A client is hospitalized following a suicide attempt after breaking up with her significant other.
The client says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll get it right?" Which is the best response by the nurse?

"You are safe here. We will make sure nothing happens to you."

"You're just lucky your roommate came home to help you when she did."

"What exactly do you plan to do?"

"I don't understand. You have so much to live for."

Answer and Explanation

The Correct Answer is C

A.   While providing reassurance is important, this response does not directly address the client's statement about future attempts.
B.   This response may minimize the seriousness of the client's statement and is not the best way to address the situation.
C.   This response directly addresses the client's statement, seeking clarification on her plans. It is important to assess the level of risk and ensure the client's safety.
D.   While expressing empathy and highlighting the client's positive qualities can be helpful, it may not directly address the immediate concern of the client's statement about future attempts.

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Correct Answer is C

Explanation

A) Incorrect. Isolating the client in his room may escalate the situation or make the client feel isolated and misunderstood.

B) Incorrect. Asking the client to stop talking may be perceived as confrontational and could potentially agitate the client further.

C) Correct. Speaking slowly and in a quiet voice can help the client focus and may reduce the flight of ideas. This calm approach can be grounding for the client.

D) Incorrect. Encouraging the client to talk more may exacerbate the flight of ideas and the manic state.

A. Institute reverse isolation B. Withhold the next dose of medication C. Begin high protein, high cholesterol diet D. Notify health care provider stat

Correct Answer is D

Explanation

A) Incorrect. Reverse isolation is not indicated in this situation. The client's symptoms are likely due to a side effect of the medication, not an infectious process.

B) Incorrect. While it may be necessary to withhold the next dose of medication, the client's symptoms require more immediate attention.

C) Incorrect. The client's symptoms are indicative of a serious adverse reaction, and dietary changes would not address the issue.

D) Correct. The client's symptoms, including severe muscle stiffness, difficulty swallowing, drooling, diaphoresis, and elevated vital signs, are indicative of neuroleptic malignant syndrome (NMS), a potentially life-threatening side effect of antipsychotic medications like risperidone.
The nurse should notify the healthcare provider immediately for further guidance and intervention.

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A client is hospitalized following a suicide attempt after breaking up with her significant other. The client says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll get it right?" Which is the best response by the nurse?

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Naxlex Comprehensive Predictor Exams

A client diagnosed with bipolar I disorder is in a manic state, rushing about the unit, and talking regularly with a flight of ideas. What is the most therapeutic intervention?

Correct Answer is C

Explanation

Correct Answer is D

Explanation

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A client is hospitalized following a suicide attempt after breaking up with her significant other.
The client says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll get it right?" Which is the best response by the nurse?