A client returns to the mental health clinic for assistance with an anxiety reaction that is manifested by a rapid heartbeat, sweating, shaking, and nausea while driving over the bay bridge. Which action in the treatment plan should the nurse implement?

Recommend that the client avoid driving over the bridge.

Teach the client to listen to music or audio books while driving.

Tell the client to drive over the bridge until fear is manageable.

Encourage the client to have the spouse drive in stressful places.

Answer and Explanation

The Correct Answer is B

A. Recommend that the client avoid driving over the bridge: Avoidance reinforces the anxiety and prevents the client from developing effective coping mechanisms. Over time, this may worsen the phobia and reduce the client’s functional independence and quality of life.

B. Teach the client to listen to music or audio books while driving: Calming distractions can help reduce anxiety symptoms and promote gradual exposure to the feared situation. This approach supports desensitization while helping the client stay in control and manage symptoms.

C. Tell the client to drive over the bridge until fear is manageable: Flooding, or forced prolonged exposure, may overwhelm the client and worsen anxiety. A more gradual, supportive approach is generally safer and more effective in treating specific and anxiety.

D. Encourage the client to have the spouse drive in stressful places: Delegating driving to someone else may provide short-term relief, but it limits the client’s independence and does not promote long-term coping or resolution of the anxiety trigger.

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Correct Answer is A

Explanation

A. The combination of cognitive impairment, physical injury, and restraints poses a high risk for complications such as infection, skin breakdown, and falls. Close monitoring and nursing interventions are critical to ensure safety, comfort, and appropriate care in this patient.

B. While this client may need some care for the electrolyte imbalance and nausea, this situation is more stable compared to the elderly client with Alzheimer's. The RN's role here would focus on managing the electrolyte disturbance and providing symptom relief.

C. Although this client is postoperative and may need some care, the RN's focus would primarily be on pain management and monitoring for infection or complications. However, the client’s condition is relatively stable compared to the elderly client with multiple risks.

D. This client is also stable and may require some ongoing monitoring for respiratory issues. However, the level of care needed is less intensive compared to a client with cognitive issues, restraints, and a recent fracture.

A. Names 3 home safety hazards to be resolved immediately. B. States 4 risk factors for the development of osteoporosis. C. Identifies 2 treatments for constipation due to immobility. D. Lists 5 calcium-rich foods to be added to the daily diet.

Correct Answer is A

Explanation

A. Names 3 home safety hazards to be resolved immediately: This addresses fall prevention, which is the most immediate and critical concern in osteoporosis due to the high risk of fractures from minimal trauma.

B. States 4 risk factors for the development of osteoporosis: While understanding risk factors is important for prevention, it is less urgent than addressing environmental hazards that could lead to injury.

C. Identifies 2 treatments for constipation due to immobility: Managing constipation is relevant for immobility but not a top priority compared to fall and fracture risk.

D. Lists 5 calcium-rich foods to be added to the daily diet: Dietary calcium supports long-term bone health but does not immediately reduce the risk of injury like eliminating hazards does.

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A client returns to the mental health clinic for assistance with an anxiety reaction that is manifested by a rapid heartbeat, sweating, shaking, and nausea while driving over the bay bridge. Which action in the treatment plan should the nurse implement?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The charge nurse of a critical care unit is informed at the beginning of the shift that less than the optimal number of registered nurses (RN) will be working that shift. In planning assignments, which client should receive the most care hours by a RN?

Correct Answer is A

Explanation

The nurse is preparing a teaching plan for an older adult client diagnosed with osteoporosis. Which expected outcome has the highest priority for this client?

Correct Answer is A

Explanation

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