A client has a diagnosis of risk for suicide r/t a past attempt. Which of the following outcome should the nurse prioritize?

The client will verbalize 3 positive attributes about themselves by day 3

The client will perform personal hygiene with no prompting

The client will attend group by day 2

The client will remain free from injury for duration of their hospitalization

Answer and Explanation

The Correct Answer is D

A. The client will verbalize 3 positive attributes about themselves by day 3. This is a good long-term goal but does not directly prevent self-harm.

B. The client will perform personal hygiene with no prompting. Improved self-care is beneficial but is not the primary priority in suicide prevention.

C. The client will attend group by day 2. Participation in therapy is helpful, but ensuring physical safety takes precedence.

D. The client will remain free from injury for the duration of their hospitalization. The most critical goal for a client at risk for suicide is preventing self-harm, making this the priority outcome.

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Correct Answer is A

Explanation

A. Discharge teaching: Phase III of post-anesthesia care focuses on preparing the patient for discharge, including teaching about post-operative care, medication instructions, and follow-up care.

B. Recovery from anesthesia: This occurs in Phase I, where patients are closely monitored as they emerge from anesthesia and regain protective reflexes.

C. Urinary catheterization if no voiding: This may be considered in Phase II, especially if urinary retention is present, but is not a defining activity of Phase III.

D. Vital signs every 15 to 30 minutes: Frequent monitoring of vital signs is a key part of Phase I, when patients are at the highest risk for complications.

A. Nonrebreather mask B. Face tent C. Nasal cannula D. Venturi mask

Correct Answer is B

Explanation

A. Nonrebreather mask. A nonrebreather mask delivers high concentrations of oxygen but requires a tight seal around the face, which is not suitable for patients with facial trauma.

B. Face tent. A face tent is the best option for a patient with facial trauma as it provides high-flow oxygen without requiring direct contact with the face, preventing pressure on injured areas.

C. Nasal cannula. A nasal cannula provides low-flow oxygen and may be ineffective for a patient requiring high-flow therapy.

D. Venturi mask. A Venturi mask delivers precise oxygen concentrations but still requires a snug fit on the face, which may not be comfortable or feasible for a patient with facial trauma.

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A client has a diagnosis of risk for suicide r/t a past attempt. Which of the following outcome should the nurse prioritize?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which nursing action is completed during phase III of post anesthesia care?

Correct Answer is A

Explanation

The nurse provides care to a patient who is recovering from facial trauma who requires high-flow oxygen therapy. Which method of oxygen delivery does the nurse recognize as best for this patient?

Correct Answer is B

Explanation

Which client is at the highest risk for the diagnosis of major depressive disorder?

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