During a family group meeting, the client's daughter tells the group, "I hope I didn't cause
Mom to be depressed." Which response is best for the nurse to provide?

I hear you say you worry about causing your mother's distress.

Are you afraid that your mother's depression will lead to her death?

What do you think you did that led to your mother's depression?

You are not alone in feeling responsible for others in your family.

Answer and Explanation

The Correct Answer is A

A.   This response acknowledges the daughter's feelings without making assumptions or placing blame, fostering open communication and understanding within the family group.
B.   This response may escalate the daughter's anxiety and is not directly related to her statement about causing her mother's depression.
C.   This response may inadvertently encourage the daughter to blame herself for her mother's depression, which is not helpful in addressing family dynamics.
D.   This response may put the daughter on the spot and could make her feel defensive or misunderstood, hindering effective communication within the family group.

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Correct Answer is C

Explanation

A. While a history of heart disease is important to consider, it is not the most crucial information to obtain prior to administering sertraline.
B. Familial history of mental illness is relevant but may not directly impact the immediate administration of sertraline.
C. Obtaining a thorough medication history is essential to identify potential drug interactions, allergies, or contraindications that could affect the safety and efficacy of sertraline.
D. While current weight may influence the dosing of certain medications, it is not typically a primary consideration prior to administering sertraline.

A. Alert the assigned staff to closely monitor client and intervene as needed to reduce risk of selfmutilation. B. Provide the client time alone in the client's room to reduce external stimulation and promote relaxation. C. Give the client firm, consistent expectations that self-mutilating behaviors are unacceptable and will not be allowed. D. Complete a thorough room search to ensure the client does not have access to objects that can be used for self-harm.

Correct Answer is A

Explanation

A. The client's increased body tension and pacing indicate escalating distress and potential risk for self-harm. Alerting staff to closely monitor the client and intervene as needed is crucial to ensure the client's safety.
B. Providing time alone in the client's room may be appropriate in some situations but may not address the immediate risk of self-mutilation if the client is experiencing escalating distress. C. Giving firm, consistent expectations about self-mutilating behaviors is important for establishing boundaries, but it may not be sufficient to address the immediate risk of self-harm without additional monitoring and intervention.
D. Completing a thorough room search is important for safety but may not address the immediate risk of self-harm if the client is already exhibiting signs of distress and pacing in the hallway.

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During a family group meeting, the client's daughter tells the group, "I hope I didn't cause Mom to be depressed." Which response is best for the nurse to provide?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse has received a new prescription for the client to begin taking sertraline. Prior to administering the initial dose of sertraline, it is most important for the nurse to obtain which information?

Correct Answer is C

Explanation

The nurse notes that a client with a history of self-mutilation has increased body tension and is pacing in the hallway. Which nursing intervention is most important at this time?

Correct Answer is A

Explanation

A male client with a recent diagnosis of bipolar disorder takes lithium carbonate daily. The client informed the school nurse of the desire to live away from home to attend college after graduating in one month. Which information is most important for the nurse to provide the client and his family?

A client requests permission for the spouse to remain in the room during the admission assessment. While interviewing the client, the nurse notes a discrepancy between the client's verbal and nonverbal communication. Which action should the nurse take?

The nurse documents that a client with schizophrenia is delusional. Which statement by the client confirms this assessment?

The nurse is admitting a male client who takes lithium carbonate twice a day. Which information should the nurse report to the healthcare provider immediately?

A nurse who is co-leading group therapy recognizes that a client is beginning to experience severe levels of anxiety. Which intervention is best for the nurse to implement?

The nurse is caring for a client Exhibits In order to help the client disclose a situation that is upsetting to him, what therapeutic communication tools could the nurse use? Select all that apply.

The nurse caring for this client is working with a new nurse. The nurse teaches the novice nurse about the legal and ethical issues surrounding the client's case. Mark whether the statement by the student nurse indicates understanding or no understanding.

During a family group meeting, the client's daughter tells the group, "I hope I didn't cause
Mom to be depressed." Which response is best for the nurse to provide?