A nurse is caring for a client who atempted suicide. Which of the following actions should the nurse take?
Serve meals with plastic utensils.
Assign another client to accompany the client to therapy sessions
Assign the client to a private room
Check on the client every 4 hr
The Correct Answer is A
Answer: A
Rationale:
A) Serve meals with plastic utensils: Serving meals with plastic utensils is essential to reduce the risk of self-harm. Metal utensils could be used by the client to inflict injury upon themselves, so providing plastic utensils is a necessary safety measure to prevent potential harm.
B) Assign another client to accompany the client to therapy sessions: Assigning another client to accompany the client to therapy sessions is not appropriate as it places an undue burden on another client and may not ensure the safety of the at-risk client. Professional staff should provide supervision and support.
C) Assign the client to a private room: Assigning the client to a private room might increase the risk of self-harm due to reduced supervision. It is generally better to place the client in a more observable setting where staff can frequently monitor their condition.
D) Check on the client every 4 hr: Checking on the client every 4 hours is insufficient for someone who has recently attempted suicide. More frequent monitoring, such as constant or every 15-minute checks, is necessary to ensure the client's safety and provide immediate intervention if needed.
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Related Questions
Correct Answer is C
Explanation
c. Instruct the client to use abdominal breathing.
When a client is experiencing a panic atack, the nurse's first priority is to help the client manage their symptoms and provide immediate relief. Instructing the client to use abdominal breathing is the most appropriate initial intervention.
Explanation for the other options:
a. Discuss the client's feelings prior to the panic atack. While discussing the client's feelings can be beneficial in addressing the underlying causes of anxiety, it may not be the most effective immediate intervention during a panic atack. The client's focus during a panic atack is typically on managing the physical symptoms and regaining control.
b. Encourage the use of positive self-talk strategies. Positive self-talk can be helpful in managing anxiety in general, but during a panic atack, the individual may have difficulty engaging in positive self-talk due to the intensity of symptoms. Addressing the immediate physical symptoms is a priority before exploring coping strategies.
d. Administer an anti-anxiety medication. Medication administration may be necessary in some cases, but it is not the first-line intervention for managing a panic atack. Non-pharmacological interventions, such as breathing techniques, should be implemented first. If the panic atack persists or worsens despite these interventions, medication may be considered.
In summary, during a panic atack, the immediate focus should be on helping the client manage their symptoms. Instructing the client to use abdominal breathing can help promote relaxation and reduce the intensity of the panic atack.
Correct Answer is A
Explanation
A. You have the right to refuse the recommended treatment plan.
As a nurse, it’s essential to respect the autonomy and decision-making capacity of your patients. Patients have the right to make informed choices about their own healthcare, including whether to accept or decline treatment recommendations. By acknowledging the patient’s right to refuse treatment, you empower them to be active participants in their care.
B.Option b is not the correct answer because it focuses on informing the provider without addressing the client's concerns or providing guidance.
C.Option c is not the correct answer because it emphasizes the medical consequences of not treating the cancer without acknowledging the client's personal beliefs or values.
D. In cases like yours, it is best to talk with your clergyperson before deciding this.
While option D acknowledges the importance of seeking emotional and spiritual support during difficult decisions, it does not directly address the patient’s right to refuse treatment. As a nurse, your primary responsibility is to respect the patient’s autonomy and provide accurate information about their treatment options. Encouraging open communication with a clergyperson or any other trusted individual can be beneficial, but it should not override the patient’s right to make their own decisions regarding their healthcare.
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