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The nurse enters the client's room and finds the client anxiously pacing the floor. The client begins shouting at the nurse, 'Get out of my room!' The best intervention by the nurse would be to
- A. approach the client and ask, 'What's wrong?'
- B. call for help and say, 'Calm down.'
- C. turn and walk away from the room without saying anything.
- D. stand at the doorway and say, 'You seem upset.'
Correct Answer: D
Rationale: Standing at a distance and acknowledging the client's distress maintains safety and encourages communication without escalating anxiety.
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Which of the following would be key points for the nurse to remember when working with persons who are suffering from anxiety disorders?
- A. It is important for the nurse to fix the client's problems.
- B. Remember to practice techniques to manage stress and anxiety in your own life.
- C. If you have any uncomfortable feelings, do not tell anyone about them.
- D. Remember that only people who suffer from anxiety disorders have stress that can interfere with daily life and work.
Correct Answer: B
Rationale: Nurses must manage their own stress to provide effective care, as stress is universal, not exclusive to those with anxiety disorders.
The nurse is teaching about postoperative wound care. As the wound is uncovered, the client begins mumbling, breathing rapidly, and trying to get out of bed, and the client does not respond when the nurse calls his name. Which of the following should be the nurse's first action?
- A. Ask the client to describe his feelings.
- B. Proceed with wound care quickly.
- C. Replace the dressing on the wound.
- D. Get the assistance of another nurse.
Correct Answer: C
Rationale: Replacing the dressing addresses severe anxiety by reducing stimuli and preventing wound contamination, prioritizing client comfort.
Which of the following are reasons that the nurse must understand why and how anxiety behaviors work? Select all that apply.
- A. To provide better care for the client
- B. To help understand the role anxiety plays in performing nursing responsibilities
- C. To help the nurse to mask his or her own feelings of anxiety
- D. So the nurse can identify that his or her own needs are more important than the clients
- E. To help nurses to function at a high level
Correct Answer: A,B,E
Rationale: Understanding anxiety improves client care, informs nursing responsibilities, and supports high-level functioning, without prioritizing the nurse's needs.
A client says to the nurse, 'I just can't talk in front of the group. I feel like I'm going to pass out.' The nurse assesses the client's anxiety to be at which level?
- A. Mild
- B. Moderate
- C. Severe
- D. Panic
Correct Answer: C
Rationale: Symptoms like feeling like passing out indicate severe anxiety, characterized by intense physiologic responses.
A client asks the nurse, 'Why do I have to go to counseling? Why can't I just take medications?' The best response by the nurse would be.
- A. Both therapies are effective. You can eventually choose one or the other.
- B. You cannot get the full effect of your medications without cognitive therapy as well.
- C. As soon as your medications reach therapeutic level, you can omit the therapy.
- D. Medications combined with therapy help you change how well you function.
Correct Answer: D
Rationale: Combining medication and therapy improves functioning by addressing both symptoms and underlying coping mechanisms.