Following an acute myocardial infarction that occurred two weeks ago, an adult male presents for his follow-up appointment, accompanied by his spouse. He tells the nurse that he has lost his appetite, cannot seem to make decisions, and cannot sleep at night.
Which intervention is most important for the nurse to implement?
Ask the spouse if the client seems to be depressed.
Tell the spouse to wait outside so the client can be assessed for depression.
Explain that depression often occurs after a life-threatening experience.
Encourage the client to further describe his feelings.
The Correct Answer is D
A. Asking the spouse about the client's depression can provide insights but might not be as effective as directly addressing the client.
B. While privacy is important, the spouse can often provide additional valuable information.
C. Explaining about post-MI depression is informative but does not directly assess the client's current emotional state.
D. Encouraging the client to describe his feelings allows the nurse to perform a thorough assessment of the client’s mental state and identify any signs of depression or anxiety.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Threatening the child with a shot may create anxiety and fear, making cooperation even more challenging.
B. Hiding medication in food without the child's knowledge can lead to mistrust and may not be safe, as the child may not consume the entire dose.
C. Misleading the child about the nature of the medication is not appropriate. It can lead to confusion and mistrust when the child realizes that it is not candy.
D. Providing choices empowers the child and makes the process of taking medication less intimidating. It also helps in engaging the child in their own care, making them feel more in control.
Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"D","dropdown-group-3":"F"}
Explanation
Pain relief: One of the primary goals and indications of effective epidural anesthesia is significant reduction or elimination of pain associated with labor contractions, as reflected in the patient asking for and receiving the epidural to manage increasing pain levels.
Progression of labor: Effective epidural anesthesia should allow the labor to progress without adding undue stress or causing significant delays. Monitoring cervical dilation and effacement as well as the baby's descent (station) helps determine if labor is progressing normally even after epidural administration.
Vital signs: Stable vital signs are important indicators that the epidural anesthesia is not causing adverse effects such as severe hypotension or bradycardia, which can sometimes occur with regional anesthesia due to the blockade of sympathetic nerves. Regular monitoring and stability of these signs are crucial for demonstrating effective and safe epidural anesthesia management.
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