A nurse in the emergency department is caring for a client who is exhibiting manifestations of a panic level of anxiety. Which of the following interventions should the nurse initiate?

Rationale for correct choices:

• Remaining neutral: The nurse should remain neutral to avoid reinforcing or escalating the client’s grandiose beliefs. This helps maintain trust and creates space for self-reflection without judgment.
• Explaining that the client is not entitled to play on a professional team: Gently addressing the client’s unrealistic expectations helps them understand the reality of their situation and fosters a more grounded perspective on their goals.

Rationale for incorrect choices:

• Questioning the client's abilities: Directly questioning the client's abilities could be seen as confrontational and may increase defensiveness. A more constructive approach would focus on challenging unrealistic beliefs.
• Challenging the client's feelings of grandiosity: Challenging grandiosity directly can make the client feel attacked. It’s better to educate and explain the reality of their expectations in a supportive way.
• Supporting the client's fear of abandonment: The client does not appear to express abandonment fears in this case. The issue is more related to grandiosity, so focusing on this would be more effective.
• Suggesting another sport: Suggesting a different sport might divert attention from the core issue—grandiosity. Addressing the client's distorted self-image is more important before offering alternatives.

A. Ensure the client's room is dark at night: A dark room can increase confusion and agitation in clients with dementia, especially at night. It’s important to provide a well-lit environment to reduce confusion and help the client maintain a sense of orientation.
B. Use symbols to assist the client in finding personal items: Using symbols, pictures, or labels to help the client identify personal items can provide orientation and reduce frustration. This approach supports independence while minimizing confusion.
C. Ask the client orientation questions many times per day: Asking orientation questions repeatedly can increase anxiety and confusion for clients with dementia. It’s more effective to provide reassurance and support rather than focusing on constant questioning of orientation.
D. Provide a high level of sensory stimulation during the day: While some level of stimulation is important, excessive sensory input can overwhelm or agitate a client with dementia. The environment should be calm and soothing to avoid overstimulation.