or provide direct support.

Encouraging verbalization of feelings (Option C) is important for therapeutic communication, but it may not be the initial priority when the client is experiencing acute anxiety.

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Correct Answer is B

Explanation

Chronic stress can weaken the immune system, making individuals more susceptible to infections, including viral infections. This is because stress hormones such as cortisol can suppress the immune response, making it harder for the body to fight off pathogens. As a result, individuals experiencing chronic stress may be more prone to illnesses such as the common cold or flu.

Incorrect:

A- Hypotension: Hypotension, or low blood pressure, is not typically associated with chronic stress. In fact, chronic stress often leads to increased sympathetic nervous system activity, which can result in elevated blood pressure.

C-Increased cognitive awareness: Chronic stress affects cognitive function. You might find it challenging to concentrate, make decisions, or stay mentally sharp.

D- Increased energy: Chronic stress typically leads to a state of exhaustion and fatigue rather than increased energy. Prolonged stress can drain a person's physical and mental energy, resulting in feelings of fatigue, lethargy, and a lack of motivation.

A. Instruct family to avoid visiting during mealtimes. B. Give the client extra time to communicate needs. C. Offer three or four large meals daily. D. Discourage rest periods during the daytime.

Correct Answer is B

Explanation

Clients with depression may experience cognitive difficulties, such as trouble concentrating or articulating their needs. Giving the client extra time to express themselves and communicate their needs allows them to feel heard and understood. It also helps establish a therapeutic relationship with the client, promoting trust and collaboration in their care.

The other interventions listed may not be appropriate or effective in addressing the client's specific symptoms of depression:

A- Instructing the family to avoid visiting during mealtimes may not be necessary unless there are specific reasons related to the client's preferences or distractions during meals. It's important to involve the family in the client's care and support, including mealtime interactions, unless there are specific concerns or circumstances.

C- Offering three or four large meals daily may not be appropriate for all clients with depression. Some individuals may have a decreased appetite or experience changes in their eating patterns. It is important to assess the client's nutritional needs and preferences and provide a balanced meal plan tailored to their specific situation.

D- Discouraging rest periods during the daytime may not be helpful, as individuals with depression may experience fatigue, lack of energy, and a desire to sleep more. Adequate rest and sleep are important for overall well-being, and it is crucial to support the client in maintaining a regular sleep schedule and addressing any sleep disturbances they may be experiencing.

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A nurse is caring for a client who reports acute, moderate anxiety. Which of the following is the priority nursing action?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who is experiencing chronic stress. Which of the following findings should the nurse expect?

Correct Answer is B

Explanation

A nurse is planning care for a client who has depression. The nurse notes that the client has weight loss, an inability to concentrate, an inability to complete everyday tasks, and a preference to sleep all day. Which of the following interventions should be included in the plan of care?

Correct Answer is B

Explanation

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A nurse is caring for a client who reports acute, moderate anxiety. Which of the following is the priority nursing action?