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: Weigh the client daily is important because chlorpromazine can cause weight gain as a side effect. Regular monitoring of the client’s weight helps in managing and mitigating this potential adverse effect.

Choice B reason: Monitor the client for signs of bleeding is not typically necessary for clients taking chlorpromazine. This medication does not commonly cause bleeding issues. Monitoring for bleeding would be more relevant for clients on anticoagulants or medications that affect platelet function.

Choice C reason: Monitor the client’s respirations every 4 hours is not specifically required for clients on chlorpromazine. While respiratory depression can be a concern with some medications, it is not a common side effect of chlorpromazine.

Choice D reason: Administer an antacid with the medication to decrease nausea is not recommended. Antacids can interfere with the absorption of chlorpromazine, reducing its effectiveness. If the client experiences nausea, other antiemetic strategies should be considered.

A. Implement a resolution. B. Evaluate the results. C. Brainstorm solutions. D. Identify the problem.

Correct Answer is D

Explanation

Choice A reason: Implement a resolution

Implementing a resolution without first understanding the root cause of the conflict can lead to ineffective solutions and may not address the underlying issues. It is essential to identify the problem first to ensure that any resolution is appropriate and effective.

Choice B reason: Evaluate the results

Evaluating the results is an important step in the conflict resolution process, but it comes after implementing a solution. Before any evaluation can take place, the problem must be identified, and a resolution must be implemented. Therefore, this step is not the first action to take.

Choice C reason: Brainstorm solutions

Brainstorming solutions is a critical part of resolving conflicts, but it should occur after the problem has been clearly identified. Without a clear understanding of the problem, brainstorming may not yield effective solutions. Identifying the problem ensures that the brainstorming session is focused and productive.

Choice D reason: Identify the problem

Identifying the problem is the first and most crucial step in resolving any conflict. Understanding the root cause of the conflict between the pharmacy and the staff nurses will provide a clear direction for developing effective solutions. This step involves gathering information, listening to all parties involved, and pinpointing the specific issues that need to be addressed.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is developing a care plan for a client who has schizophrenia and is taking chlorpromazine. Which of the following actions should the nurse include in the plan?

Correct Answer is A

Explanation

A nurse manager has recently become aware of a conflict between the pharmacy and the staff nurses regarding sending and receiving medications. Which of the following actions should the nurse take first to resolve the conflict?

Correct Answer is D

Explanation

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