A nurse is speaking with a client who is experiencing a situational crisis following the sudden death of his partner. Which of the following questions should the nurse ask the client first?
"Who do you talk to when you feel overwhelmed?"
"Are you thinking about harming yourself?"
"Can we talk about how your partner's death has affected you?"
"What do you usually do to calm your thoughts?"
The Correct Answer is B
Choice A rationale:
Asking who the client talks to when overwhelmed is important, but assessing for suicidal thoughts is more urgent.
Choice B rationale:
Assessing the client's risk for harm to themselves is the priority when dealing with a person in crisis. This helps determine the need for immediate intervention to ensure their safety.
Choice C rationale:
Discussing the impact of the partner's death can be therapeutic, but ensuring immediate safety is the priority.
Choice D rationale:
Inquiring about coping strategies is important, but assessing for suicidal thoughts takes precedence.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
A high-protein diet might not be recommended for a client with chronic pancreatitis, as certain high-protein foods can exacerbate symptoms.
Choice B Rationale:
Encouraging the client to eat high-fiber foods can help manage symptoms of chronic pancreatitis, as well as promote regular bowel movements and prevent constipation.
Choice C rationale:
Administering laxatives daily is not typically part of the management plan for chronic pancreatitis and can lead to dependency.
Choice D rationale:
Providing six small meals per day might be helpful, but the specific dietary content is important for managing chronic pancreatitis.
Correct Answer is A
Explanation
Choice A rationale:
Keeping the television on at a low volume in the background can provide sensory stimulation and a familiar environment for the client with Alzheimer's disease. It can also help decrease feelings of isolation and confusion.
Choice B rationale:
Abstract paintings may be confusing or agitating for a person with Alzheimer's disease. Familiar and recognizable decorations are more suitable.
Choice C rationale:
Reorienting the client daily to the day and time can be helpful, but it is not the priority teaching in this context.
Choice D rationale:
Using dim lighting is not recommended as it can contribute to confusion and disorientation in a person with Alzheimer's disease. Adequate lighting is important for safety and orientation.
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