A patient being seen in the clinic for superficial cuts on both wrists is pacing and sobbing. After a few minutes, the patient is calmer. The nurse attempts to determine the patient’s perception of the precipitating event by saying which of the following?
"What was happening just before you started to feel this way?"
"How can I help you feel more comfortable?"
"Tell me why you were crying."
"How did your wrists get injured?"
The Correct Answer is A
Choice A reason: This open-ended question is the gold standard for identifying the precipitating event in a crisis or psychiatric assessment. By asking about the sequence of events immediately preceding the emotional distress, the nurse helps the patient connect their internal emotional state to external stressors, facilitating cognitive processing and assessment.
Choice B reason: While this response demonstrates empathy and a desire to provide comfort, it does not address the nurse's specific goal of determining the patient's perception of the precipitating event. This is a supportive intervention rather than an assessment tool for identifying the root cause of the current crisis.
Choice C reason: Asking "why" can often be perceived as accusatory or demanding by a patient in distress, potentially causing them to become defensive or shut down. It requires a level of abstract insight that a patient who was just sobbing and pacing may not be able to articulate immediately.
Choice D reason: This question focuses on the physical mechanism of the injury rather than the psychological precipitant. While the nurse must document the nature of the superficial cuts, the immediate goal of psychological assessment is to understand the emotional trigger that led to the self-harming behavior and distress.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Mood is the patient's internal, subjective emotional state, which the patient describes as "sad" and "hopeless" (depressed). Affect is the objective, observable expression of emotion. A facial expression "without emotion" is the clinical definition of a flat affect, where there is no visible emotional reactivity.
Choice B reason: Labile affect refers to rapid, often exaggerated changes in mood, and euphoric mood refers to intense happiness or elation. Neither of these clinical descriptors matches the patient's presentation of persistent sadness and a complete lack of emotional expression on the face.
Choice C reason: This choice incorrectly swaps the terms. "Depressed" describes the patient's internal emotional climate (mood), whereas "flat" describes the observable external display (affect). Documentation must accurately distinguish between the patient's self-report and the nurse's objective observation of the patient's physical appearance and facial gestures.
Choice D reason: Incongruent affect occurs when the objective expression does not match the subjective mood (e.g., laughing while saying they feel sad). In this case, the lack of expression (flat) is actually consistent with the low energy and hopelessness of a depressed mood, even if it is an extreme lack of expression.
Correct Answer is C
Explanation
Choice A reason: While the 15 to 19 age range is a period of increased risk for suicide attempts, being in this age group is a demographic fact rather than an individual clinical characteristic that "alerts" a nurse to an imminent or specific possibility of suicide without other accompanying symptoms.
Choice B reason: Threatening to cause harm to peers is an indicator of potential violence toward others (homicidal ideation or conduct disorder) rather than self-directed violence. While all threats of harm must be taken seriously, this specifically points toward an externalized aggression rather than an internalized suicidal intent.
Choice C reason: Research consistently shows that LGBTQ+ youth face significantly higher rates of suicidal ideation and attempts due to societal stigma, bullying, and lack of support. When combined with a history of depression, this creates a high-risk clinical profile that requires proactive screening and targeted suicide prevention interventions.
Choice D reason: A history of torturing or abusing animals is a hallmark of conduct disorder and is often associated with the development of antisocial personality disorder. While it indicates significant psychological pathology and a risk for future interpersonal violence, it is not a classic or specific predictor of suicidal behavior.
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