A nurse is caring for a client who is experiencing panic-level anxiety and is becoming increasingly agitated with the staff. Which of the following interventions should the nurse attempt first?

Administer a sedative medication to the client.

Encourage strenuous physical activity to decrease tension.

Encourage the client to explore feelings that contribute to anxiety.

Speak to the client using short and simple statements in calm voice.

Answer and Explanation

The Correct Answer is D

A) Administer a sedative medication to the client: While sedative medications can help manage acute anxiety, they should not be the first intervention. Medication administration comes after attempting non-pharmacological strategies to de-escalate the situation.

B) Encourage strenuous physical activity to decrease tension: Strenuous physical activity can sometimes exacerbate anxiety rather than alleviate it, particularly during a panic-level episode. It might not be safe or effective for immediate calming.

C) Encourage the client to explore feelings that contribute to anxiety: Exploring feelings is more appropriate once the client has been calmed. During a panic-level anxiety episode, the client may not be able to engage in reflective thinking or communication effectively.

D) Speak to the client using short and simple statements in calm voice: Using short, simple statements in a calm voice helps to provide clear and concise communication, which can be grounding and reassuring for someone experiencing panic-level anxiety. This approach helps to de-escalate the situation by reducing confusion and agitation.

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Correct Answer is A

Explanation

A) Lymphocytes 30%:
Lymphocyte levels are typically elevated during the acute phase of mononucleosis as the body fights the Epstein-Barr virus. A level of 30% indicates that the lymphocyte count is returning to a more normal range, which suggests the client is recovering from the infection.

B) RBC 4.4:
The red blood cell count is not directly indicative of recovery from mononucleosis. While it provides information about the client's overall hematologic status, it does not specifically reflect the status of the viral infection.

C) Hgb 14 g/dL:
Hemoglobin levels can provide information about the client's oxygen-carrying capacity but do not specifically indicate recovery from mononucleosis. Normal hemoglobin levels are reassuring but not directly related to the viral infection's resolution.

D) Hct 42%:
Hematocrit levels, like hemoglobin, offer information about the client's blood composition but do not directly indicate recovery from mononucleosis. While normal hematocrit levels are desirable, they are not specific to the recovery status of the viral illness.

A. "Limit sodium intake to 3,500 milligrams per day." B. "Take ibuprofen for discomfort." C. "Increase the distance you walk by 100 feet daily, even if you feel fatigued." D. "Include no more than 2,000 milliliters of fluid intake in 24 hours."

Correct Answer is D

Explanation

A) "Limit sodium intake to 3,500 milligrams per day.":
Limiting sodium intake is crucial for managing heart failure to prevent fluid retention and exacerbation of symptoms. However, the recommended limit is typically much lower, around 1,500 to 2,000 milligrams per day, not 3,500 milligrams.

B) "Take ibuprofen for discomfort.":
Ibuprofen and other NSAIDs are not recommended for clients with heart failure as they can cause fluid retention, worsen heart failure symptoms, and increase the risk of kidney problems. Alternatives such as acetaminophen are generally safer for pain relief.

C) "Increase the distance you walk by 100 feet daily, even if you feel fatigued.":
While regular exercise is important, clients with heart failure should not push through fatigue, as overexertion can lead to worsening symptoms. Exercise recommendations should be tailored to the individual's tolerance and should be adjusted based on their energy levels.

D) "Include no more than 2,000 milliliters of fluid intake in 24 hours.":
Restricting fluid intake to 2,000 milliliters per day helps prevent fluid overload, which is critical for managing heart failure. Monitoring and limiting fluid intake can help control symptoms such as edema and shortness of breath.

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A nurse is caring for a client who is experiencing panic-level anxiety and is becoming increasingly agitated with the staff. Which of the following interventions should the nurse attempt first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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