A nurse is caring for a client who is experiencing a situational crisis.
Which of the following actions should the nurse take first?.

Reinforce teaching on the client's use of coping skills

Encourage the client to use personal support systems.

Assist with a client referral for social services.

Identify if the client has thoughts of self-harm.

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Reinforcing teaching on the client’s use of coping skills is important, but it’s not the first action the nurse should take. The nurse must first ensure the client’s safety.

Choice B rationale:

Encouraging the client to use personal support systems is beneficial, but it’s not the first action. Safety is the priority.

Choice C rationale:

Assisting with a client referral for social services can be helpful, but it’s not the first action. The nurse must first assess for immediate safety risks.

Choice D rationale:

Identifying if the client has thoughts of self-harm is the first action the nurse should take. In a crisis situation, the client’s safety is the priority.

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Correct Answer is C

Explanation

Choice A rationale:

Absence of impulsive behaviors is not a risk factor for becoming a perpetrator of child abuse. Impulsive behaviors can lead to unpredictable and potentially harmful actions, but their absence does not increase the risk of abusive behavior.

Choice B rationale:

Being involved in community activities is generally a positive factor and does not increase the risk of becoming a perpetrator of child abuse. It can provide a support network and positive role models, which can help prevent abusive behaviors.

Choice C rationale:

Low tolerance for frustration is a risk factor for becoming a perpetrator of child abuse. Frustration can lead to anger and potentially harmful actions, especially if the person does not have effective coping mechanisms.

Choice D rationale:

A submissive personality is not a risk factor for becoming a perpetrator of child abuse. While it may affect interpersonal relationships, it does not directly increase the risk of abusive behavior.

A. Administer the medication with meals. B. Monitor the client for hypoglycemia. C. Decrease the client's dietary potassium. D. Increase the client's daily caloric intake.

Correct Answer is A

Explanation

Choice A rationale:

Administering lithium with meals can help reduce gastrointestinal upset, a common side effect of the medication.

Choice B rationale:

Lithium does not typically cause hypoglycemia. It primarily affects the nervous system and kidneys.

Choice C rationale:

There’s no need to decrease dietary potassium. Lithium can affect sodium levels, but not potassium.

Choice D rationale:

Increasing daily caloric intake is not necessary when taking lithium. The medication does not affect metabolism or caloric needs.

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A nurse is caring for a client who is experiencing a situational crisis. Which of the following actions should the nurse take first?.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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A nurse is caring for a client who is experiencing a situational crisis.
Which of the following actions should the nurse take first?.