Which of the following nursing interventions takes priority with a newly admitted client having suicidal ideations
Educate the patient at the time period before new medications before affective
Have the client verbalize their plans for discharge
Encouraging the client to participate in group therapy
Monitor the client closely but at random intervals
The Correct Answer is D
A. Educate the patient about the time period before new medications become effective. Education is important but not the priority in a crisis situation. Immediate safety is the top concern.
B. Have the client verbalize their plans for discharge. This is a future-oriented intervention, but the priority is ensuring the client's safety now.
C. Encouraging the client to participate in group therapy. Group therapy is beneficial but does not take precedence over ensuring immediate safety.
D. Monitor the client closely but at random intervals. Patients with suicidal ideation require close monitoring to prevent self-harm. Observing at random intervals reduces the chance of the patient anticipating when they are not being watched.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. The client will verbalize 3 positive attributes about themselves by day 3. This is a good long-term goal but does not directly prevent self-harm.
B. The client will perform personal hygiene with no prompting. Improved self-care is beneficial but is not the primary priority in suicide prevention.
C. The client will attend group by day 2. Participation in therapy is helpful, but ensuring physical safety takes precedence.
D. The client will remain free from injury for the duration of their hospitalization. The most critical goal for a client at risk for suicide is preventing self-harm, making this the priority outcome.
Correct Answer is C
Explanation
A. Verifying the information with the patient's family members at the bedside: While family members can provide insight, the most critical step is gathering information directly from the patient about the reaction.
B. Placing an alert bracelet on the patient before leaving the unit: While this is necessary, the nurse should first confirm the details of the allergy.
C. Asking the patient to describe the reaction that occurs: The nurse must determine whether the reaction is a true allergy (e.g., anaphylaxis, rash, difficulty breathing) or an intolerance (e.g., nausea, drowsiness). This ensures appropriate precautions are taken.
D. Documenting the information on the patient's medical record: Documentation is crucial but should follow verification of the allergy details.
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