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Which of the following interventions is inappropriate for a client experiencing a panic attack?
- A. Provide a well-lit environment.
- B. Encourage deep breathing.
- C. Move the client to a quiet environment.
- D. Administer prescribed antianxiety medication.
Correct Answer: A
Rationale: During a panic attack, a well-lit environment might exacerbate the client's symptoms due to sensory overload. Therefore, it is inappropriate to provide a well-lit environment during a panic attack. Encouraging deep breathing, moving the client to a quiet environment, and administering prescribed antianxiety medication are appropriate interventions for managing a panic attack. These actions help create a calming atmosphere and address the physiological symptoms associated with panic attacks.
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Which of the following interventions should not be included in the care plan for a client with major depressive disorder?
- A. Encourage participation in activities
- B. Promote adequate nutrition and hydration
- C. Discourage verbalization of feelings
- D. Monitor for suicidal ideation
Correct Answer: C
Rationale: Interventions for a client with major depressive disorder should focus on promoting activities, adequate nutrition, hydration, and monitoring for suicidal ideation. Verbalizing feelings is a crucial part of therapy for clients with depression as it helps in processing emotions and seeking support. Therefore, discouraging verbalization of feelings is not appropriate and goes against therapeutic principles.
A client prescribed sertraline for depression is receiving discharge instructions. Which statement by the client indicates an accurate understanding of the medication?
- A. I should take this medication at bedtime to avoid nausea.
- B. I should avoid drinking alcohol while taking this medication.
- C. I should take this medication with food to avoid stomach upset.
- D. It may take several weeks for this medication to be effective.
Correct Answer: D
Rationale: The correct answer is D because sertraline, used for depression, typically takes several weeks to become effective. It is important for clients to understand this delayed onset of action to manage their expectations and continue taking the medication as prescribed despite not seeing immediate results.
A client with bipolar disorder is experiencing a manic episode. Which intervention should the nurse implement to ensure the client's safety?
- A. Provide a structured environment with minimal stimuli.
- B. Monitor the client closely for signs of exhaustion.
- C. Encourage the client to rest and sleep as needed.
- D. Encourage the client to engage in regular physical activity.
Correct Answer: A
Rationale: During a manic episode in bipolar disorder, individuals may exhibit increased energy levels, impulsivity, and reduced need for sleep, which can lead to risky behaviors and accidents. Providing a structured environment with minimal stimuli helps to reduce the risk of overstimulation and impulsive actions, thereby promoting the client's safety. This intervention aims to create a calm and controlled setting that can prevent potential harm to the client during this phase of the disorder.
A client diagnosed with schizophrenia is prescribed an antipsychotic medication. Which of the following side effects should the nurse not monitor for? Select all that apply.
- A. Tardive dyskinesia
- B. Neuroleptic malignant syndrome
- C. Orthostatic hypotension
- D. Hyperglycemia
Correct Answer: A
Rationale: The nurse should not monitor for tardive dyskinesia as it is a potential long-term side effect of antipsychotic medications. However, the nurse should monitor for neuroleptic malignant syndrome, orthostatic hypotension, and hyperglycemia as these are common side effects associated with antipsychotic medications. Tardive dyskinesia is characterized by involuntary movements of the face, tongue, and extremities and may develop after prolonged use of antipsychotic drugs.
When caring for a client experiencing alcohol withdrawal, which intervention should the nurse implement to prevent complications?
- A. Provide a well-lit environment.
- B. Administer antipsychotic medication as prescribed.
- C. Monitor the client's vital signs closely.
- D. Encourage the client to express their feelings.
Correct Answer: C
Rationale: Monitoring the client's vital signs closely is crucial during alcohol withdrawal as it helps detect any physiological changes early, such as hypertension, tachycardia, or fever, which can indicate potential complications like delirium tremens. Early identification and prompt intervention can prevent severe outcomes in clients experiencing alcohol withdrawal.