The Advanced Practice Registered Nurse (APRN) sees a patient in the primary care office for a routine physical exam. The patient reports suicidal thoughts. What is the APRN's most appropriate next step?
Notify the patient's family of the findings.
Refer the patient to a psychologist.
Prescribe the patient a selective serotonin reuptake inhibitor (SSRI).
Ask the patient if they have a specific plan as to when, where, or how they would do it.
The Correct Answer is D
Assessment of suicidal ideation in a primary care setting requires immediate, structured evaluation of the patient’s level of risk. Suicidal thoughts range from passive ideation to active intent with a specific plan and means. The priority is to determine the severity, immediacy, and specificity of the risk before initiating referrals or treatment. This ensures patient safety and guides the urgency of intervention.
Rationale:
A. Notifying the patient’s family without the patient’s consent is not the appropriate first step unless there is imminent danger and the patient is at high risk of harm. Confidentiality must be maintained while conducting a proper risk assessment. Premature disclosure may also damage trust and hinder therapeutic communication.
B. Referring the patient to a psychologist is an important part of long-term management but is not the immediate priority when suicidal ideation is newly identified. The APRN must first assess the severity of risk to determine whether urgent emergency intervention is required. Referral decisions depend on the outcome of a thorough suicide risk evaluation.
C. Prescribing a selective serotonin reuptake inhibitor such as an antidepressant is not the immediate intervention in the context of active suicidal ideation without prior risk assessment. Antidepressants take weeks to become effective and may initially increase energy before mood improves, which can increase risk in some patients. Immediate safety assessment must occur first.
D. The most appropriate next step is to directly assess suicide risk by asking about a specific plan, including when, where, and how the patient would act on the thoughts. This determines the level of risk (low, moderate, or high) and guides urgent management decisions such as safety planning or emergency hospitalization. It is a critical step in ensuring immediate patient safety.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Knee joint swelling assessment helps determine the presence and severity of intra-articular fluid accumulation. The “balloon sign” (bulge sign) is a clinical maneuver used to detect effusion in the suprapatellar pouch by shifting synovial fluid within the joint space. The amount of fluid displaced and palpated helps distinguish between minor and significant joint effusions. A clearly palpable fluid wave or ballooning suggests a larger volume of intra-articular fluid.
Rationale:
A. Bursitis is inflammation of a bursa, typically presenting as localized swelling, warmth, and tenderness over a specific area such as the prepatellar or infrapatellar region. It does not involve free fluid within the joint space and therefore does not produce a positive balloon sign. The maneuver described assesses intra-articular effusion rather than bursal inflammation.
B. Minor effusion may cause subtle swelling and may produce a weak or barely detectable bulge sign, but not a clearly palpable fluid wave or ballooning effect. In minor fluid accumulation, the amount of synovial fluid is insufficient to create a strong displacement response. Therefore, a definitive balloon sign indicates more than a minimal effusion.
C. Rheumatoid arthritis is a chronic inflammatory joint disease that can lead to joint effusions, but it is not defined by the presence of a balloon sign. While RA may cause synovitis and swelling, the test result reflects the quantity of fluid rather than the underlying etiology. The balloon sign alone does not specifically indicate rheumatoid arthritis.
D. Major knee effusion is correctly indicated by a positive balloon (bulge) sign with palpable fluid displacement. This finding suggests a significant accumulation of synovial fluid within the joint capsule, enough to be shifted and felt during examination. It is commonly associated with trauma, inflammatory arthritis, or infection, but the sign specifically reflects large-volume intra-articular fluid.Top of FormBottom of Form
Correct Answer is C
Explanation
Level of consciousness (LOC) is a key component of the neurologic assessment and reflects a patient’s awareness of self and environment, as well as their ability to respond to external stimuli. Changes in LOC can indicate underlying neurological, metabolic, or systemic conditions. Clinicians use standardized descriptors such as alert, lethargic, obtunded, and stuporous to document the degree of arousal and responsiveness. Accurate classification helps guide urgency of intervention and further diagnostic evaluation.
Rationale:
A. Alert describes a patient who is fully awake, responsive, and able to interact appropriately without the need for external stimulation. This patient requires no verbal or physical prompting to maintain wakefulness or respond to questions. In this scenario, the need for loud verbal stimulation and rapid return to sleep does not meet the criteria for alertness.
B. Obtunded refers to a more significant decrease in consciousness where the patient has difficulty maintaining alertness and responds slowly or inconsistently to stimuli. These patients typically require repeated or more vigorous stimulation and may show delayed or confused responses. The patient in this case is still able to answer appropriately and responds promptly, which is less severe than obtundation.
C. Lethargic is the most appropriate classification because the patient opens their eyes when spoken to loudly, responds appropriately, and then quickly falls back asleep. This indicates a mildly reduced level of consciousness with easy arousability but inability to maintain sustained wakefulness. It reflects decreased alertness but intact cognitive responsiveness when stimulated.
D. Stuporous describes a severely depressed level of consciousness where the patient only responds to vigorous or painful stimuli and does not interact meaningfully. Responses, if present, are minimal and inconsistent. Since this patient responds appropriately to verbal stimulation and can answer questions coherently, stupor is not consistent with the findings.
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