A nurse is planning care using systematic desensitization for a client who has severe claustrophobia. Which of the following interventions should the nurse include in the plan of care?

Identify the client's preferred relaxation technique to use prior to each step of the therapy.

Administer an anxiolytic medication 1 hr prior to the scheduled therapy session.

Expose the client to an excess amount of anxiety-inducing stimulus to extinguish the phobia.

Ask the client to snap a rubber band worn on the wrist to minimize anxiety when thinking about the phobia.

Answer and Explanation

The Correct Answer is A

A) Identify the client's preferred relaxation technique to use prior to each step of the therapy:
Systematic desensitization involves gradually exposing the client to the anxiety-inducing stimulus while using relaxation techniques to manage anxiety. Identifying the client's preferred relaxation technique is crucial to help them remain calm and reduce their phobia-related anxiety during each step of the therapy.

B) Administer an anxiolytic medication 1 hr prior to the scheduled therapy session:
While anxiolytic medications can help reduce anxiety, systematic desensitization typically relies on non-pharmacological methods to help the client gradually overcome their phobia. The goal is for the client to develop coping mechanisms without medication.

C) Expose the client to an excess amount of anxiety-inducing stimulus to extinguish the phobia:
Exposing the client to an excess amount of anxiety-inducing stimuli is not appropriate for systematic desensitization. This method, known as flooding, can overwhelm the client and increase their anxiety, potentially worsening the phobia rather than alleviating it.

D) Ask the client to snap a rubber band worn on the wrist to minimize anxiety when thinking about the phobia:
Snapping a rubber band on the wrist is a distraction technique that might provide temporary relief from anxiety. However, it is not a core component of systematic desensitization, which focuses on gradual exposure and the use of relaxation techniques to manage anxiety

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Correct Answer is C

Explanation

A) Use petroleum jelly on a cotton ball to plug your ear when shampooing.
This technique helps prevent water from entering the ear during activities like showering. While it is useful for keeping the ear dry, it does not directly address preventing trauma or further hearing impairment post-surgery.

B) Clean dried blood in your ear canal with a cotton-tipped applicator.
Using cotton-tipped applicators can cause damage to the delicate ear canal and potentially disturb the surgical site. This action increases the risk of infection and trauma, potentially worsening hearing loss instead of preventing it.

C) Avoid blowing your nose for 1 month after surgery.
Refraining from nose blowing is essential because it prevents pressure changes that could disrupt the surgical repair. Such pressure changes can lead to complications like graft displacement, which can cause trauma and impair hearing.

D) Notify your provider if you have popping or crackling sensations in the affected ear.
Popping or crackling can be common as the ear heals and adjusts. These sensations typically do not indicate a problem unless accompanied by pain or other symptoms. Thus, while monitoring is important, it is not a primary preventative measure for trauma or hearing issues.

A. Decreased deep-tendon reflexes B. Regular heart rhythm C. Hypoactive bowel sounds D. Respiratory rate 10/min

Correct Answer is B

Explanation

A) Decreased deep-tendon reflexes: Decreased deep-tendon reflexes can indicate hyperkalemia, which occurs when potassium levels are too high. This is not a sign of effective potassium chloride supplementation for hypokalemia, as it suggests an imbalance in the opposite direction.

B) Regular heart rhythm: A regular heart rhythm is a key indicator that potassium levels are within the normal range. Potassium is crucial for proper cardiac function, and maintaining an adequate level helps prevent arrhythmias and supports effective heart rhythms.

C) Hypoactive bowel sounds: Hypoactive bowel sounds can be associated with various conditions, including electrolyte imbalances like hypokalemia. However, the presence of hypoactive bowel sounds does not directly indicate that potassium chloride supplementation is effective.

D) Respiratory rate 10/min: A respiratory rate of 10/min is below the normal range and can be a sign of respiratory depression or other issues. This finding does not relate to the effectiveness of potassium chloride supplements in treating hypokalemia.

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A nurse is planning care using systematic desensitization for a client who has severe claustrophobia. Which of the following interventions should the nurse include in the plan of care?

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