A nurse notices that a client who has moderate anxiety is pacing the hall and mumbling As the nurse approaches the client, he states, "I am at the end of my rope. I don't think I can take any more bad news." Which of the following responses should the nurse make?

"Most clients with anxiety issues benefit from lying down."

"An antianxiety pill works best for situations like this."

"Providers usually recommend relaxation exercises for clients who are as upset as you are."

"Come with me to an area where we can talk without interruption."

Answer and Explanation

The Correct Answer is D

This response demonstrates a therapeutic and empathetic approach to the client's distress. By offering to talk in a private area without interruption, the nurse provides the client with a safe space to express their feelings and concerns. It also allows the nurse to conduct a more in-depth assessment of the client's current emotional state and any specific triggers contributing to their anxiety.

A- Encouraging the client to lie down assumes that all clients with anxiety benefit from this approach, which may not be the case for everyone.

B- Simply suggesting medication may not address the underlying concerns or provide an opportunity for the client to express themselves.

C- While relaxation exercises can be beneficial for managing anxiety, suggesting them right away may not be the best response when the client is in a heightened state of distress.

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Correct Answer is A

Explanation

A.The client runs 4 miles outdoors every afternoon. This is correct. Intense physical activity, especially in hot weather, can lead to dehydration and sodium loss through sweat, both of which can increase the risk of lithium toxicity.

B.The client drinks 2 liters of liquids daily. Adequate fluid intake helps maintain a stable lithium level and is generally recommended to reduce the risk of toxicity.

C. The client eats 2 to 3 gm of sodium-containing foods daily. A consistent intake of sodium helps maintain stable lithium levels. Significant changes in sodium intake, rather than a stable intake, would be more concerning.D. The client eats foods high in tyramine. Tyramine-rich foods are a concern for clients taking MAO inhibitors, not lithium. Therefore, this is not relevant to lithium toxicity.

A. Anxiety and diaphoresis B. Muscle aches and chills C. Fatigue and depression D. Arrhythmia and respiratory depression

Correct Answer is A

Explanation

Anxiety and diaphoresis: Alcohol withdrawal commonly presents with symptoms of anxiety, restlessness, and excessive sweating (diaphoresis). These symptoms are due to the central nervous system's hyperactivity caused by the sudden cessation of alcohol intake.

Incorrect:

B- Muscle aches and chills: Muscle aches and chills are not typical manifestations of alcohol withdrawal. These symptoms are more commonly associated with opioid withdrawal rather than alcohol withdrawal.

C- Fatigue and depression: Fatigue and depression are common symptoms during alcohol withdrawal. The client may feel tired, lack energy, and experience a low mood due to the neurochemical imbalances that occur during withdrawal.

D- Arrhythmia and respiratory depression: While alcohol withdrawal can lead to some cardiovascular and respiratory symptoms, such as increased heart rate and blood pressure, severe arrhythmia and respiratory depression are not typical findings. These more severe symptoms may indicate a more severe withdrawal syndrome or coexisting medical conditions that require immediate medical attention.

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A nurse notices that a client who has moderate anxiety is pacing the hall and mumbling As the nurse approaches the client, he states, "I am at the end of my rope. I don't think I can take any more bad news." Which of the following responses should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is providing discharge teaching to a client who has bipolar disorder and will be discharged with a prescription for lithium. The nurse should teach the client that which of the following factors puts her at risk for lithium toxicity?

Correct Answer is A

Explanation

A nurse is caring for a client who is experiencing alcohol withdrawal. Which of the following findings should the nurse expect?

Correct Answer is A

Explanation

A nurse is assessing a client who is experiencing chronic stress. Which of the following findings should the nurse expect?

A nurse is caring for a client who is having difficulty sleeping and is pacing the floor. The client's head down, and he is wringing his hands. Which of the following actions should the nurse take?

A nurse is assessing a client who has a history of alcohol use disorder. Which of the following questions should the nurse include to deter the use of alcohol affects the client's psychosocial behaviors?

A nurse observes that a client who has depression is sitting alone in the room crying. As the nurse approaches, the client states, "I'm feeling really down and don't want to talk to anyone right now." Which of the following responses should the nurse make?

A nurse on the psychiatric unit is assessing a client who has moderate anxiety disorder. Which of the following findings should the nurse expect?

A nurse is planning care for a client who has depression. The nurse notes that the client has weight loss, an inability to concentrate, an inability to complete everyday tasks, and a preference to sleep all day. Which of the following interventions should be included in the plan of care?

A nurse is caring for a client who reports acute, moderate anxiety. Which of the following is the priority nursing action?

A nurse is admitting a client who has multiple injuries following a motor vehicle crash. Shortly after admission, the client's partner distraught and blames himself for the accident. Which of the following responses should the nurse make?