A nurse caring for a client who has depression observes the client comes to breakfast freshly bathed wearing clean clothes, and styled hair. Which of the following responses by the nurse is therapeutic?

"Why are you all dressed up today?”

“I see you have done some grooming today"

“Everyone feels better after showering”

"You must be getting better. You look great”

Answer and Explanation

The Correct Answer is B

This response acknowledges the client's effort and self-care without making assumptions or imposing judgment. It is an open and non-intrusive statement that shows the nurse is paying attention to the client's appearance and recognizing their positive action of self-grooming. It allows the client to share their feelings or thoughts if they choose to without feeling pressured or judged. This response demonstrates empathy and understanding, creating a supportive and non-threatening environment for the client to express themselves if they wish to do so.

Incorrect:

A- "Why are you all dressed up today?" This question may put the client on the spot and make them feel self-conscious or defensive. It assumes that there must be a specific reason for the client's appearance, which may not be the case. It can also imply that the client's usual appearance is different or not as desirable.

C- "Everyone feels better after showering." While it is true that personal hygiene can have a positive impact on one's mood, this statement may come across as dismissive or oversimplifying the client's experience. It may invalidate any underlying emotions or struggles the client is facing with their depression. It is important to acknowledge and address the client's feelings rather than making broad generalizations.

D- "You must be getting better. You look great." This statement assumes that physical appearance is directly correlated with the client's mental health and suggests that improvement in appearance equates to improvement in mental well-being. However, a person's outward appearance may not accurately reflect their internal struggles or progress in managing depression. Additionally, it can create pressure for the client to maintain a certain appearance to be perceived as "better."

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Correct Answer is A

Explanation

This question directly addresses the impact of alcohol use on the client's work-related behaviors and performance, which is an essential aspect of their psychosocial functioning. It can provide valuable information about potential impairments in work productivity, relationships with colleagues, and overall job stability.

While the other questions are also relevant and important in assessing a client with a history of alcohol use disorder, they focus on different aspects of the client's history and treatment. For example:

B- "Do you receive treatment for any mental health disorders?" helps to assess if there are coexisting mental health issues that may be contributing to or affected by alcohol use.

C- "At what age did you begin drinking alcohol?" helps to understand the timeline of the client's alcohol use and potential early risk factors for developing alcohol use disorder.

D- "Have you received prior treatment for substance use disorder?" provides insights into the client's past attempts at addressing their alcohol use and any prior experiences with treatment.

A. Recognizing the warning signs of suicide B. Identifying individuals who are at higher risk for attempting suicide C. Performing life-saving measures following a suicide attempt D. Providing support for family and friends following a suicide

Correct Answer is C

Explanation

Secondary interventions are aimed at reducing the harm or preventing further complications in individuals who have already engaged in suicidal behavior. In this case, performing life-saving measures after a suicide attempt, such as cardiopulmonary resuscitation (CPR) or administering first aid, falls under the category of secondary intervention.

The other options are examples of primary and tertiary interventions:

A- Recognizing the warning signs of suicide: This is an example of primary intervention, which focuses on preventing suicidal behavior before it occurs by raising awareness, promoting mental health, and identifying risk factors and warning signs.

B- Identifying individuals who are at higher risk for attempting suicide: This is also an example of primary intervention, as it involves assessing and identifying individuals who may be at greater risk for suicidal behavior and implementing preventive measures.

D- Providing support for family and friends following a suicide: This is an example of tertiary intervention, which aims to provide support and care to those who have been affected by a suicide, including family and friends. Tertiary interventions focus on postvention, addressing the aftermath and providing support for survivors.

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A nurse caring for a client who has depression observes the client comes to breakfast freshly bathed wearing clean clothes, and styled hair. Which of the following responses by the nurse is therapeutic?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who has a history of alcohol use disorder. Which of the following questions should the nurse include to deter the use of alcohol affects the client's psychosocial behaviors?

Correct Answer is A

Explanation

A charge nurse is discussing suicide interventions with nursing staff. Which of the following should the nurse identify as an example of secondary intervention?

Correct Answer is C

Explanation

A nurse in a clinic is caring for a client who is 3 weeks postpartum following the birth of a healthy newborn. The client reports feeling "down" and sad, having no energy, and wanting to cry. Which of the following is a priority action by the nurse?

A nurse is admitting a client who has multiple injuries following a motor vehicle crash. Shortly after admission, the client's partner distraught and blames himself for the accident. Which of the following responses should the nurse make?

A school nurse is talking with a 13-year-old female at her annual health-screening visit. Which of the following comments made by the adolescent should be the nurse's priority to address?

A nurse is caring for a client who is experiencing acute manifestations of withdrawal from alcohol. Which of the following medications should th nurse expect to administer to the client?

A nurse notices that a client who has moderate anxiety is pacing the hall and mumbling As the nurse approaches the client, he states, "I am at the end of my rope. I don't think I can take any more bad news." Which of the following responses should the nurse make?

A nurse observes that a client who has depression is sitting alone in the room crying. As the nurse approaches, the client states, "I'm feeling really down and don't want to talk to anyone right now." Which of the following responses should the nurse make?

A nurse is caring for a client who is having difficulty sleeping and is pacing the floor. The client's head down, and he is wringing his hands. Which of the following actions should the nurse take?

A nurse is caring for a client who reports acute, moderate anxiety. Which of the following is the priority nursing action?