A nurse is assessing a newly admitted client who states that they do not want to live anymore and plan to end their life.
Which of the following actions should the nurse take?.
Ask the client about the lethality of their plan
Encourage the client to focus on the positive aspects of life.
Reassure the client that everything is going to work out.
Allow the client time alone to self-reflect.
The Correct Answer is A
Choice A rationale:
Asking the client about the lethality of their plan is the most appropriate action. This allows the nurse to assess the immediate risk to the client’s safety.
Choice B rationale:
Encouraging the client to focus on the positive aspects of life may be helpful in some situations, but it does not address the immediate safety concern.
Choice C rationale:
Reassuring the client that everything is going to work out may provide temporary relief, but it does not address the immediate safety concern.
Choice D rationale:
Allowing the client time alone to self-reflect is not appropriate in this situation as it could increase the risk of self-harm.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
No explanation
Correct Answer is B
Explanation
Choice A rationale:
Depersonalization is a symptom of PTSD, but it involves feeling detached from oneself, not reenacting traumatic events.
Choice B rationale:
Posttraumatic play is a common manifestation of PTSD in children. It involves the child reenacting the traumatic event, which can be seen in the child’s mimicking of shooting a gun.
Choice C rationale:
Omen formation is a belief that there were warning signs predicting the trauma. It’s not related to the child’s behavior.
Choice D rationale:
Time skewing involves a shift in the perception of time during the recall of the traumatic event. It’s not demonstrated in this scenario.
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