A nurse is assessing a client who reports an increase in anxiety. Which of the following responses should the nurse make?

It doesn’t appear as though you are feeling anxious.

Tell me what has been happening lately.

I think you should see a therapist.

Do you think your anxiety is worse than everyone else’s?

Answer and Explanation

The Correct Answer is B

Choice A reason:

Saying “It doesn’t appear as though you are feeling anxious” is not an appropriate response. This statement invalidates the client’s feelings and can make them feel misunderstood or dismissed. It is important for the nurse to acknowledge the client’s report of anxiety and provide a supportive environment for them to express their concerns.

Choice B reason:

“Tell me what has been happening lately” is the most appropriate response. This open-ended question encourages the client to share more about their experiences and feelings, which can help the nurse understand the underlying causes of the anxiety. It also shows empathy and a willingness to listen, which are crucial in building a therapeutic relationship.

Choice C reason:

“I think you should see a therapist” might be a helpful suggestion, but it is not the best immediate response. While referring the client to a therapist can be part of the long-term management plan, the nurse should first listen to the client’s concerns and provide immediate support. Suggesting therapy right away might make the client feel like their concerns are being brushed off.

Choice D reason:

“Do you think your anxiety is worse than everyone else’s?” is not a helpful response. This question can come across as judgmental and may make the client feel defensive or invalidated. It is important for the nurse to focus on understanding the client’s individual experience rather than comparing it to others.

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Correct Answer is A

Explanation

Choice A reason: I may have a dry mouth while taking this medication

Dry mouth is a common side effect of chlorpromazine, which is an antipsychotic medication used to treat various mental health conditions. This side effect occurs because chlorpromazine can reduce saliva production. Patients should be advised to maintain good oral hygiene and stay hydrated to manage this symptom.

Choice B reason: This medication may cause me to urinate frequently

Frequent urination is not a typical side effect of chlorpromazine. Instead, chlorpromazine can cause urinary retention, which is the inability to empty the bladder completely. Therefore, this statement does not indicate a correct understanding of the medication’s side effects.

Choice C reason: This medication will help me stop smoking

Chlorpromazine is not used to help people stop smoking. It is primarily prescribed for the treatment of schizophrenia, bipolar disorder, and other psychotic disorders. Medications specifically designed to aid smoking cessation include nicotine replacement therapies and other drugs like varenicline or bupropion.

Choice D reason: I should expect flu-like symptoms while taking this medication

Flu-like symptoms are not commonly associated with chlorpromazine. While some side effects can mimic flu symptoms, such as fatigue or muscle aches, they are not typical and should be reported to a healthcare provider if they occur. This statement does not reflect a correct understanding of the medication’s expected side effects.

A. Babinski’s sign B. Chvostek’s sign C. Brudzinski’s sign D. Kernig’s sign

Correct Answer is B

Explanation

Choice A reason: Babinski’s sign

Babinski’s sign is a reflex action where the big toe moves upward or toward the top surface of the foot and the other toes fan out when the sole of the foot is stimulated. This sign is used to assess neurological function, particularly in the context of central nervous system disorders. It is not related to hypocalcemia, which is the likely cause of the tingling sensation in this scenario.

Choice B reason: Chvostek’s sign

Chvostek’s sign is a clinical indicator of hypocalcemia. It is elicited by tapping the facial nerve at the angle of the jaw, which causes twitching of the facial muscles. Hypocalcemia is a common complication following thyroidectomy due to potential damage or removal of the parathyroid glands, which regulate calcium levels. The tingling sensation reported by the client is a classic symptom of hypocalcemia, making Chvostek’s sign the most relevant assessment.

Choice C reason: Brudzinski’s sign

Brudzinski’s sign is used to assess for meningitis. It involves flexing the client’s neck and observing for involuntary flexion of the hips and knees. This sign is not related to hypocalcemia or the symptoms described by the client following thyroidectomy.

Choice D reason: Kernig’s sign

Kernig’s sign is another test for meningitis. It involves flexing the client’s hip and knee, then straightening the knee. Pain and resistance to straightening the knee indicate a positive Kernig’s sign. This sign is not relevant to the assessment of hypocalcemia or the symptoms described by the client.

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A nurse is assessing a client who reports an increase in anxiety. Which of the following responses should the nurse make?

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Naxlex Comprehensive Predictor Exams

A nurse is teaching a client who has a new prescription for chlorpromazine. Which of the following statements indicates an understanding of the teaching?

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Explanation

A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should the nurse assess the client?

Correct Answer is B

Explanation

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