A nurse is planning care for a client with a phobia.
Which nursing intervention is appropriate for this client?

Encouraging the client to face their fear gradually.

Administering benzodiazepines as needed for acute anxiety.

Providing psychoeducation about the causes and effects of phobias.

Teaching the client relaxation techniques to manage anxiety.

Answer and Explanation

The Correct Answer is A

Choice A rationale:

Encouraging the client to face their fear gradually is an appropriate nursing intervention for a client with a phobia. This approach is consistent with exposure therapy, which is a widely recognized and effective treatment for phobias. Exposure therapy involves gradually exposing the client to the feared object or situation in a controlled and supportive environment. By doing so, the client can learn to confront and manage their fear over time. This approach is evidence-based and helps the client build resilience and reduce anxiety.

Choice B rationale:

Administering benzodiazepines as needed for acute anxiety (Choice B) is not the first-line treatment for phobias. While benzodiazepines can provide temporary relief from anxiety symptoms, they do not address the underlying phobia and can lead to dependence and tolerance with prolonged use. Moreover, they are generally reserved for acute anxiety episodes and not considered a primary treatment for phobias.

Choice C rationale:

Providing psychoeducation about the causes and effects of phobias (Choice C) is a valuable component of treatment, but it alone may not be sufficient. Psychoeducation can help clients understand the nature of their phobia and reduce stigma, but it should be combined with evidence-based therapies like exposure therapy for comprehensive care.

Choice D rationale:

Teaching the client relaxation techniques to manage anxiety (Choice D) can be a helpful adjunct to treatment, but it is not the primary intervention for phobias. Relaxation techniques can be part of a broader strategy to reduce anxiety, but the client also needs exposure therapy or cognitive-behavioral therapy to address the phobia directly.

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Correct Answer is B

Explanation

Choice A rationale:

Reporting the 24-hour intake at the current infusion rate is not the most important finding to report to the healthcare provider in this case. It is essential to monitor intake and output, but a single report of the 24-hour intake is not as critical as other findings.

Choice B rationale:

Reporting a serum potassium level of 3.1 mEq/L (3.1 mmol/L) is the most important finding to report to the healthcare provider. The patient's potassium level is below the normal range, indicating hypokalemia. Hypokalemia can have serious cardiac and neuromuscular effects, including arrhythmias and muscle weakness. Prompt intervention, such as potassium supplementation or adjustment of IV fluids, is necessary to address this potentially life-threatening condition.

Choice C rationale:

Reporting a gastric output of 900 mL in the last 24 hours is significant and should be reported to the healthcare provider, but it is not as urgent as the low potassium level. Gastric output should be monitored to assess for signs of improvement or worsening, but hypokalemia takes precedence due to its immediate health risks.

Choice D rationale:

Reporting an increased blood urea nitrogen (BUN) is important for the overall assessment of the patient's renal function but is not the most critical finding in this scenario. The low potassium level is a more immediate concern and requires immediate attention.

A. Reassure the client that someone will check on him hourly. B. Place fresh water and a glass within reach on the bedside table. C. Ensure that the call bell is easily accessible to the client. D. Offer the client an evening snack before providing oral care.

Correct Answer is C

Explanation

The correct answer is choice c. Ensure that the call bell is easily accessible to the client.

Choice A rationale:

Reassuring the client that someone will check on him hourly is supportive but does not directly address the immediate need for the client to call for assistance if he needs to use the bathroom during the night.

Choice B rationale:

Placing fresh water and a glass within reach is helpful for hydration but may increase the need to urinate, which could exacerbate the issue of urinary frequency at night.

Choice C rationale:

Ensuring that the call bell is easily accessible allows the client to quickly and safely request assistance if he needs to use the bathroom, reducing the risk of falls and ensuring timely help.

Choice D rationale:

Offering an evening snack before providing oral care is a good practice for comfort and nutrition but does not directly address the issue of urinary frequency or the need for nighttime assistance.

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A nurse is planning care for a client with a phobia.Which nursing intervention is appropriate for this client?

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A nurse is planning care for a client with a phobia.
Which nursing intervention is appropriate for this client?