The nurse is assessing a nervous 18-year-old patient who has vital signs of P 120, R 30, and BP 160/90. The patient states that he feels something bad is about to happen. Based on this data alone, how should the nurse identify the patient's level of anxiety?
Moderate
Panic
Mild
Severe
The Correct Answer is D
A. Moderate: Moderate anxiety typically involves increased alertness and focus, not severe physiological changes.
B. Panic: Panic is characterized by extreme dread and inability to function, often with a sense of unreality.
C. Mild: Mild anxiety involves slight discomfort and can enhance learning and performance.
D. Severe: Severe anxiety includes significant physiological responses (elevated vital signs) and a sense of impending doom.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is F
Explanation
A. Insert nasogastric tube: A nasogastric tube may be inserted early to prevent aspiration and manage gastric distension.
B. Initiate fluid therapy: Fluid therapy is crucial and initiated early to combat hypovolemic shock.
C. Insert Foley catheter: A Foley catheter is often inserted early to monitor urine output and assess renal function.
D. Establish airway: Establishing an airway is the highest priority intervention for burn victims, especially if there are signs of inhalation injury.
E. Administer analgesics: Pain management is crucial but is initiated early in the treatment process.
F. Tetanus prophylaxis: Tetanus prophylaxis is important to prevent infection but is typically administered after the immediate life-threatening issues have been addressed.
Correct Answer is B
Explanation
A. Weekly for at least 6 months, then decrease the dose to once a month: Methadone is typically administered daily, not weekly, to maintain stable blood levels and manage withdrawal symptoms effectively.
B. Daily until stabilized, then gradually reduce the dose to zero. Methadone is usually given daily to stabilize the patient. Once stabilized, the dose is gradually tapered off to prevent withdrawal symptoms and reduce dependence.
C. Monthly for 6 to 10 months, then decrease the dose to zero. Methadone treatment requires daily dosing for effective management, not monthly.
D. Daily for the rest of his life. While some patients may require long-term maintenance on methadone, the goal is usually to taper off the dose gradually if possible.
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