A client states, "I don't know what to do.
My life is a mess." What is an appropriate response by the nurse?
Place the client on a 72-hour hold immediately.
Remain attentive, but silent.
Leave the room immediately.
Tell the client that everything will be fine.
The Correct Answer is B
Remaining attentive but silent is an appropriate response by the nurse.
This allows the client to express their feelings and concerns without interruption or judgment.
It also shows the client that the nurse is actively listening and interested in what they have to say.
Choice A is not an appropriate response because placing a client on a 72-hour hold should only be done if the client is a danger to themselves or others.
Choice C is not an appropriate response because leaving the room immediately would be unprofessional and could make the client feel abandoned.
Choice D is not an appropriate response because telling the client that everything will be fine may not be true and could give false hope.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The client is experiencing neuropathic pain.
Pain after amputation can involve both nociceptive pain due to bone and soft tissue injury and neuropathic pain from direct neural trauma and central sensitization1.
This can lead to a complicated, mixed form of pain.
Choice A is not the correct answer because nociceptive pain is not the only type of pain that can occur after amputation.
Choice C is not the correct answer because cutaneous pain is not the type of pain being described.
Choice D is not the correct answer because visceral pain is not the type of pain being described.
Correct Answer is D
Explanation
Encouraging bed rest would be an inappropriate nursing intervention to promote mobility for a client with decreased mobility.
Bed rest can lead to further complications of immobility1.
Choice A is not an answer because teaching the client to do active range of motion (AROM) exercises every 2 hours can help maintain joint mobility and muscle strength2.
Choice B is not an answer because evaluating the client’s need for ambulatory aids can help them move safely and independently1.
Choice C is not an answer because keeping skin clean and dry is important for preventing skin breakdown, which can be a complication of immobility1.
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