A 16-year-old female client who attempted suicide that morning is admitted to the psychiatric unit. To determine the seriousness of the adolescent's suicide attempt, which question is most important for the nurse to ask the family?
"How long has she seemed depressed?"
"Has she ever attempted suicide before?"
"Has anything occurred which might have precipitated this suicide attempt?"
"How did she attempt to kill herself?"
The Correct Answer is D
Choice A: Inquiring about how long the adolescent has seemed depressed is important for assessing the client's overall mental health history, but it may not provide immediate information about the seriousness of the suicide attempt.
Choice B: Asking about any previous suicide attempts is important for understanding the client's history and risk factors, but it does not directly assess the seriousness of the current attempt.
Choice C: Inquiring about any precipitating events is essential for understanding the context and triggers for the suicide attempt, but it may not be the most immediate question to assess seriousness.
Choice D: Asking "How did she attempt to kill herself?" is the most crucial question to assess the seriousness of the suicide attempt. It provides critical information about the method used, which can help determine the lethality of the attempt and guide immediate interventions and safety measures.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
- A: Placing the 6-month-old with RSV in a double room with a 4-month-old who also has RSV is appropriate because they have the same infection, which reduces the risk of cross-infection with other pathogens. Cohorting patients with the same infectious disease is a common practice to prevent the spread to other patients.
- B: A private room with negative air pressure is typically used for patients who have airborne infections, which require a higher level of isolation to prevent the spread of diseases that are transmitted through the air. RSV is primarily spread through close contact and droplets, not through the air.
- C: A private room furthest from the nurse's station would not be ideal as it could delay care and observation for a young infant with a serious respiratory infection. Proximity to the nursing staff ensures prompt attention if the infant's condition changes.
- D: A double room with a 6-month-old on droplet precautions is not the best choice because it poses a risk of transmitting RSV to the other infant, who may not have RSV, leading to potential complications and further spread of infection within the unit.
Correct Answer is A
Explanation
A. Document the findings in the record – A bluish-black discoloration over the lumbosacral area is most likely a Mongolian spot, a benign congenital birthmark commonly seen in infants with darker skin tones. It does not require intervention, only documentation.
B. Report possible child abuse to protective services – Mongolian spots may resemble bruises, but they are not a sign of abuse. Reporting without further assessment is inappropriate.
C. Gently rub the area with skin cream to promote healing – Mongolian spots are not injuries and do not require treatment.
D. Ask the mother about the discoloration – While obtaining history is important, Mongolian spots are well-known benign findings that do not require further clarification from the parent.
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