A nurse is caring for a client who lost their child 6 months ago. The client states, "Not only do I miss my child, but I also feel so distant from my partner." Which of the following responses should the nurse make?

"Dwelling on these struggles will not help you move past your loss."

"Everyone struggles with loss, but you'll be okay in time."

"Attending a support group may help both you and your partner."

"Spend more time focusing on your relationship with your partner."

Answer and Explanation

The Correct Answer is C

A. "Dwelling on these struggles will not help you move past your loss.": This response dismisses the client’s feelings and may minimize their grief. Acknowledging their emotions is important for therapeutic communication, and telling the client to stop dwelling may feel invalidating.

B. "Everyone struggles with loss, but you'll be okay in time.": While this response is intended to offer comfort, it may sound dismissive and could undermine the client’s grief experience. Each person processes loss differently, and it's important to acknowledge their feelings.

C. "Attending a support group may help both you and your partner.": This response is supportive and practical. It acknowledges that grief affects both individuals in a relationship and suggests a helpful resource. Support groups provide validation and connection with others going through similar experiences.

D. "Spend more time focusing on your relationship with your partner.": This response oversimplifies the situation and does not acknowledge the depth of the client’s grief. It may feel directive and might not address the underlying emotional need.

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Correct Answer is B

Explanation

A. Place the client in mechanical restraints: Restraints should only be used as a last resort and only when the client poses an immediate risk to themselves or others. The first priority should be to try to de-escalate the situation verbally.

B. Ask the client to describe how they are feeling: This is the most appropriate intervention. Asking the client to express their emotions helps acknowledge their feelings and can de-escalate the situation. This approach is non-threatening and allows the nurse to assess the client's state and intervene appropriately.

C. Stand directly in front of the client when speaking to them: Standing directly in front of the client can be perceived as confrontational, especially when the client is angry. It is better to stand at an angle to the client, maintaining a non-threatening stance.

D. Use therapeutic touch when addressing the client: Therapeutic touch may escalate the situation, especially if the client is already angry. It is important to maintain a safe distance and avoid physical contact until the client’s emotional state is more stable.

A. Provide information to the client about local support groups. B. Ask the client how they have dealt with stress in the past. C. Determine if the client is experiencing thoughts of self-harm D. Schedule a follow up visit with the client's primary provider.

Correct Answer is C

Explanation

A. Provide information to the client about local support groups: While this is helpful, it is not the first priority. The client's immediate safety and emotional well-being must be addressed first, especially to rule out any thoughts of self-harm or suicidal ideation.

B. Ask the client how they have dealt with stress in the past: While understanding past coping strategies is important, the first priority should be assessing for immediate risks, such as thoughts of self-harm, before discussing past coping mechanisms.

C. Determine if the client is experiencing thoughts of self-harm: This is the first priority. After an assault, clients are at increased risk for self-harm or suicide. The nurse must assess for these thoughts immediately to ensure the client's safety.

D. Schedule a follow-up visit with the client's primary provider: Scheduling follow-up care is important, but it is not the first step. Immediate assessment for safety, including thoughts of self-harm, should take precedence.

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A nurse is caring for a client who lost their child 6 months ago. The client states, "Not only do I miss my child, but I also feel so distant from my partner." Which of the following responses should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is C

Explanation

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