A nurse is caring for a client following a recent suicide attempt. Which of the following actions should the nurse take?
Initiate one to one constant supervision around the clock.
Ensure the client's hands are always visible.
Tuck bedcovers over client's hands and arms.
Inspect the client's personal belongings.
Check the environment for possible hazards.
Assign the client to a private room.
Place only plastic utensils on the client's meal tray.
Correct Answer : A,E
a. Initiate one to one constant supervision around the clock: A client who has attempted suicide is at high risk for further harm, and close monitoring is necessary to prevent further attempts. Initiation of one-to- one constant supervision around the clock ensures that the client is continuously monitored, and any signs of suicidal ideation or behavior can be immediately addressed.
e. Check the environment for possible hazards: It is important to check the client's environment for potential hazards, such as sharp objects, cords, or other items that could be used to harm oneself. This step helps to ensure the client's safety and prevent further attempts.
The other options are not appropriate or necessary in this situation:
b. Ensure the client's hands are always visible: This action may be necessary if the client has a history of self-harm or aggressive behavior, but it is not specifically related to preventing suicide attempts.
c. Tuck bedcovers over client's hands and arms: This action may be necessary if the client has a history of self-harm, but it is not specifically related to preventing suicide attempts.
d. Inspect the client's personal belongings: While it may be important to inspect the client's personal belongings for any items that could be used for self-harm, this action is not as urgent as initiating constant supervision and checking the environment for hazards.
f. Assign the client to a private room: While a private room may be beneficial for the client's comfort and privacy, it is not specifically related to preventing suicide attempts.
g. Place only plastic utensils on the client's meal tray: This action is not specifically related to preventing suicide attempts, unless there is concern that the client may harm themselves with utensils.
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Naxlex Comprehensive Predictor Exams
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Correct Answer is A
Explanation
The therapist's statement shows a lack of remorse or guilt for committing Medicare fraud. The statement suggests that the therapist does not see anything wrong with overbilling Medicare and taking advantage of the government. This lack of remorse or guilt is a common trait seen in individuals who engage in fraudulent behaviour.
Correct Answer is C
Explanation
When a client is admitted with an involuntary status, it means that the client did not consent to the admission and was likely admitted due to being a danger to themselves or others. This can lead to increased stress and anxiety for the client, so the nurse should closely monitor the client for signs of severe anxiety and stress.
Options a, b, and d are not appropriate interventions for a client admitted with an involuntary status.
Option a is more appropriate for a client with a history of opioid use.
Option b is more appropriate for a client with a history of violence or aggression towards family members.
Option d is more appropriate for a client with a history of methamphetamine use.
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