A client who has coronary artery disease tells the nurse he is afraid of dying from a heart attack. Which of the following responses should the nurse make?
"Perhaps you should discuss this with your physician."
"Of course, you aren't going to die, at least not in the immediate future."
"I recommend you exercise daily and avoid smoking to decrease your risk."
"Tell me more about these fears of dying from a heart attack.".
The Correct Answer is D
Choice A rationale:
Deflecting the client's concerns to the physician dismisses the client's immediate need for emotional support and therapeutic communication.
It can hinder the development of a trusting nurse-client relationship.
The nurse is responsible for addressing the client's psychosocial needs, not solely deferring them to other healthcare professionals.
Choice B rationale:
Offering false reassurance is inappropriate and potentially harmful. It can erode trust if the client's fears are later realized.
It minimizes the client's legitimate concerns and invalidates their emotional experience.
Choice C rationale:
While lifestyle modifications are essential for managing coronary artery disease, providing unsolicited advice at this moment disregards the client's emotional distress.
It prioritizes physical health over the client's psychological well-being. It can be perceived as dismissive of the client's fears and concerns.
Choice D rationale:
Inviting the client to elaborate on their fears demonstrates active listening and encourages therapeutic communication. It validates the client's concerns and shows empathy for their emotional experience.
It provides an opportunity to assess the client's understanding of their condition and identify specific fears or misconceptions. It establishes a foundation for exploring coping mechanisms and providing appropriate support and education.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale: Clients who are admitted involuntarily cannot be hospitalized for as long as the provider deems necessary. There are legal and ethical guidelines that dictate the length and conditions of involuntary hospitalization. These guidelines vary by jurisdiction, but they generally require periodic review and reevaluation of the client’s condition and the necessity of continued hospitalization.
Choice B rationale: Clients cannot be given medications against their will under normal circumstances. Informed consent is a fundamental right in healthcare, including mental health care. This means that clients have the right to be fully informed about the potential benefits, risks, and alternatives of a proposed treatment, and to make an informed decision about whether to accept or refuse the treatment. There are exceptions in emergency situations where the client poses an immediate danger to self or others, but these are governed by strict legal and ethical guidelines.
Choice C rationale: Clients who are involuntarily admitted do have the right to informed consent. This means that even if a client is admitted to a mental health facility against their will, they still have the right to be informed about their treatment and to make decisions about their care. This includes the right to be informed about the potential benefits, risks, and alternatives of proposed treatments, and the right to refuse treatment.
Choice D rationale: The laws regarding restraints are not different for clients who are admitted involuntarily. Restraints can only be used as a last resort when less restrictive interventions have failed and the client poses an immediate danger to self or others. The use of restraints is governed by strict legal and ethical guidelines, and these apply to all clients, regardless of whether they were admitted voluntarily or involuntarily.
Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"B"},"E":{"answers":"A"},"F":{"answers":"A"}}
Explanation
The correct answer/s is Choice/s.
Choice A rationale: Requesting to decrease the dose of oral glycemic medication might not be the most appropriate action for the nurse to take. The client reports overeating since they were 14 years old, which could potentially lead to obesity and related health issues such as type 2 diabetes. However, without more information about the client’s current health status and blood glucose levels, it’s not clear whether a decrease in oral glycemic medication is warranted. It’s important for healthcare providers to monitor and adjust medication dosages based on individual patient needs and responses.
Choice B rationale: Encouraging the client to eat small, frequent meals could be a beneficial strategy. Overeating can lead to weight gain and related health problems. Eating smaller meals more frequently throughout the day can help to control hunger and manage portion sizes, which could potentially help the client to reduce overeating.
Choice C rationale: Instructing the client to weigh themselves daily might not be the best approach. While it’s important for individuals to be aware of their weight as part of overall health management, daily weighing can become a source of stress and anxiety. It might be more helpful to focus on promoting healthy behaviors and coping strategies to manage overeating.
Choice D rationale: Anticipating a potassium supplement for the client might not be necessary. While potassium is an essential nutrient, there’s no indication from the information provided that the client has a potassium deficiency. Overeating does not necessarily lead to nutrient deficiencies, and supplementation should be based on individual needs and medical advice.
Choice E rationale: Teaching the client to plan meals ahead could be a very helpful strategy. Meal planning can help individuals manage portion sizes, ensure a balanced diet, and avoid impulsive eating decisions. This could potentially help the client manage their overeating.
Choice F rationale: Recommending that the client journal about their feelings could be a beneficial strategy. Emotional eating, or eating in response to feelings rather than hunger, is a common issue. Journaling can help individuals identify emotional triggers for overeating and develop healthier coping strategies.
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