A patient is being treated on the mental health unit for an anxiety disorder. The patient approaches the nurse and reports feeling dizzy and weak, with a sensation of a racing heart. The nursing care plan includes interventions of imagery exercises and as-needed lorazepam (Ativan) for symptoms of anxiety. What should the nurse do first?
Obtain the patient's vital signs.
Give the patient the prescribed as-needed lorazepam.
Instruct the patient to sit and breathe deeply.
Instruct the patient in an imagery exercise.
The Correct Answer is A
Choice A reason: The first step should always be to assess the patient's physical state to rule out any immediate life-threatening conditions before proceeding with psychiatric interventions.
Choice B reason: Administering medication may be necessary, but it should not precede an assessment of the patient's vital signs.
Choice C reason: While instructing the patient to sit and breathe deeply can help alleviate symptoms of anxiety, it is not the first action to take before assessing the patient's vital signs.
Choice D reason: Imagery exercises can be helpful for managing anxiety, but they are not the priority before ensuring the patient's physiological stability.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Getting plenty of outdoor exercise all year is beneficial for overall health but does not specifically prevent Raynaud's attacks, especially in cold weather.
Choice B reason: Keeping affected body areas covered, especially in cold weather, helps prevent Raynaud's attacks by maintaining warmth.
Choice C reason: Taking vasopressors is not a measure to prevent Raynaud's attacks; vasopressors could potentially worsen the condition by causing further vasoconstriction.
Choice D reason: Avoiding stimulation that causes vasoconstriction, such as stress and cold temperatures, is key to preventing Raynaud's attacks.
Correct Answer is B
Explanation
Choice A reason: Divorce can be a stressor, but it is not universally stressful to every individual; it depends on the person's experience and perception.
Choice B reason: Stress is subjective, and what one person finds stressful may not be stressful to another. Therefore, if the patient identifies an event as stressful, it should be considered as such.
Choice C reason: Loss of job can be a significant stressor due to financial and social implications, but again, it depends on the individual's circumstances and perception.
Choice D reason: Surgery can be a stressor due to its impact on physical health and potential for causing anxiety about medical procedures and outcomes.
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