A nurse on an acute care mental health unit is caring for a client who has generalized anxiety disorder. The client received an upsetting telephone call and is now rapidly pacing the corridors of the unit. Which of the following actions should the nurse take?
Allow the client to pace alone until physically tired.
Walk with the client at a gradually slowing pace.
Ask a small group of other clients to walk with the client.
Calmly instruct the client to stop pacing and sit in the dayroom.
The Correct Answer is B
The nurse should walk with the client at a gradually slowing pace when caring for a client with a generalized anxiety disorder who is rapidly pacing the corridors of the unit. This intervention provides the client with support and helps to prevent the client from becoming overwhelmed or getting injured. Allowing the client to pace alone until physically tired.
choice A can increase the sense of isolation and anxiety. Asking a small group of other clients to walk with the client.
choice C may be inappropriate or even harmful in some cases. Calmly instructing the client to stop pacing and sit in the dayroom.
choice D can be perceived by the client as dismissive and may escalate the anxiety level. The nurse should work with the client and their family to develop an individualized plan of care that meets the client's needs and goals.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Answer: B. Cloudy dialysate outflow.
Rationale:
A) Blood-tinged dialysate outflow.
While blood-tinged outflow can be concerning, it may not always indicate a severe complication, especially if it is minimal. It should be monitored and documented, but it does not require immediate reporting unless it becomes excessive.
B) Cloudy dialysate outflow.
This finding is significant and warrants immediate reporting to the provider as it may indicate peritonitis, an infection of the peritoneal cavity. Prompt intervention is critical to address potential complications associated with dialysis.
C) Dialysate leakage during inflow.
Dialysate leakage can occur and might be due to improper catheter placement or other issues. While it requires attention, it is not as urgent as cloudy dialysate outflow and can typically be managed without immediate escalation.
D) Report of discomfort during dialysate inflow.
Mild discomfort during inflow can be common, especially in the initial stages of peritoneal dialysis. It should be noted and assessed, but it does not necessarily require immediate reporting unless it is severe or persistent.
Correct Answer is ["C","E"]
Explanation
"I call a friend who makes me smile and laugh," and "I tense and release my muscles, starting with my feet." These are adaptive coping strategies that help to reduce stress and promote relaxation. Calling a friend who makes you smile and laugh, for example, can help to distract from negative thoughts and promote positive emotions. Tense and release exercises can help to reduce muscle tension and promote relaxation.
Choice A, "I sleep in in the mornings," is not an adaptive coping strategy because it doesn't address the source of stress and may actually lead to avoidance.
Choice B, "I isolate myself in my room for a few hours when things get overwhelming," is not adaptive because it promotes social withdrawal and avoidance.
Choice D, "I think about being on my favorite beach vacation," is not adaptive because it promotes avoidance and doesn't address the source of stress.
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