A nurse is caring for a client with generalized anxiety disorder who is experiencing a panic attack. Which of the following is the nurse's priority action for this client?
Escort the client to the common area.
Contact security for possible restraints.
Stay with the client.
Stay away from the client.
The Correct Answer is C
Choice A reason:
Escorting the client to the common area is not the priority action. While being around others can sometimes be comforting, during a panic attack, the client may feel overwhelmed and exposed, which could exacerbate the situation.
Choice B reason:
Contacting security for possible restraints should be a last resort and is not the priority action. Restraints can increase anxiety and fear, potentially escalating the panic attack. The use of restraints is only considered when the client is at risk of harming themselves or others and all other interventions have failed.
Choice C reason:
Staying with the client is the priority action. During a panic attack, the client needs reassurance and a sense of safety. The nurse's presence can provide comfort. The nurse should remain calm, use a quiet voice, and avoid making any sudden movements. Implementing relaxation techniques and promoting a calming environment are also beneficial.
Choice D reason:
Staying away from the client is not the priority action. Leaving the client alone can increase feelings of isolation and fear. The nurse should provide continuous observation and support during the panic attack.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason:
Caffeine is not typically associated with liver cirrhosis. While excessive consumption of caffeine can have various health implications, it is not considered a direct cause of liver cirrhosis. The liver metabolizes caffeine without significant damage or scarring to the liver tissue.
Choice B reason:
Alcohol is the primary cause of liver cirrhosis in many cases. Chronic alcohol abuse leads to liver damage and subsequent scarring, known as cirrhosis. The liver's function is to process and filter toxins, including alcohol. Excessive and prolonged alcohol consumption overwhelms the liver's ability to process it, leading to inflammation, damage, and eventually scarring of the liver tissue.
Choice C reason:
Inhalants are substances that produce chemical vapors that can be inhaled to induce a psychoactive, or mind-altering, effect. While they can cause a range of acute and chronic health issues, including damage to the heart, kidneys, lungs, and brain, they are not commonly associated with liver cirrhosis. Liver cirrhosis is not a typical consequence of inhalant use.
Choice D reason:
Cocaine use can lead to various health problems, including cardiovascular and neurological issues, but it is not commonly identified as a primary cause of liver cirrhosis. Cocaine metabolites can be toxic to the liver; however, the direct causation of cirrhosis from cocaine alone is less established compared to alcohol-related liver disease.
Correct Answer is B
Explanation
Choice A reason:
Eating foods high in tyramine is not a risk factor for lithium toxicity. Tyramine is associated with dietary restrictions in patients taking monoamine oxidase inhibitors, not lithium.
Choice B reason:
Engaging in activities that cause excessive sweating, such as running 4 miles outdoors every afternoon, can lead to dehydration. Dehydration is a significant risk factor for lithium toxicity because it can increase lithium levels in the blood, potentially leading to toxicity.
Choice C reason:
Drinking 2 liters of liquids daily is generally recommended for hydration and is not a risk factor for lithium toxicity. Adequate hydration can help prevent lithium toxicity by ensuring that lithium is properly excreted through the kidneys.
Choice D reason:
Eating 2 to 3 grams of sodium-containing foods daily is within normal dietary intake ranges and is not a risk factor for lithium toxicity. Maintaining a consistent sodium intake is important when taking lithium, as low sodium levels can lead to increased lithium retention and potential toxicity.
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