A client states, *I don't know what to do. My life is a mess." What is an appropriate response by the nurse?
Place the client on a 72-hour hold immediately
Remain attentive, but silent
Leave the room immediately
Tell the client that everything will be fine
The Correct Answer is B
An appropriate response by the nurse to a client who states, "I don't know what to do. My life is a mess." would be to remain attentive and engage with the client in a therapeutic way. This type of statement by the client may indicate feelings of hopelessness, despair, or even suicidal ideation, so it's important for the nurse to respond in a supportive and empathetic manner.
Placing the client on a 72-hour hold immediately would not be an appropriate response unless the client presents an imminent danger to themselves or others. Similarly, leaving the room immediately or telling the client that everything will be fine would not address the client's concerns or provide appropriate support.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The priority action of the nurse to ensure client safety during a transfer from the bed to a wheelchair is to lock the wheels of the wheelchair. This will prevent the wheelchair from moving and provide a stable surface for the client to transfer onto.
Encouraging the client to push up from the wheelchair is not a safe option, as it could result in the client losing their balance and falling.
Ensuring the client is bathed before getting into the wheelchair is not directly related to client safety during the transfer.
Placing the bed in the lithotomy position, which involves positioning the client with their feet in stirrups and their legs elevated, is not necessary for a transfer to a wheelchair and could potentially increase the risk of injury.
Correct Answer is B
Explanation
A surgical sponge left in a client's incision is considered a "never event." A never event is a serious, preventable medical error that should never occur in healthcare settings. Leaving a surgical sponge in a client's incision is a serious medical error that can cause harm, including infection, abscesses, and other complications.
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