A nurse is conducting an admission interview with a new client who tells the nurse, "My life is so stressful.
I can't take it anymore.”. Which of the following responses should the nurse make first?

"Tell me what makes you feel stressed.”.

"How have you dealt with stress in the past?".

"Let's talk more about what you are experiencing.”.

"Are you thinking of harming yourself?". .

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Asking the client to describe what makes them feel stressed is important for understanding their situation, but it is not the immediate priority when there is concern about self-harm.

Choice B rationale:

Inquiring about the client's past coping mechanisms is relevant, but it should not be the first question when there is a potential risk of self-harm.

Choice C rationale:

Discussing what the client is experiencing is important, but it is not the primary concern when there is a risk of self-harm.

Choice D rationale:

Asking the client if they are thinking of harming themselves is the immediate priority in this situation. It helps assess the client's safety and the need for further intervention. Please let me know if you have more questions or need further explanations. .

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Correct Answer is B

Explanation

Choice B rationale:

Confidentiality is a fundamental principle in debriefing sessions, and reassuring staff members that the debriefing is confidential helps create a safe environment where they can openly discuss their experiences. This choice sets the foundation for open communication and trust among the participants.

Choice A rationale:

Asking staff members to describe their most traumatic memories of the event as the first intervention may not be the best approach. This could be overwhelming and trigger emotional distress in participants. It's essential to start the debriefing with a more general and supportive approach.

Choice C rationale:

Having staff members discuss their involvement in the event is important, but it's better suited for a later stage of the debriefing process. The initial focus should be on creating a safe and confidential environment for participants to express their feelings.

Choice D rationale:

Providing stress-management exercises to the staff members is a valuable intervention but should be introduced after the initial stage of creating a safe and supportive atmosphere. It's essential to address the emotional needs and concerns of the participants before moving on to stress-management techniques. .

A. Role model healthy ways to express anger. B. Assist the client to explore techniques to reduce stress. C. Suggest the client make a list of things that make him angry. D. Ask the client if he intends to harm others.

Correct Answer is D

Explanation

Choice A rationale:

While role modeling healthy ways to express anger is important, it is not the priority when a client is being aggressive toward others. Safety is the primary concern.

Choice B rationale:

Assisting the client to explore techniques to reduce stress is a helpful intervention but is not the priority when the client is actively being aggressive toward others.

Choice C rationale:

Suggesting the client make a list of things that make him angry is a therapeutic intervention, but it is not the priority when the client's behavior poses an immediate threat to others.

Choice D rationale:

Asking the client if he intends to harm others is the priority because it assesses the immediate risk to the safety of others. This information is crucial for determining the appropriate interventions to ensure the safety of everyone in the facility. Depending on the client's response, the nurse can take further steps to manage the aggressive behavior. Safety is the top priority in such situations. .

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A nurse is conducting an admission interview with a new client who tells the nurse, "My life is so stressful.I can't take it anymore.”. Which of the following responses should the nurse make first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is leading a critical incident stress debriefing with a group of staff members following a mass trauma incident.Which of the following interventions should the nurse take first?

Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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A nurse is conducting an admission interview with a new client who tells the nurse, "My life is so stressful.
I can't take it anymore.”. Which of the following responses should the nurse make first?