A nurse is providing discharge instructions to a client who was hospitalized for a suicide attempt. Which information is included in the instructions?
Get adequate sleep and eat healthy.
When stressed, write down the emotions and reflect on them.
Occasional use of alcohol during the holidays is acceptable.
Join a local gym and visit the trainer twice per week.
The Correct Answer is B
The primary goal of discharge instructions for a patient following a suicide attempt is to provide active coping strategies and a concrete safety plan. General health habits are important, but the most critical intervention is teaching the patient how to manage the acute emotional distress that preceded the crisis. Encouraging the patient to externalize and reflect on their emotions through writing helps interrupt the cycle of impulsive action and provides a buffer between the feeling of despair and the act of self-harm.
Rationale:
A. Getting adequate sleep and eating healthy are general wellness goals (health promotion), but they are not specific crisis intervention strategies. For a patient who has just survived a suicide attempt, these instructions are too vague and do not address the immediate psychological safety needs required to prevent a relapse.
B. This instruction is a form of Cognitive Behavioral Therapy (CBT) technique. By writing down emotions, the patient practices emotional regulation and self-reflection. This allows the patient to identify triggers and utilize their safety plan before their distress reaches an unmanageable level. It shifts the patient from a state of reacting to an emotion to observing it.
C. Alcohol is a central nervous system depressant and a potent disinhibitor. Its use significantly increases the risk of impulsive behavior and can deepen depressive symptoms. For a patient with a history of suicide attempts, total abstinence is typically recommended, especially during high-stress periods like holidays.
D. Exercise is beneficial for long-term mental health, but joining a gym is a lifestyle recommendation rather than a clinical safety instruction. It does not provide the patient with the immediate psychological tools needed to navigate a mental health crisis or the sudden return of suicidal ideation.
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Correct Answer is D
Explanation
Flat affect is a pathological lack of emotional expression characterized by a near-total absence of facial movement and vocal inflection. It is frequently observed in schizophrenia and represents a severe deficit in the limbic system's external manifestation of internal emotional states.
Rationale:
A. Broad affect is considered the normative range of emotional expression. It describes a client who can display a full spectrum of emotions, such as joy or sadness, appropriately according to the social context or the topic being discussed.
B. Absent affect is not a standard clinical descriptor used in psychiatric documentation. It implies a total lack of response, but the medically standardized term for the complete absence of any facial or vocal emotional expression is flat affect.
C. Restricted affect, also known as blunted affect, involves a reduction in the intensity or range of emotional expression. However, it is less severe than a flat affect, as the client might still show minimal or muted emotional responses.
D. Flat affect is the specific term for a complete void of emotional expression. The nurse observes no facial movement or animation despite the stimulating nature of the park outing and peer interaction, making this the correct descriptor.
Correct Answer is B
Explanation
The Kübler-Ross model describes the psychological transitions experienced by individuals facing terminal illness. These stages include denial, anger, bargaining, depression, and acceptance. In clinical practice, the nurse must assess for prolonged maladaptive responses where the patient fails to progress toward an integrated understanding of their terminal prognosis and physiological decline.
Rationale:
A. Expressing hope for a peaceful and dignified death is a hallmark of the acceptance stage. This indicates the client has processed the terminal nature of their illness and is focusing on palliative goals. It shows a healthy transition toward end-of-life planning and does not require further acute psychological intervention.
B. Stating one is well while making long-term future plans indicates persistent denial. Although denial serves as an initial defense mechanism, maintaining it when death is imminent prevents necessary end-of-life preparations. The nurse must intervene to help the client eventually move toward reality and appropriate decision-making.
C. Reviewing one's life and discussing death are components of reminiscence therapy and life review. These actions suggest the client is actively engaging in meaning-making and emotional processing. This behavior is considered a therapeutic and adaptive way to resolve internal conflicts before the end of life occurs.
D. Wanting to live life to the fullest suggests the client has reached a level of emotional integration. This perspective acknowledges the limited timeframe while choosing to focus on quality of life. It is a positive coping mechanism that reflects a realistic appraisal of the situation without ignoring the terminal diagnosis.
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