A nurse is caring for a client who has a history of depression and is experiencing a situational crisis. Which of the following actions should the nurse take first?
Confirm the client’s perception of the event.
Teach the client relaxation techniques.
Help the client identify personal strengths.
Notify the client’s support person.
The Correct Answer is A
Choice A reason: Confirming the client’s perception of the crisis is the first step, establishing trust and understanding their emotional state, critical for effective intervention. This guides tailored support, essential for addressing depression in a situational crisis, ensuring therapeutic communication, and promoting coping in mental health care settings.
Choice B reason: Teaching relaxation techniques is useful but secondary to understanding the client’s crisis perception, which informs interventions. Assuming techniques are first risks misaligned support, potentially escalating distress, critical to avoid in ensuring effective crisis management for clients with depression experiencing situational stressors.
Choice C reason: Identifying strengths supports coping but follows confirming the client’s crisis perception, which sets the therapeutic foundation. Prioritizing strengths risks overlooking the client’s immediate emotional needs, potentially delaying effective intervention, critical to prevent in managing depression during a situational crisis in mental health care.
Choice D reason: Notifying a support person is secondary to understanding the client’s crisis perception, which guides initial intervention. Assuming notification is first risks bypassing the client’s perspective, potentially reducing trust, critical to avoid in ensuring client-centered care for depression in situational crisis management.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: Alone time for reflection may increase rumination in alcohol use disorder, not fostering self-control; positive feedback reinforces coping. Assuming alone time helps risks isolation, potentially worsening stress, critical to avoid in supporting adaptive behaviors and recovery in clients with alcohol use disorders.
Choice B reason: Gradual alcohol reduction is not ideal for alcohol use disorder, where abstinence is often recommended; positive feedback supports coping. Assuming reduction is effective risks enabling continued use, delaying recovery, critical to prevent in fostering self-control and sobriety in clients with alcohol dependence.
Choice C reason: Having the partner monitor alcohol intake undermines client autonomy, not promoting self-control; positive feedback reinforces independence. Assuming partner responsibility risks dependency, potentially hindering personal accountability, critical to avoid in supporting self-managed recovery in clients with alcohol use disorder.
Choice D reason: Giving positive feedback for adaptive coping strategies reinforces healthy stress management, promoting self-control in alcohol use disorder. This builds confidence, critical for sustained sobriety, encouraging alternative coping mechanisms, and supporting long-term recovery, essential for effective behavioral change in clients managing stress without alcohol.
Correct Answer is A
Explanation
Choice A reason: Using an eight electric razor reduces bleeding risk in clients on warfarin, an anticoagulant that increases bleeding tendency, critical for safety. This instruction prevents cuts, essential for minimizing hemorrhage, supporting adherence, and ensuring safe daily activities in clients managing anticoagulation therapy.
Choice B reason: Milk products do not interact with warfarin; consistent vitamin K intake is key. Assuming milk avoidance is needed risks unnecessary dietary restriction, potentially affecting nutrition, critical to avoid in ensuring accurate dietary education for clients on warfarin therapy.
Choice C reason: Back pain is not a common warfarin side effect; bleeding is the primary concern. Assuming back pain is related risks misinforming the client, potentially causing unnecessary worry, critical to prevent in ensuring accurate education and safety for clients on anticoagulation therapy.
Choice D reason: Sunlight exposure does not significantly affect warfarin; photosensitivity is unrelated. Assuming sunlight avoidance is needed risks unnecessary lifestyle restrictions, critical to avoid in ensuring accurate teaching, focusing on bleeding precautions, and supporting safe warfarin use in clients requiring anticoagulation.
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