A nurse in an acute care mental health facility is assessing a client who has bipolar disorder. Which of the following findings indicates the client is at risk for suicide?
The client has begun playing basketball with several other clients during the past month.
The client identifies with problems expressed by other clients.
The client's behavior has become impulsive in the past few weeks.
The client states she wants to go home to be with her children and partner.
The Correct Answer is C
A. The client has begun playing basketball with several other clients during the past month.
Engaging in activities and social interactions can actually be a positive sign, as it suggests involvement and connection with others, which can be protective against suicide.
B. The client identifies with problems expressed by other clients.
Identifying with others' problems may indicate empathy, but it is not necessarily indicative of suicide risk on its own.
C. The client's behavior has become impulsive in the past few weeks.
Explanation: Impulsivity can be a significant risk factor for suicide. A sudden increase in impulsive behavior might indicate that the client is not thinking clearly and is acting without considering the potential consequences. Impulsivity can lead to actions that are harmful or dangerous, including suicidal behaviors.
D. The client states she wants to go home to be with her children and partner.
Expressing a desire to be with loved ones is generally not an indicator of suicide risk. In fact, having a strong support system can be protective against suicidal thoughts.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Plan the client's schedule to allow time for rituals.
Explanation:
For individuals with obsessive-compulsive disorder (OCD), engaging in rituals or repetitive behaviors can be a way to manage anxiety. Allowing time for these rituals within the client's schedule, while gently working towards reducing their impact, is a part of a gradual therapeutic approach known as Exposure and Response Prevention (ERP). ERP aims to help the client gradually face their anxiety triggers while refraining from engaging in compulsions.
Why the other choices are incorrect:
B. Confront the client about the senseless nature of the repetitive behaviors.
Confrontation can increase the client's anxiety and resistance to treatment. Instead, the nurse should approach the client with understanding and gradually work on strategies to reduce the compulsive behaviors.
C. Isolate the client for a period of time.
Isolating the client is not a therapeutic approach for managing OCD. It can lead to increased distress and negatively impact their mental health. Inclusion and support are more effective strategies.
D. Set strict limits on the behaviors so that the client can conform to the unit rules and schedules.
Setting strict limits may escalate the client's anxiety and could be counterproductive. It's important to work collaboratively with the client and apply evidence-based approaches like ERP to manage their symptoms effectively.
Correct Answer is C
Explanation
A. The client will implement alternative strategies for managing anxiety.
While addressing anxiety is important for the overall well-being of the client, it may not be the highest priority in this context. The immediate physical safety of the client during alcohol withdrawal takes precedence over addressing anxiety.
B. The client will acknowledge alcohol dependence and need for treatment.
Recognizing alcohol dependence and the need for treatment is an important step, but it may not be the highest priority. It is more focused on the client's acceptance and understanding of their situation rather than addressing immediate health risks.
C. The client's withdrawal from alcohol will be managed without complications.
This is the correct answer. Managing alcohol withdrawal without complications is the highest priority goal in this scenario. Alcohol withdrawal can lead to severe physical symptoms, including seizures and delirium tremens, which can be life-threatening. Ensuring the safe and medically supervised management of withdrawal is crucial for the client's immediate well-being.
D. The client will rebuild damaged interpersonal relationships.
While repairing damaged relationships is important for the client's overall rehabilitation, it's not the highest priority in this context. Physical health and safety take precedence over addressing interpersonal issues.
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