A nurse is discussing mental health with a client. Which of the following statements by the client requires follow-up by the nurse?
"My boss often asks me to work overtime, but I have to refuse the extra hours due to my responsibilities at home."
"The demands of raising two young children by myself are often overwhelming, and I sometimes need some alone time to recharge."
"On the weekends when my kids are with their other parent, I often just lay in bed all day and cry, because I feel hopeless."
"Work can be extremely stressful at times, so I often need to take a walk during my lunch break."
The Correct Answer is C
Rationale:
A. This statement reflects a healthy boundary-setting behavior, where the client recognizes their limits and makes decisions accordingly.
B. This reflects a healthy coping mechanism, where the client acknowledges their stress and takes time to recharge, which is important for mental health.
C. This statement indicates a possible depressive symptom, as feeling hopeless and withdrawing from activities (like staying in bed and crying) can be signs of depression. This requires follow-up to assess the client's mental health and provide appropriate support.
D. Taking a walk during stressful times is a positive coping strategy that helps manage stress and maintain mental health.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Rationale:
A. Removing the PICC line should only be done if directed by a provider after further assessment.
B. The first action is to measure the circumference of both arms to assess for possible complications such as thrombosis or infiltration. This measurement will help determine the extent of the swelling and inform subsequent actions.
C. Notifying the provider is important but should be done after gathering relevant assessment data, such as the arm circumference.
D. Applying a cold pack may be appropriate for reducing swelling but is not the first step. Assessment should come first.
Correct Answer is D
Explanation
Rationale:
A. Spending time searching for new recipes does not necessarily indicate anorexia nervosa and might be associated with interest in food without consumption.
B. Reporting high energy levels is not characteristic of anorexia nervosa, where clients often suffer from fatigue due to inadequate nutrition.
C. Enjoying wearing form-fitting clothes is more indicative of a positive body image, which is not typical of those with anorexia nervosa.
D. The statement "I know I am skinny" reflects an awareness of low body weight, which, in the context of anorexia nervosa, might indicate a distorted body image and an unhealthy focus on being underweight.
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