A client with somatic symptom disorder reports experiencing chest pain to the nurse. Which action should the nurse take?

Administer a PRN analgesic to the client.

Further assess the client's pain and vital signs.

Ask if the client to compare this pain to the pain in the past.

Remind the client that the symptoms are psychological in cause.

Answer and Explanation

The Correct Answer is B

A) Administering a PRN analgesic may provide temporary relief but does not address the need for a comprehensive assessment of the client's condition. It is essential to understand the nature and cause of the chest pain before treating it.

B) Further assessing the client's pain and vital signs is the most appropriate action. This allows the nurse to gather important clinical information that can help determine whether the chest pain is related to a medical condition or is part of the somatic symptom disorder. A thorough assessment is critical in ensuring the client's safety and addressing any potential underlying health issues.

C) Asking the client to compare this pain to past pain can provide context but is not a priority action. The immediate focus should be on assessing the current situation rather than reflecting on past experiences.

D) Reminding the client that the symptoms are psychological in cause can be invalidating and may hinder the therapeutic relationship. It is crucial to approach the client with empathy and understanding, rather than dismissing their experience.

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Correct Answer is A

Explanation

A) The statement "It is essential not to abruptly discontinue taking the medication" indicates the client’s awareness of the critical importance of tapering off benzodiazepines like alprazolam to avoid withdrawal symptoms, which can include rebound anxiety, seizures, and other complications. This demonstrates a fundamental understanding of medication safety and the potential risks associated with abrupt discontinuation.

B) Reporting any decrease in anxiety using a 10-point scale is beneficial for monitoring progress but is not as critical as understanding the implications of stopping medication suddenly. This reflects an awareness of managing anxiety but not necessarily the highest priority in self-care.

C) Attending individual and group therapy sessions is important for comprehensive treatment of GAD. However, this statement does not reflect the most immediate self-care concern related to the medication.

D) Reporting dizziness, light-headedness, or sedation shows the client’s awareness of potential side effects, which is important, but again, it does not encompass the crucial self-care goal regarding the safe management of alprazolam.

A. The healthcare provider's history and physical. B. Baseline nursing admission assessment. C. Recent urine drug testing (UDT) results. D. Abnormal Involuntary Movement Scale (AIMS).

Correct Answer is D

Explanation

A) Reviewing the healthcare provider's history and physical may provide some background on the client's overall health and medication history, but it won't specifically address the symptoms currently being observed. While this information is useful, it does not directly relate to the assessment of involuntary movements.

B) The baseline nursing admission assessment can offer insights into the client's initial condition and any prior neurological assessments. However, it may not contain the specific details necessary to evaluate the current symptoms of uncontrollable hand movements and tongue protrusion, which are indicative of potential tardive dyskinesia or other movement disorders.

C) Recent urine drug testing (UDT) results could help identify any illicit substance use or non-compliance with prescribed medications. However, UDT results would not provide a clear correlation to the motor symptoms observed. Understanding the client’s current medication compliance is important, but it is not as directly relevant as the assessment of involuntary movements.

D) Reviewing the Abnormal Involuntary Movement Scale (AIMS) is crucial, as it specifically assesses involuntary movements associated with the use of antipsychotic medications and other psychotropic drugs. AIMS can provide baseline data and track any changes in involuntary movements over time. Given the client's symptoms of uncontrollable hand movements and excessive tongue protrusion, AIMS results will be key to determining if the client is experiencing tardive dyskinesia or other medication-related side effects.

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A client with somatic symptom disorder reports experiencing chest pain to the nurse. Which action should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is preparing a client for discharge who has been taking alprazolam long-term for generalized anxiety disorder (GAD). When evaluating the client's understanding of the discharge teaching, which statement made by the client shows awareness of the most important self-care goal?

Correct Answer is A

Explanation

When assessing a client who takes psychotropic medications, the nurse notes that the client has uncontrollable hand movements and is excessively protruding the tongue. Which assessment in the client's record should the nurse review?

Correct Answer is D

Explanation

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