A nurse is assessing a newly admitted client who states that they do not want to live anymore and plan to end their life. Which of the following actions should the nurse take?
Reassure the client that everything is going to work out.
Ask the client about the lethality of their plan.
Allow the client time alone to self-reflect
Encourage the client to focus on the positive aspects of life.
The Correct Answer is B
Rationale:
A. Offering reassurance without addressing the client's immediate concerns may minimize the severity of the situation and delay necessary interventions.
B. Asking the client about the lethality of their plan is crucial for assessing the level of risk and determining the urgency of the intervention required. This information is essential for planning appropriate care and ensuring the client's safety.
C. Allowing the client to be alone is not appropriate when they have expressed suicidal intent, as this could increase the risk of self-harm.
D. Encouraging the client to focus on the positive aspects of life may be part of long-term therapy, but in the acute phase, the priority is to assess and address the immediate risk of suicide.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. Schizophrenia is typically diagnosed earlier in males compared to females, with onset often occurring in late adolescence to early adulthood.
B. Biologically female clients are generally diagnosed later in life compared to males.
C. Schizophrenia is rarely diagnosed in individuals under the age of 12; it commonly presents in late adolescence or early adulthood.
D. People with schizophrenia are not necessarily more violent than others; rather, violence is not a defining characteristic of the disorder.
Correct Answer is D
Explanation
Rationale:
A. Action involves actively making changes or implementing strategies to alter behavior. The client's refusal to follow dietary advice indicates they are not actively engaging in behavior change.
B. Preparation entails planning and getting ready to make a change. The client’s statement shows no intention of preparing for a change.
C. Contemplation involves recognizing the need for change and considering it but not yet committed to making it. The client’s dismissive attitude suggests they are not at this stage.
D. Precontemplation is characterized by a lack of awareness or denial of the need for change. The client’s indifference to the dietary recommendations reflects this stage, as they are not yet considering changing their behavior.
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