A nurse is caring for an adolescent who has major depressive disorder. Which of the following actions should the nurse take first?
Ask the client if he is considering harming himself.
Encourage the client to attend a group therapy session.
Administer an antidepressant to the client.
Assist the client in completing his ADLs.
The Correct Answer is A
Rationale:
A. Assessing the risk of self-harm or suicide is the top priority when caring for a patient with major depressive disorder. It allows the nurse to intervene immediately if there's a risk of harm.
B. While group therapy can be beneficial for individuals with depression, it's not the first priority when assessing for safety concerns.
C. Administering antidepressants may be part of the treatment plan, but it's essential to assess the immediate risk of self-harm before proceeding with medication administration.
D. Assisting with activities of daily living is important, but it's not the first action to take when assessing for safety in a patient with major depressive disorder.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Rationale:
A. Periodic chest x-rays may be done to monitor lung function in cystic fibrosis, but it's not directly related to home care following discharge.
B. Tonsillectomy and adenoidectomy are not routine procedures for cystic fibrosis management unless there are specific indications beyond the disease itself.
C. Pancreatic enzyme replacement therapy with meals and snacks is essential for children with cystic fibrosis to aid in digestion and nutrient absorption due to pancreatic insufficiency, so this statement is crucial for home care.
D. Isoniazid is an antibiotic used to treat tuberculosis (TB), not cystic fibrosis, so this statement is incorrect and not relevant to cystic fibrosis home care.
Correct Answer is A
Explanation
Rationale:
A. An elevated creatinine level may indicate kidney dysfunction, which is a potential adverse effect of gentamicin therapy. It should be reported to the provider for further evaluation.
B. A creatinine level within the normal range is expected.
C. BUN within the normal range is expected.
D. BUN within the normal range is expected.
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