A client, who is wearing dirty clothes and has a foul body odor, comes to the clinic reporting feeling scared because of a stalker. Which action is most important for the nurse to take?
Recommend that the client talk with a social worker today.
Offer the client a safe place to relax before the Interview.
Assure client of an interview with the healthcare provider today.
Ask the client to describe the stalker and If It is frequent.
The Correct Answer is B
A. Referral to a social worker may be beneficial for long-term support and resources. However, it does not address the client’s immediate sense of fear and need for safety.
B. Offering a safe place to relax is the priority because the client is expressing fear and possible threat from a stalker. Ensuring immediate safety and reducing anxiety aligns with the priority principle of protecting the client from harm.
C. Arranging an interview with the healthcare provider is important for further evaluation and planning. However, it does not address the client’s immediate emotional distress and perceived danger.
D. Asking for details about the stalker may be part of assessment, but it should occur after the client feels safe. Gathering information is secondary to ensuring the client’s immediate safety and emotional stabilization.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale: Headaches can be associated with various factors and are not specific to depression.
Choice B rationale: Back pain can have multiple causes and is not specific to depression. Choice C rationale: Dizziness may have various causes and is not specific to depression. Choice D rationale: Excessive tiredness (fatigue) is a common symptom of depression and often associated with the overall low energy levels experienced by individuals with depressive disorders.
Correct Answer is A
Explanation
Choice A rationale: Waiting for the client to respond allows for a patient-centered approach, respecting the client's pace and giving them the opportunity to express themselves when ready.
Choice B rationale: Assuming the client's ability to hear the question may be accurate, but the client's nonverbal cues suggest a need for patience and a non-coercive approach.
Choice C rationale: Changing the question may not address the client's current feelings and might disrupt the therapeutic process.
Choice D rationale: Returning at a later time might be appropriate if the client continues to be unresponsive, but it is not the initial action in this situation.
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