A nurse is caring for several clients who are attending community-based mental health programs. Which Of the following clients should the nurse plan to visit first?
Select one:
A client who recently burned her arm by accident while using a hot iron at home.
A client who tells the nurse he experienced manifestations of severe anxiety before and during a job interview.
A client who requests that her antipsychotic medication be changed due to some new adverse effects.
A client that says he is hearing a voice that tells him he is not worthy of living anymore.
The Correct Answer is D
This client is experiencing auditory hallucinations and may be at risk for self-harm or suicide. The nurse should prioritize visiting this client first to assess their safety and provide appropriate interventions.
Option a. A client who recently burned her arm by accident while using a hot iron at home may require wound care and education on safety, but this situation is not as urgent as the client experiencing auditory hallucinations.
Option b. A client who tells the nurse he experienced manifestations of severe anxiety before and during a job interview may benefit from interventions to manage anxiety, but this situation is not as urgent as the client experiencing auditory hallucinations.
Option c. A client who requests that her antipsychotic medication be changed due to some new adverse effects may require medication adjustment and monitoring for side effects, but this situation is not as urgent as the client experiencing auditory hallucinations.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
This response acknowledges the client's distress and opens the opportunity for the client to express their feelings and concerns. It also demonstrates empathy and a willingness to listen, which can help deescalate the situation and build trust between the nurse and client.
Option a ("Others are being distracted; Please, quiet down and go to your room") is dismissive of the client's feelings and may further escalate the situation.
Option c ("Please go to your room to get control of yourself") is directive and may be perceived as confrontational, potentially increasing the client's agitation.
Option d ("What's going on? Be quiet") is insensitive and dismissive of the client's distress and may further agitate the client.
Correct Answer is ["A","B","C","F","H"]
Explanation
a. Substance abuse disorder
b. Schizophrenia
c. Age greater than 55 years old
f. Male gender
h. Previous suicide attempt.
Option a. Substance abuse disorder can increase the risk of suicide because it can exacerbate underlying mental health conditions and impair judgment.
Option b. Schizophrenia is a mental health condition that can increase the risk of suicide due to symptoms such as delusions and hallucinations.
Option c. Age greater than 55 years old is a risk factor for suicide because older adults may experience social isolation, chronic health conditions, and loss of independence.
Option f. Male gender is a risk factor for suicide because men are more likely to die by suicide than women. Option h. Previous suicide attempt is a strong predictor of future suicide attempts and completed suicides. Option d. Female gender is not a known risk factor for suicide.
Option e. Being currently married is not a known risk factor for suicide. Option g. Having a bachelor’s degree is not a known risk factor for suicide.
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