A patient comes to the emergency department with complaints of a headache and vomiting. Upon questioning, the patient says she is taking the drug phenelzine. The nurse should continue the assessment by first asking:.

What foods have you been eating?.

What dose of phenelzine are you taking?.

Do you have flu symptoms?.

Tell me about your history of headaches.

Answer and Explanation

The Correct Answer is A

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Correct Answer is D

Explanation

A. Panic. Panic-level anxiety typically involves extreme fear and severe physical symptoms such as palpitations, sweating, trembling, and a sense of impending doom. The client's reported symptoms (chest pain, headache, shortness of breath) do not align with the intense nature of panic anxiety.

B.Mild. Mild anxiety is characterized by heightened awareness and alertness. The client's symptoms and statement about his wife leaving him suggest more than mild anxiety as they indicate emotional distress beyond simple alertness.

C.Moderate. Moderate anxiety is associated with increased muscle tension, restlessness, and impaired concentration. Moderate anxiety (choice C) is characterized by increased alertness and decreased concentration but is manageable with support.

D. Severe anxiety significantly impairs daily functioning. It can cause physical symptoms such as chest pain, shortness of breath, and headaches. The client’s presentation aligns with severe anxiety, given the impact on his well-being.

A. Place metal utensils on the client's meal tray. B. Inspect the client's personal belongings. C. Assign the client to a private room. D. Tuck bedcovers over the client's hands and arms. PREVIOUSs . E. Assign the client to a private room. Rationale: This choice is incorrect. While providing privacy and a safe space is important, isolating the client in a private room could potentially increase feelings of loneliness and distress, especially during a vulnerable time. Keeping the client in a supportive and monitored environment is more appropriate.

Correct Answer is B

No explanation

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A patient comes to the emergency department with complaints of a headache and vomiting. Upon questioning, the patient says she is taking the drug phenelzine. The nurse should continue the assessment by first asking:.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in the emergency department is caring for a client who reports chest pain, headache, and shortness of breath. He continues to state, "I don't know why my wife left me." The client receives a diagnosis of anxiety. The nurse realizes the client's findings support which level of anxiety?

Correct Answer is D

Explanation

A nurse is caring for a client following a recent suicide attempt. Which of the following actions should the nurse take?

Correct Answer is B

A nurse is making a home visit for a 16-year old adolescent who attempted suicide. Which of the following behaviors should alert the nurse that the adolescent still has suicidal intent?

A nurse caring for a client who has depression observes the client coming to breakfast freshly bathed, wearing clean clothes, and with combed and styled hair. Which of the following responses by the nurse is therapeutic?

A nurse is creating a plan of care for a client who is experiencing mania. Which of the following interventions should the nurse include in the plan? (Select all that apply.).

A nurse is caring for a client who has depression. The client refuses to get out of bed, go to activities, or participate in any of the unit's programs. Which of the following responses should the nurse make?

A nurse is caring for a client who has bipolar disorder. Which of the following actions by the client should the nurse interpret as displaying manic behavior? (Select all that apply.).

A nurse on an acute mental health unit is caring for a client who has major depressive disorder. Which of the following interventions is the nurse's priority?

A nurse notices that a client who has moderate anxiety is pacing the hall and mumbling. As the nurse approaches the client, he states, "I am at the end of my rope. I don't think I can take any more bad news." Which of the following responses should the nurse make?

A nurse is caring for a client who is experiencing a manic episode. Other clients begin to complain about her disruptive behavior on the unit. Which of the following actions should the nurse take?