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.

Answer and Explanation

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.

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Correct Answer is B

Explanation

Rationale:

A. Harassment involves targeted and persistent mistreatment, which is not the same as the behavior described.

B. Incivility includes behaviors such as interrupting or being rude, which undermines professional communication and respect.

C. Abuse is a more severe and harmful behavior that involves systematic mistreatment, not just disruptive actions.

D. Anger may be involved but does not specifically describe the ongoing behavior of interruption.

A. Anabolic steroids B. Hallucinogens C. Stimulants D. Opioids

Correct Answer is B

Explanation

Rationale:

A. Anabolic steroids are associated with mood swings and aggressive behavior but are less likely to cause the acute symptoms of paranoia, hallucinations, and severe agitation described here.

B. Hallucinogens, such as LSD or PCP, can cause intense paranoia, hallucinations, and erratic behavior, as seen in the client’s symptoms. These substances often lead to altered perceptions of reality, including visual and auditory hallucinations.

C. Stimulants like cocaine or methamphetamines can cause paranoia and hyperactivity but are less likely to cause the vivid hallucinations described.

D. Opioids typically cause drowsiness, respiratory depression, and a sense of euphoria rather than hallucinations and severe agitation.

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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?

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Explanation

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