A patient is being treated on the mental health unit for an anxiety disorder. The patient approaches the nurse and reports feeling dizzy and weak, with a sensation of a racing heart. The nursing care plan includes interventions of imagery exercises and as-needed lorazepam (Ativan) for symptoms of anxiety. What should the nurse do first?

Obtain the patient's vital signs.

Give the patient the prescribed as-needed lorazepam.

Instruct the patient to sit and breathe deeply.

Instruct the patient in an imagery exercise.

Answer and Explanation

The Correct Answer is A

Choice A reason: The first step should always be to assess the patient's physical state to rule out any immediate life-threatening conditions before proceeding with psychiatric interventions.

Choice B reason: Administering medication may be necessary, but it should not precede an assessment of the patient's vital signs.

Choice C reason: While instructing the patient to sit and breathe deeply can help alleviate symptoms of anxiety, it is not the first action to take before assessing the patient's vital signs.

Choice D reason: Imagery exercises can be helpful for managing anxiety, but they are not the priority before ensuring the patient's physiological stability.

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Correct Answer is C

Explanation

Choice A reason: Paranoid personality disorder is characterized by distrust and suspicion, not the behaviors described.

Choice B reason: Dependent personality disorder involves a need to be taken care of and a fear of separation, which does not align with David's behaviors.

Choice C reason: Antisocial personality disorder includes a disregard for and violation of the rights of others, deceitfulness, and impulsivity, which aligns with David's behaviors.

Choice D reason: Schizoid personality disorder is characterized by detachment from social relationships and a restricted range of emotional expression, not matching David's behaviors.

A. Observe the patient's nonverbal communication for data on the patient's thoughts and feelings. B. Maximize stimuli to create diversion from the anxiety. C. Discourage activities, as activities might only increase a patient's anxiety level. D. Document only positive changes in behavior. E. Encourage the patient to verbalize all thoughts and feelings. F. Observe for signs of suicidal thoughts.

Correct Answer is ["B","C","D"]

Explanation

Choice A reason: Observing nonverbal communication is a valid nursing intervention for assessing a patient's anxiety level.

Choice B reason: Maximizing stimuli can overwhelm a patient with anxiety and is not a recommended intervention.

Choice C reason: Discouraging activities is not recommended as activities can be a form of therapy for anxiety disorders.

Choice D reason: Documenting only positive changes is not appropriate as all changes, positive or negative, should be documented for a comprehensive understanding of the patient's condition.

Choice E reason: Encouraging patients to verbalize thoughts and feelings is a therapeutic intervention that can help manage anxiety.

Choice F reason: Observing for signs of suicidal thoughts is crucial as anxiety disorders can increase the risk of suicide.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

Which of the following are NOT nursing interventions for people with anxiety disorders? Select all that apply.

Correct Answer is ["B","C","D"]

Explanation

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