which of the following would be the most appropriate intervention for a patient experiencing severe anxiety

ATI RN

ATI Mental Health Practice A

1. Which of the following would be the most appropriate intervention for a patient experiencing severe anxiety?

A. Encourage the patient to talk about their feelings.
B. Use a firm, authoritative approach.
C. Stay with the patient and provide a quiet environment.
D. Suggest the patient watch TV to distract themselves.

Correct answer: C

Rationale: During a severe anxiety episode, it's crucial to stay with the patient and create a quiet environment. This approach helps reduce anxiety by providing a sense of safety and support. Encouraging the patient to talk about their feelings may not be effective during an acute episode of severe anxiety. Using a firm, authoritative approach can escalate the situation and worsen the anxiety. Suggesting distractions like watching TV may not address the root cause of the anxiety or provide the necessary support.

2. A patient with bipolar disorder has been prescribed lithium. Which dietary advice is important for the nurse to include?

A. Avoid foods high in tyramine.
B. Maintain a consistent salt intake.
C. Increase protein intake.
D. Avoid foods high in fat.

Correct answer: B

Rationale: Patients prescribed lithium should maintain a consistent salt intake to prevent fluctuations in lithium levels. Salt intake can impact lithium levels, and sudden changes in salt intake can affect how the body absorbs and excretes lithium. Therefore, advising the patient to maintain a stable salt intake is crucial for the effectiveness and safety of lithium therapy. Choices A, C, and D are incorrect. Avoiding foods high in tyramine is more relevant for patients taking MAOIs, not lithium. Increasing protein intake or avoiding foods high in fat are not specific dietary recommendations for patients on lithium therapy.

3. Which statement is an example of reflection?

A. I think this feeling will pass.
B. So you are saying that life has no meaning.
C. I'm not sure I understand what you mean.
D. You look sad.

Correct answer: B

Rationale: The correct answer is B. Reflection involves restating the patient's words or feelings to show understanding and encourage further discussion. Choice B restates the patient's statement, demonstrating active listening and empathy.

4. April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April's mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that:

A. Time-out is an important part of April's baseline discipline.
B. Time-out is no longer an effective therapeutic measure.
C. April enjoys time-out, and acts out to get some alone time.
D. Time-out will need to be replaced with seclusion and restraint.

Correct answer: B

Rationale: Frequent use of time-out has reduced its effectiveness as a therapeutic measure for April.

5. During an acute panic attack, which intervention should the nurse implement?

A. Encourage the client to discuss their feelings
B. Provide a calm environment
C. Teach the client deep breathing exercises
D. Leave the client alone to calm down

Correct answer: C

Rationale: During an acute panic attack, the priority intervention is to create a calm and safe environment. Teaching the client deep breathing exercises is crucial as it promotes relaxation and reduces hyperventilation, helping to manage the panic attack effectively. Encouraging the client to discuss their feelings may exacerbate the panic by increasing emotional distress. Providing a busy environment can escalate stress levels rather than alleviate them. Leaving the client alone may lead to feelings of abandonment or worsen the panic attack. Therefore, the most appropriate intervention is to teach deep breathing exercises to help the client regain control and manage the panic attack.