A charge nurse is supervising a newly licensed nurse who is caring for a client who is experiencing auditory hallucinations and is refusing medication. The newly licensed nurse suggests placing the medication in the client's food to the charge nurse. Which of the following actions should the charge nurse take?
Suggest the family persuade the client to take the medication.
Recommend that the medication be delivered intramuscularly.
Remind the newly licensed nurse that the client has a right to refuse medication.
Suggest the newly licensed nurse contact the pharmacy to inquire about compatible foods.
The Correct Answer is C
The charge nurse should remind the newly licensed nurse that the client has a right to refuse medication. It is important for healthcare providers to respect the autonomy and rights of their clients, including the right to refuse treatment.
Option a is incorrect because it may not be appropriate for the family to persuade the client to take medication against their wishes.
Option b is incorrect because delivering medication intramuscularly against the client's wishes would violate their right to refuse treatment.
Option d is incorrect because inquiring about compatible foods with the pharmacy would not address the issue of the client's right to refuse medication.
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Correct Answer is C
Explanation
c. Instruct the client to use abdominal breathing.
When a client is experiencing a panic atack, the nurse's first priority is to help the client manage their symptoms and provide immediate relief. Instructing the client to use abdominal breathing is the most appropriate initial intervention.
Explanation for the other options:
a. Discuss the client's feelings prior to the panic atack. While discussing the client's feelings can be beneficial in addressing the underlying causes of anxiety, it may not be the most effective immediate intervention during a panic atack. The client's focus during a panic atack is typically on managing the physical symptoms and regaining control.
b. Encourage the use of positive self-talk strategies. Positive self-talk can be helpful in managing anxiety in general, but during a panic atack, the individual may have difficulty engaging in positive self-talk due to the intensity of symptoms. Addressing the immediate physical symptoms is a priority before exploring coping strategies.
d. Administer an anti-anxiety medication. Medication administration may be necessary in some cases, but it is not the first-line intervention for managing a panic atack. Non-pharmacological interventions, such as breathing techniques, should be implemented first. If the panic atack persists or worsens despite these interventions, medication may be considered.
In summary, during a panic atack, the immediate focus should be on helping the client manage their symptoms. Instructing the client to use abdominal breathing can help promote relaxation and reduce the intensity of the panic atack.
Correct Answer is D
Explanation
A client with heart failure should limit their sodium intake. Bottled salad dressings can be high in sodium, so replacing them with homemade vinegar and oil dressing can help reduce sodium intake.
The other options are not recommended for a client with heart failure who needs to limit their sodium intake.
a) Prepared frozen dinners are often high in sodium.
b) Adding salt when preparing a meal would increase sodium intake.
c) Imitation crab and lobster products (option can also be high in sodium.
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