A nurse is talking with a client who reports that they have started feeling anxious every time they have to leave their house. Which of the following responses should the nurse make?
"Have you tried leaving your house just once per day?"
"Have you thought about moving to a new neighborhood?"
"Let's discuss how you feel when you leave your house."
"Tell me why you have developed an aversion to leaving your house."
The Correct Answer is C
Choice A Reason:
"Have you tried leaving your house just once per day?" This response assumes a potential solution without fully understanding the client's feelings. It doesn't encourage open discussion or exploration of the client's anxiety.
Choice B Reason:
"Have you thought about moving to a new neighborhood?" This response jumps to a significant life change as a solution without exploring the client's current situation and emotions. It may not be a practical or necessary step.
Choice C Reason:
"Let's discuss how you feel when you leave your house." This response is an open and therapeutic approach that encourages the client to express their feelings and thoughts about the situation. It allows the nurse to gather more information and better understand the client's anxiety related to leaving the house. The other options do not facilitate open communication or exploration of the client's feelings.
Choice D Reason:
"Tell me why you have developed an aversion to leaving your house." While this response is more open-ended, it phrases the question in a somewhat confrontational manner, which might make the client defensive. The previous response ("Let's discuss how you feel when you leave your house") is gentler and inviting.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason:
Documenting the infiltration is important for the client's medical record, but it should not be the first action when infiltration is suspected.
Choice B Reason:
Elevating the arm can help reduce swelling, but it should come after stopping the infusion.
Choice C Reason:
Applying a warm compress can help with comfort and may be done after stopping the infusion, but it is not the first action.
Choice D Reason:
Stop the infusion is correct. When a nurse observes signs of infiltration around an IV insertion site, such as edema and coolness of the skin, the first and most important action is to stop the infusion immediately. Infiltration occurs when the IV fluid leaks into the surrounding tissue instead of going into the vein. Stopping the infusion prevents further damage to the surrounding tissue and minimizes the risk of complications.
Correct Answer is A
Explanation
Choice A Reason:
Correct - Avoiding milk with the iron supplement is a good recommendation.
Choice B Reason:
Green tea contains tannins that can inhibit iron absorption, so it's not recommended to take iron with it.
Choice C Reason:
Berries and citrus fruits, while high in vitamin C, can actually enhance iron absorption, so there's no need to eliminate them from the diet.
Choice D Reason:
Increasing dietary fiber intake can be beneficial for overall health but does not have a direct effect on iron absorption.
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