The nurse is caring for a patient who is one day post-mastectomy and notes that she is sobbing and gasping for breath. What should the nurse do first?
Notify the registered nurse.
Raise the head of the bed.
Sit with her and listen to her concerns.
Ask the patient what is wrong.
The Correct Answer is B
Choice A reason: Notifying the registered nurse is important but should come after initially assessing the patient's immediate needs.
Choice B reason: Raising the head of the bed may help with breathing but does not address the cause of the patient's distress.
Choice C reason: Sitting with her and listening to her concerns is supportive but should follow an initial assessment of why she is sobbing and gasping for breath.
Choice D reason: Asking the patient what is wrong is the first step in assessing the situation and providing appropriate care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Direct communication with the surgeon can provide the patient with reassurance and specific information about the surgery, which may alleviate fears.
Choice B reason: Offering spiritual support may be helpful, but it does not directly address the patient's concern about the surgery itself.
Choice C reason: Providing statistics may be reassuring, but it may not fully address the patient's individual fears.
Choice D reason: Recommending analgesics only addresses pain management and not the patient's expressed fear regarding the surgery.
Correct Answer is C
Explanation
Choice A reason: While limit-setting is important, it should not be overly strict as it can increase anxiety in patients who are already highly anxious.
Choice B reason: Increasing environmental stimuli may overwhelm a highly anxious patient rather than help them.
Choice C reason: Providing support and a therapeutic milieu offers a safe and structured environment, which can help reduce anxiety and promote healing.
Choice D reason: More freedom can be beneficial, but it must be balanced with the need for a supportive and structured environment for a highly anxious patient.
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