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A nurse is caring for a newly admitted client who has obsessive-compulsive disorder.
Which of the following actions should the nurse take first? .

Administer an antianxiety medication

Calculate the client's score on the Hamilton Rating Scale for Anxiety.

Explain the use of response prevention to the client.

Discuss the benefits of relaxation exercises with the client.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Administering an antianxiety medication can help manage symptoms, but it’s not the first action a nurse should take.

Choice B rationale:

Calculating the client’s score on the Hamilton Rating Scale for Anxiety is the first step in assessing the severity of the client’s anxiety.

Choice C rationale:

Explaining the use of response prevention can be beneficial, but it’s not the first action the nurse should take.

Choice D rationale:

Discussing the benefits of relaxation exercises can help manage anxiety, but it’s not the first action the nurse should take.

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Correct Answer is C

Explanation

Choice A rationale:

Discouraging visitation from the client’s family could increase feelings of isolation and confusion, which could exacerbate delirium.

Choice B rationale:

A high-stimulation environment could overstimulate the client and worsen delirium.

Choice C rationale:

Limiting the client’s need to make decisions can reduce stress and confusion, which can help manage delirium.

Choice D rationale:

Keeping the client’s room dark at night could disrupt the client’s sleep-wake cycle and potentially worsen delirium.

A. Cardiac arrhythmia B. Crohn's disease. C. Renal colic. D. Asthma.

Correct Answer is A

Explanation

Choice A rationale:

Cardiac arrhythmia is a contraindication for electroconvulsive therapy (ECT) because ECT can cause changes in heart rate and blood pressure, which could be dangerous for someone with an existing heart condition.

Choice B rationale:

Crohn’s disease is not a contraindication for ECT. It is a chronic inflammatory bowel disease, and while it can cause significant health problems, it does not directly affect the safety or efficacy of ECT.

Choice C rationale:

Renal colic, a type of pain that can occur when a kidney stone is present, is not a contraindication for ECT. It is unrelated to the brain and nervous system and does not affect the safety or efficacy of ECT.

Choice D rationale:

Asthma is not a contraindication for ECT. While severe asthma should be well-controlled before any procedure that involves anesthesia, it is not a direct contraindication for ECT.

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A nurse is caring for a newly admitted client who has obsessive-compulsive disorder. Which of the following actions should the nurse take first? .

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A nurse is caring for a newly admitted client who has obsessive-compulsive disorder.
Which of the following actions should the nurse take first? .