A depressed patient says, "nothing matters anymore." What is the most appropriate response by the nurse?

Try to stay hopeful. Things have a way of working out."

"Are you having thoughts of suicide?"

"Tell me more about what interested you before you became depressed."

"I am not sure I understand what you are trying to say."

Answer and Explanation

The Correct Answer is B

A. Offering platitudes can minimize the patient’s feelings and may shut down further disclosure.
B. Directly asking about suicidal thoughts is the most important and therapeutic response because the statement expresses hopelessness, a major risk factor for suicide. This question assesses immediate safety and guides next steps (ask about intent, plan, means; implement suicide precautions and notify the provider as indicated).
C. Exploring past interests can be therapeutic later, but it does not address the immediate safety concern suggested by the patient’s hopeless statement.
D. Saying you don’t understand is vague and avoids addressing the potential crisis; a direct, nonjudgmental assessment of suicidal ideation is required.

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Correct Answer is A

Explanation

A. Clozapine can cause agranulocytosis, a life-threatening drop in white blood cells, leaving the client highly vulnerable to infection. Flu-like symptoms (fever, sore throat, malaise) may be early warning signs and require immediate provider notification and WBC count monitoring.

B. Olanzapine commonly causes orthostatic hypotension. Dizziness when standing is expected early in treatment and can often be managed with slow position changes, not an emergency.

C. Thioridazine, like many antipsychotics, can cause sedation. Daytime drowsiness is a common side effect and not urgent.

D. Chlorpromazine may cause GI upset such as nausea and vomiting. While bothersome, it is not immediately life-threatening unless severe or persistent.

A. chronic deterioration. B. medication nonadherence. C. the need for psychoeducation. D. relapse.

Correct Answer is D

Explanation

A. Chronic deterioration refers to a gradual, long-term decline in functioning, not the sudden emergence of new or worsening psychotic symptoms.

B. While relapse can sometimes be related to nonadherence, there is no direct evidence here that the patient has stopped taking medication, so this cannot be assumed.

C. Psychoeducation may be helpful, but the immediate concern is the reemergence of psychotic symptoms, not just a lack of understanding about the illness.

D. The patient is displaying insomnia, tension, difficulty concentrating, and paranoid delusions, which are early warning signs of a psychotic relapse in schizophrenia. Prompt intervention is necessary to prevent full exacerbation.

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A depressed patient says, "nothing matters anymore." What is the most appropriate response by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for several clients who have mental health disorders at an assisted-living facility. Which of the following clients should the nurse determine needs to be seen by a provider immediately?

Correct Answer is A

Explanation

Correct Answer is D

Explanation

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