A nurse is caring for a client who has depressive disorder. The client states, "Everyone would be better off if I were not around." Which of the following responses should the nurse make?
When you get better you will not feel this way.
Why would you think a thing like that?
What would your family do without you?
Are you thinking of hurting yourself?
The Correct Answer is D
Are you thinking of hurting yourself?
When a client expresses thoughts of self-harm or suggests that others would be better off without them, it is essential for the nurse to assess for suicidal ideation and ensure the client's safety. Asking directly about thoughts of self-harm is an appropriate and crucial response in this situation.
When you get better you will not feel this way in (option A) is incorrect. This response minimizes the client's feelings and does not address the seriousness of the situation. It is important to assess the client's immediate safety before discussing long-term improvement.
Why would you think a thing like that? In (option B) is incorrect. This response may come across as judgmental or dismissive of the client's feelings. It is essential to provide a supportive and non- judgmental environment for the client to express their thoughts and concerns.
What would your family do without you? In (option C) is incorrect This response also minimizes the client's feelings and does not address the underlying issue. It is crucial to focus on the client's immediate safety and well-being rather than shifting the focus to the impact on others.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
a. To ensure accurate identification and avoid medication errors, the nurse should use at least two patient identifiers, such as the client's full name and date of birth. This information is critical in verifying that the right patient receives the correct medication.
b.While a telephone number could potentially be used as an identifier, it is not typically used in acute care settings due to the possibility of errors or outdated information. It is also not practical as a primary means of patient identification.
c.Knowing the client's room number is important to confirm the correct location of the client in the acute care setting. This helps ensure that the nurse administers the medications to the correct client. However, the room number alone is not sufficient for accurate client identification. Room numbers may change, and multiple clients may share the same room. Relying on the room number alone can lead to errors.
d.While the client's diagnosis is important for understanding their medical condition and providing appropriate care, it is not specifically required for identifying the client when administering medications.
Correct Answer is A
Explanation
A.Sunlight exposure can actually be beneficial for clients with psoriasis, as ultraviolet (UV) light can help reduce the growth of skin cells and alleviate symptoms. If the client is limiting their sunlight exposure, they might be missing out on a potential therapeutic benefit. However, it is important to balance sun exposure and avoid overexposure to prevent skin damage.
B.Avoiding fabric softener can be a proactive measure to prevent skin irritation, which is beneficial for someone with psoriasis.
C.This could indicate emotional distress or body image concerns, but it doesn’t necessarily need to be reported unless the client shows signs of depression or anxiety affecting their daily life.
D.This is correct practice to ensure the effectiveness of the medication.
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