A nurse is planning care for a newly admitted client diagnosed with major depressive disorder following the loss of a child. Which of the following goals should the nurse identify as the priority?

The client assumes an active role in her care planning process.

The client identifies positive qualities about herself.

The client exhibits expected grieving behaviors.

The client makes a contract to avoid self-harm.

Answer and Explanation

The Correct Answer is D

Choice A reason:
While it is beneficial for clients to be involved in their care planning, this is not the immediate priority. Active participation in care planning is a goal that can be pursued once the client's safety and stability are ensured.

Choice B reason:
Identifying positive qualities about oneself is an important step in improving self-esteem and promoting recovery in clients with major depressive disorder. However, this is not the most immediate priority when compared to ensuring the client's safety¹.

Choice C reason:
Exhibiting expected grieving behaviors is a natural and necessary process for healing after the loss of a loved one. However, the priority in the acute phase of care, especially when a client is at risk for self-harm, is to ensure safety.

Choice D reason:
The priority nursing goal for a client with major depressive disorder, especially following a significant loss, is to ensure safety. Making a contract to avoid self-harm is a critical intervention that addresses the risk of suicide, which is heightened in individuals with major depressive disorder and recent significant loss. This contract is a verbal or written agreement between the client and the healthcare provider that the client will not harm themselves and will seek help if they have thoughts of self-harm.

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Correct Answer is A

Explanation

Choice A reason:
Alcohol use disorder (AUD) is associated with various workplace problems. Individuals with AUD may experience a decline in their work performance due to cognitive, emotional, and behavioral impairments caused by alcohol use. This can manifest as frequent tardiness, absenteeism, and a decrease in productivity. Moreover, alcohol use can lead to workplace injuries and conflicts, which further affect an individual's ability to perform their job effectively. Therefore, asking about the impact of alcohol use on work performance can provide insights into the extent of the disorder's effect on the client's psychosocial behaviors.

Choice B reason:
The age at which an individual begins drinking alcohol is a significant factor in the development of AUD. Studies have shown that early onset of drinking increases the risk of developing alcohol dependence later in life. While this information is valuable for understanding the client's history with alcohol, it does not directly address the current impact of alcohol use on their psychosocial behaviors.

Choice C reason:
Previous treatment for substance use disorder can indicate the severity of the client's condition and their history of seeking help. Treatment history can also reveal patterns of relapse or recovery, which are important in the management of AUD. However, this choice does not specifically inquire about the current psychosocial impact of alcohol use.

Choice D reason:
Mental health disorders often co-occur with AUD, and the presence of such disorders can exacerbate the psychosocial impact of alcohol use. While it is crucial to understand the client's overall mental health, this question does not focus on the specific effects of alcohol use on work performance and other psychosocial behaviors.

A. Support the client's attempt to rebuild damaged interpersonal relationships. B. Teach the client about the effects of alcohol dependence and the need for rehabilitation. C. Teach the client alternative strategies for managing anxiety. D. Prepare to administer Ativan as ordered.

Correct Answer is D

Explanation

Choice A reason:
Supporting the client's attempt to rebuild damaged interpersonal relationships is an important long-term goal in the recovery process. However, it is not the immediate priority when a client is experiencing acute withdrawal symptoms, which can be life-threatening.

Choice B reason:
Educating the client about the effects of alcohol dependence and the need for rehabilitation is crucial for long-term recovery and preventing relapse. Nevertheless, during acute withdrawal, the priority is to manage the physical and psychological symptoms safely.

Choice C reason:
Teaching the client alternative strategies for managing anxiety is a valuable part of therapy and helps in long-term coping. However, during acute withdrawal, the client may not be able to learn or apply these strategies effectively due to the severity of their symptoms.

Choice D reason:
Preparing to administer Ativan as ordered is the priority action. Ativan (lorazepam) is a benzodiazepine commonly used to treat alcohol withdrawal symptoms. It helps to prevent seizures, reduce agitation, and manage other withdrawal symptoms. During the acute phase of alcohol withdrawal, maintaining physiological stability and ensuring the client's safety are the primary concerns.

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A nurse is planning care for a newly admitted client diagnosed with major depressive disorder following the loss of a child. Which of the following goals should the nurse identify as the priority?

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has a history of alcohol use disorder. Which of the following questions should the nurse include to determine how the use of alcohol affects the client's psychosocial behaviors?

Correct Answer is A

Explanation

The nurse is caring for a client who has a history of alcohol use disorder and is experiencing withdrawal symptoms. Which of the following should be the priority action by the nurse?

Correct Answer is D

Explanation

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