A nurse is gathering data from a client who has severe anxiety. Which of the following findings should the nurse identify as an Indication that the client is experiencing a crisis?
Client isolates themselves from their family and friends
Client reports intermittent depressed mood
Client reports a decreased appetite
Client expresses an inability to experience pleasure
The Correct Answer is A
Choice A Reason:
Client isolates themselves from their family and friends. Isolating oneself from family and friends is an indication that the client is experiencing a crisis. Social withdrawal and isolation can be common responses to severe anxiety or a crisis situation. It suggests that the client is having difficulty coping with their anxiety or the stressor, and they may benefit from intervention and support.
Choice B Reason:
Reporting intermittent depressed mood may be indicative of a mood disorder but does not necessarily indicate a crisis.
Choice C Reason:
Reporting a decreased appetite can be a symptom of anxiety, but it is not specific to a crisis situation.
Choice D Reason:
Expressing an inability to experience pleasure is a symptom often associated with depression but does not provide specific information about the presence of a crisis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A Reason:
"I should do aerobic exercises once per day." While exercise is important for individuals with COPD, the frequency and intensity of exercise should be determined based on the individual's condition and healthcare provider's recommendations. One-size-fits-all recommendations may not apply to all clients.
Choice B Reason:
"I should practice pursed-lip breathing exercises." Pursed-lip breathing exercises are a beneficial technique for individuals with COPD. This technique can help improve breathing efficiency and decrease shortness of breath. Clients with COPD are often taught to use pursed-lip breathing during activities that require increased effort or when experiencing shortness of breath.
Choice C Reason:
"I will increase my fluid intake to 1,700 milliliters per day." While staying adequately hydrated is essential, the specific fluid intake should be determined based on the client's needs, medical condition, and healthcare provider's advice. The recommended daily fluid intake can vary among individuals.
Choice D Reason:
"I will consume low-protein, low-calorie foods." Nutrition is an important aspect of COPD management, but the dietary recommendations should be tailored to the client's specific needs, including their nutritional status, energy expenditure, and other factors. A generalized statement about low-protein, low-calorie foods may not be appropriate for all individuals with COPD.
Correct Answer is D
Explanation
Choice A Reason:
Time-critical medications should generally be given within a specific time frame, usually 30 minutes before or after the scheduled time. Waiting for 60 minutes may lead to suboptimal therapeutic effects or potential complications.
Choice B Reason:
Documentation should occur after medication administration to ensure accuracy. Administering the medication should be confirmed before recording it in the patient's chart.
Choice C Reason:
Correct identification of the patient is crucial to ensure that the medication is given to the right person. Using at least two patient identifiers (e.g., name and date of birth) is a common practice to enhance accuracy.
Choice D Reason:
This is a fundamental safety measure in medication administration. The nurse should check the medication against the medication administration record three times: when removing it from storage, when preparing it, and before administering it to the patient. This helps prevent medication errors.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.