During the initial interview with a client in crisis, the initial priority is to:

Determine the precrisis level of functioning.

Assess for substance use.

Evaluate the potential for self-harm.

Assess the adequacy of the support system.

Answer and Explanation

The Correct Answer is C

Choice A reason: Understanding the client’s baseline functioning is important for long-term planning but is not the immediate priority in a crisis. Safety and stabilization must come first.

Choice B reason: Substance use assessment is relevant, especially if it contributes to the crisis, but it is secondary to evaluating immediate risk to life or safety.

Choice C reason: Evaluating the potential for self-harm is the top priority during a crisis interview. Ensuring the client’s safety is the foundation for all other interventions. Risk of suicide or self-injury must be addressed before proceeding with other assessments.

Choice D reason: Support systems are important for recovery and coping, but they are not the first concern in a crisis. If the client is at risk of self-harm, immediate protective measures must be taken before evaluating social resources.

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Correct Answer is D

Explanation

Choice A reason: Memory assessment involves evaluating the client’s ability to recall past and recent events. It does not address the logic or coherence of ideas.

Choice B reason: Thought content refers to what the client is thinking—such as delusions, obsessions, or suicidal ideation. It does not assess the structure or flow of those thoughts.

Choice C reason: Sensorium includes orientation to time, place, and person, as well as attention and concentration. It does not evaluate the logic or organization of ideas.

Choice D reason: Thought process refers to how the client organizes and connects ideas. It includes assessing whether thoughts are logical, goal-directed, coherent, or disorganized. Evaluating whether ideas make sense falls directly under this domain.

A. Treating all people fairly and equally. B. A person's right to self-determination and independence. C. The requirement to do no harm to others either intentionally or unintentionally. D. The duty to be honest or truthful.

Correct Answer is C

Explanation

Choice A reason: Treating people fairly and equally refers to the principle of justice. It emphasizes equitable distribution of resources and impartiality in care, not the avoidance of harm.

Choice B reason: The right to self-determination and independence is the principle of autonomy. It supports informed consent and respect for the client’s choices, but it is distinct from nonmaleficence.

Choice C reason: Nonmaleficence is a foundational ethical principle in healthcare that obligates providers to avoid causing harm. This includes both acts of commission and omission. Nurses must consider the risks of interventions and strive to minimize potential harm in all aspects of care.

Choice D reason: Honesty and truthfulness fall under the principle of veracity. While important, veracity is separate from the obligation to prevent harm.

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During the initial interview with a client in crisis, the initial priority is to:

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Naxlex Comprehensive Predictor Exams

When the nurse is assessing whether or not the client’s ideas are logical and make sense, the nurse is examining which of the following?

Correct Answer is D

Explanation

The term nonmaleficence means:

Correct Answer is C

Explanation

The nurse is conducting an admission assessment on a new client. What are the cultural factors the nurse should consider during assessment? Select all that apply.

A client has a prescription for haloperidol 5 mg orally two times a day, as ordered by the physician. The client is suspicious and refuses to take the medication. The nurse says, "If you don't take this pill, I'll get an order to give you an injection." The nurse's statement is an example of:

The client tells the nurse, "I never do anything right. I make a mess of everything. Ask anyone, they’ll tell you the same thing." The nurse recognizes these statements as examples of:

During a therapy session, the client states that he is 14 trillion years old and created the world. The nurse documents this statement as an example of which type of thinking displayed by the client?

A nurse documents that a patient has a blunted affect. The student nurse knows that blunted affect means:

Which of the following give cues to the nurse that a client may be grieving for a loss?

A child who has witnessed the murder of his classmate while at school would experience which kind of loss?

A woman has just had a therapeutic abortion to end an unintended pregnancy. Afterward, the woman cries because, although she wanted to have children in future years, this pregnancy was not well-timed. Which type of grief is this woman most likely to experience?