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A nurse is caring for a client who states during a counseling session, "I am sliding off a cliff." Which of the following statements should the nurse make?

"I don't think that is really what is happening to you."

"Don't worry. Everything will be okay."

"How are things going at your job?"

"You must be feeling very frightened right now."

Answer and Explanation

The Correct Answer is D

A. This statement dismisses the client's feelings.

B. Offering false reassurance is not therapeutic.

C. Changing the subject does not address the client's distress.

D. This is the correct answer. Acknowledging the client's feelings is a therapeutic response that encourages further discussion.

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Correct Answer is C

Explanation

A. Weight gain is a sign of hypothyroidism, not thyrotoxicosis.

B. Bradycardia is associated with hypothyroidism, whereas thyrotoxicosis causes tachycardia.

C. This is the correct answer. Fever is a symptom of thyrotoxicosis, which results from excessive thyroid hormone levels, leading to hypermetabolism. Other signs include tachycardia, anxiety, heat intolerance, and weight loss.

D. Drowsiness is more commonly associated with hypothyroidism.

A. "Would you tell me more about the changes you see in your body?" B. "How long have you had these feelings of uselessness? C. "Did anything in particular make you feel this way? D. "Do you ever think about harming yourself?"

Correct Answer is D

Explanation

A. Asking about body changes is important for understanding the client’s self-perception, but it does not address immediate safety concerns.

B. Inquiring about the duration of feelings of uselessness is helpful for assessing depressive symptoms, but it is not the priority over assessing for suicidal intent.

C. Exploring triggers for these feelings is useful for emotional support and planning interventions but is secondary to assessing for immediate risk of self-harm.

D. This question assesses for suicidal ideation, which is the nurse’s priority because older adults experiencing feelings of uselessness or hopelessness are at higher risk for depression and suicide. Early identification of suicidal thoughts ensures prompt intervention and support.

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A nurse is caring for a client who states during a counseling session, "I am sliding off a cliff." Which of the following statements should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a client who has a new prescription for levothyroxine (T4) about thyrotoxicosis. The nurse should instruct the client to monitor and report which of the following findings?

Correct Answer is C

Explanation

A nurse in a provider's office is talking with an older adult client who tells the nurse that he fears he is "aging badly" and feels "so useless." Which of the following assessment questions is the nurse's priority?

Correct Answer is D

Explanation

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