The nurse is caring for a client diagnosed with catatonia. Which of the following should be a priority action by the nurse?

Schedule the client for a therapeutic group session.

Encourage the client to walk in the hallway.

Encourage the client to verbalize feelings at all times.

Offer small, frequent fluids throughout the day.

Answer and Explanation

The Correct Answer is D

Choice A Reason:
Scheduling the client for a therapeutic group session may not be appropriate as a priority action. Clients with catatonia often experience significant psychomotor disturbances, which can include immobility or stupor, making participation in group activities challenging and potentially distressing.

Choice B Reason:
Encouraging the client to walk in the hallway is not the most immediate concern. While mobility is important, the safety and medical stability of the client take precedence, especially considering the potential for immobility and resistance to movement in catatonic states.

Choice C Reason:
Encouraging the client to verbalize feelings at all times is not practical as a priority action. Catatonia can involve mutism or significantly reduced responsiveness, making it difficult for the client to express themselves verbally.

Choice D Reason:
Offering small, frequent fluids throughout the day is a priority action for a client with catatonia. Due to the potential for decreased oral intake and the risk of dehydration, ensuring the client receives adequate hydration is essential. This intervention addresses a basic physiological need and can prevent further complications.

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Correct Answer is B

Explanation

Choice A Reason:
While interviewing is a component of the nursing process, specifically during the assessment phase, describing the nursing process solely as a method for interviewing is incomplete. The nursing process encompasses much more, including diagnosis, planning, implementation, and evaluation.

Choice B Reason:
This statement accurately reflects the purpose of the nursing process. It is a systematic method used by nurses to assist clients in adapting to stressors, whether they are physical, psychological, or social. The process involves assessing the client's needs, diagnosing issues, planning and implementing interventions, and evaluating the outcomes.

Choice C Reason:
The nursing process does play a role in minimizing allegations of negligence by providing a structured approach to care, but this is not its primary purpose. The main goal is to deliver individualized and effective care to clients, not just to protect against legal issues.

Choice D Reason:
Supporting a psychiatric diagnosis is part of the nursing process, but the statement is too narrow to describe the overall purpose. The nursing process is used to plan and provide personalized care, which goes beyond just supporting a diagnosis.

A. "Perhaps you should discuss this with your physician." B. "Of course, you aren't going to die, at least not in the immediate future." C. "Tell me more about these fears of dying from a heart attack." D. "I recommend you exercise daily and avoid smoking to decrease your risk."

Correct Answer is C

Explanation

Choice A Reason:
While suggesting the client discuss their concerns with their physician is a valid response, it may not provide the immediate emotional support the client is seeking. It's important for the nurse to address the client's current anxiety and provide reassurance before referring them to their physician.

Choice B Reason:
This response dismisses the client's fears and may come across as insensitive. It's crucial to acknowledge the client's emotions and provide a supportive environment where they feel heard and understood.

Choice C Reason:
Encouraging the client to express their fears allows the nurse to provide emotional support and helps in understanding the client's perspective. This approach fosters a therapeutic relationship and can help alleviate the client's anxiety.

Choice D Reason:
While recommending lifestyle changes is beneficial for overall health, this response does not address the client's immediate emotional needs. The nurse should first provide support for the client's expressed fears before discussing lifestyle modifications.

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The nurse is caring for a client diagnosed with catatonia. Which of the following should be a priority action by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nursing instructor teaches students about the purpose of using the nursing process in the care of psychiatric clients. Which of the following statements by a student indicates that learning has occurred?

Correct Answer is B

Explanation

A client diagnosed with end-stage renal disease tells the nurse he is afraid of dying from a heart attack. Which of the following responses should the nurse make?

Correct Answer is C

Explanation

The lead nurse is orienting a new nurse in a mental health unit about the roles of the nurse in Cognitive Behavioral Therapy (CBT). Which statement made by the new nurse demonstrates an understanding of the role of the nurse in CBT? (Select all that apply.)

A home health nurse drives up to the house of her client, who has schizophrenia with manic episodes. The client is sitting on his front porch with a shotgun in his arms. Which of the following actions should the nurse take?

While in a therapeutic group, two clients get into a heated debate over politics that turns aggressive. The nurse makes the decision to have both patients removed from the group session. The nurse has demonstrated which leadership style?

A nurse is caring for a client who is about to undergo open-heart surgery. The client states that he is very nervous about the surgery. Which of the following responses should the nurse make?

A nurse is leading a group family therapy session for a mother, father, and two adolescent siblings. Which of the following statements should the nurse recognize as an example of effective communication among family members?

A nurse on a mental health unit is caring for a client whose plan of care includes learning work-related skills. Which of the following members of the interprofessional team is appropriate for this client?

A nurse is caring for a group of clients on a mental health unit. Which of the following actions should the nurse implement to establish therapeutic relationships with the clients?