A nurse on an inpatient mental health unit is admitting a client who has panic-level anxiety. After showing the client to his room, which of the following nursing actions is most therapeutic at this time?
Have the client join a therapy group.
Suggest that the client rest in bed.
Remain with the client for a while.
Medicate the client with a sedative.
The Correct Answer is C
Remaining with the client provides them with a sense of security, reassurance, and support. It shows the client that they are not alone and that the nurse is there to provide assistance and care. By being present and offering a calming presence, the nurse can help the client feel more at ease and gradually reduce their anxiety.
It's important to note that the other options are not the most appropriate actions in this situation:
A- Having the client join a therapy group may be overwhelming and may not be suitable during the acute phase of panic-level anxiety.
B- Suggesting that the client rest in bed may not address their immediate anxiety and may not be feasible if the client is experiencing intense anxiety symptoms.
D- Medicating the client with a sedative should be done based on a healthcare provider's order and assessment of the client's condition. It is not the initial therapeutic intervention and should only be considered if other non-medication interventions are ineffective or if the client's anxiety becomes severe and unmanageable.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","E"]
Explanation
When caring for an adolescent female with an eating disorder, the nurse should expect the following manifestations:
A- Amenorrhea: Amenorrhea refers to the absence of menstruation, which is commonly seen in individuals with eating disorders, particularly in cases of severe weight loss or malnutrition.
B- Altered body image: Individuals with eating disorders often have a distorted perception of their body shape and size. They may see themselves as overweight or have a negative body image, even when they are significantly underweight.
C- Hyperactivity: Some individuals with eating disorders may exhibit excessive physical activity or restlessness. This hyperactivity can be a result of increased energy expenditure, driven by a fear of weight gain or a compulsive need to burn calories.
E- Bradycardia: Bradycardia, or a slow heart rate, is a common finding in individuals with severe malnutrition or very low body weight. It can be a result of the body's adaptive response to conserve energy in a state of limited food intake.
Incorrect:
D- Verbalized desire to gain weight is not typically expected in individuals with eating disorders. They may express a desire to lose weight or have a fear of gaining weight instead.
Correct Answer is A
Explanation
In this scenario, the nurse's priority should be initiating suicide precautions. Safety is of utmost importance when caring for a client following a suicide attempt. By implementing suicide precautions, the nurse can take steps to ensure the client's physical and emotional well-being, such as removing potential means of self-harm and closely monitoring the client's behavior. This action aims to prevent further harm and promote a safe environment for the client.
Incorrect:
B- Administering the Hamilton Depression Scale: While assessing the client's level of depression is important, it is not the priority in this situation. The client has just attempted suicide, indicating a high level of risk. Therefore, the nurse should prioritize safety measures and immediate interventions rather than administering a depression scale.
C- Making a contract with the client for eating behavior: While addressing the client's eating behavior is important, it is not the priority in this situation. The client has just attempted suicide, indicating a significant risk to their life. Ensuring their safety and providing appropriate mental health support take precedence over addressing their eating behavior.
D- Reviewing the client's toxicology laboratory report: While reviewing the client's toxicology report may provide valuable information about substance abuse, it is not the priority in this scenario. The immediate concern is the client's safety following a suicide attempt. The nurse should focus on implementing suicide precautions and addressing the client's emotional and physical well-being.
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