What would be the best response to the client's repeated complaints of pain:

Correct Answer: A

Rationale: The correct answer is A because it acknowledges the client's pain while also addressing the fact that test results are negative, validating their experience. This response shows empathy and understanding. B is incorrect as it dismisses the client's pain, potentially causing them to feel unheard. C is incorrect as it suggests avoiding the issue rather than addressing it. D is not the best response as it does not acknowledge the negative test results, which may confuse the client.

Correct Answer: C

Rationale: The correct answer is C: Remains in a safe and secure environment. This is the primary nursing intervention because clients with moderate stage dementia may have impaired judgment and memory, making them vulnerable to accidents or wandering. Keeping them in a safe and secure environment helps prevent injuries or getting lost. Choice A is important but not the primary intervention as safety comes first. Choice B, reminiscing, is beneficial for cognitive stimulation but not a priority for safety. Choice D, self-care, may be challenging for clients with dementia, so ensuring safety takes precedence.

Correct Answer: C

Rationale: The correct answer is C: Claustrophobia. Claustrophobia is an intense fear of confined spaces, such as elevators. In this case, the individual's fear of riding an elevator and the belief of dying inside indicate a fear of being trapped in a small space, which aligns with the symptoms of claustrophobia. Agoraphobia (A) is a fear of open or public spaces, social phobia (B) is a fear of social situations, and xenophobia (D) is a fear of strangers or foreigners, none of which match the symptoms described in the scenario.

Correct Answer: D

Rationale: The correct answer is D: Use the services of an interpreter. This is the best nursing intervention because it ensures accurate communication and understanding between the nurse and the psychiatric client who speaks a foreign language. Using an interpreter helps convey complex and nuanced information effectively, promotes trust and rapport, and ensures the client's needs are accurately addressed. Rationale for why the other choices are incorrect: A: Relying on nonverbal communication may lead to misunderstandings and misinterpretations, especially in a psychiatric setting where verbal communication is crucial. B: Selecting symbolic pictures as aids may be helpful to some extent, but it may not fully address the client's communication needs and may limit the depth of conversation. C: Speaking in universal phrases may be too simplistic and may not capture the complexity of the client's thoughts and emotions when addressing mental health issues.

Correct Answer: C

Rationale: The correct answer is C: The client speaks in coherent sentences. Improvement in disturbed thought processes due to flight of ideas in bipolar disorder is indicated by the client speaking in coherent sentences, demonstrating improved concentration and organization of thoughts. Verbalizing feelings directly (choice A) may not directly relate to improved thought processes. Positive "self" statements (choice B) may reflect self-esteem but do not address the issue of thought processes. Reporting feeling calmer (choice D) is too general and does not specifically address the improvement in thought processes.