While visiting the community mental health center, a client with a diagnosis of major depressive disorder asks the nurse if what is shared with the staff will be shared with family members. How should the nurse respond to this client?

Provide the client with a written hospital policy regarding privacy of information laws.

Tell the client that confidentiality will be maintained, except when one’s safety is threatened.

Nod in the affirmative, but make no verbal commitment to the client.

Assure the client that information provided will be shared with the staff only.

Answer and Explanation

The Correct Answer is B

A.   Providing the client with written information about privacy laws is a good practice, but a verbal explanation is also necessary to address the immediate concern.
B.   This response provides accurate information about confidentiality while acknowledging exceptions when safety is at risk.
C. Non-verbal gestures may be ambiguous and could lead to misunderstandings. It's important to communicate clearly with the client.
D.   Assuring the client that information will be shared only with the staff may not be entirely accurate, as there are situations where confidentiality must be breached, such as when safety is a concern.

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Correct Answer is C

Explanation

A. While allowing freedom in choosing seats may be acceptable, in this scenario, encouraging a more cohesive and interactive group setting is beneficial.
B. Suggesting that they all sit together to increase interaction is a reasonable approach to enhance group dynamics.
C. Asking the adolescent sitting on the couch to join the group at the table promotes inclusivity and equal participation.
D. Determining which adolescents would like to participate may not be necessary; encouraging all to participate fosters a collaborative atmosphere.

A. Advise the mother to call the police if violent behavior occurs again. B. Refer the mother for psychiatric evaluation for anxiety and depression. C. Reinforce the need for the adolescent to attend group therapy sessions. D. Tell the mother to describe her feelings of helplessness to her son.

Correct Answer is A

Explanation

A. Advising the mother to call the police if violent behavior occurs again addresses the safety of the client and others and is a necessary step to ensure appropriate intervention.
B. Referring the mother for psychiatric evaluation is important but may not directly address the immediate safety concern related to the recent violent behavior.
C. Reinforcing the need for the adolescent to attend group therapy sessions is relevant, but the immediate focus should be on addressing the safety issue.
D. Telling the mother to describe her feelings may be helpful for therapeutic communication but may not be the most urgent intervention in response to the reported violent behavior.

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While visiting the community mental health center, a client with a diagnosis of major depressive disorder asks the nurse if what is shared with the staff will be shared with family members. How should the nurse respond to this client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is teaching a group of adolescents about assertive communication. Two of the adolescents are seated at a round table and another is sitting on a small sofa nearby. To facilitate group interaction, which intervention is best for the nurse to implement?

Correct Answer is C

Explanation

Correct Answer is A

Explanation

The nurse observes a client with a history of psychosis repeatedly looking to the side and mumbling responses to no one present in that direction. Which comment is best for the nurse to make?

A male client with schizophrenia continues to talk to others on the mental health unit using tangential speech. What intervention should the nurse implement?

Naloxone is administered to an adult client following a suicide attempt with an overdose of hydrocodone bitartrate. Within 15 minutes, the client is alert and oriented. In planning nursing care, which intervention has the highest priority at this time?

A client is admitted to an inpatient psychiatric unit, and the antipsychotic medication clozapine is prescribed. Which intervention should the nurse include in this client’s plan of care?

The nurse completes an assessment of a client experiencing intimate partner violence (IPV). Which finding of the injuries should the nurse include in the documentation?

Which individual should the nurse consider at the highest risk for suicide?

The nurse assesses a client who recently began experiencing violent nightmares. Which factor in the client’s history should the nurse further explore?