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?
"What would your family do without you?”
"When you get better you will not feel this way.”
"Why would you think a thing like that?”
"Are you thinking of hurting yourself?”
The Correct Answer is D
Choice A rationale:
Asking, "What would your family do without you?" can be seen as judgmental and may not encourage open communication. It doesn't directly address the client's statement about feeling like a burden or wanting to be gone.
Choice B rationale:
Saying, "When you get better you will not feel this way," minimizes the client's feelings and can be invalidating. It does not show empathy or concern for the client's current emotional state.
Choice C rationale:
Asking, "Why would you think a thing like that?" can come across as judgmental and may make the client defensive. It does not directly address the client's emotional distress or suicidal ideation.
Choice D rationale:
This is the correct answer. "Are you thinking of hurting yourself?" is a direct and appropriate question to assess the client's risk of self-harm or suicide. It demonstrates concern for the client's well-being and opens the door for a more in-depth conversation about their feelings and thoughts. Assessing for suicidal ideation is a crucial step in providing appropriate care for a client with depressive disorder.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B"]
Explanation
The correct answer is choice b. Reduced fat in the stools.
Choice A rationale:
Decreased sodium excretion is not a therapeutic effect of pancrelipase. Pancrelipase is an enzyme replacement therapy that helps in the digestion of fats, proteins, and carbohydrates, but it does not affect sodium excretion.
Choice B rationale:
Reduced fat in the stools is the correct answer. Pancrelipase helps in the digestion of fats, which reduces the amount of fat excreted in the stools. This is particularly important for patients with cystic fibrosis, who often have pancreatic insufficiency leading to malabsorption of fats.
Choice C rationale:
Improved respiratory function is not a direct therapeutic effect of pancrelipase. While better nutrition and absorption can indirectly support overall health, including respiratory function, pancrelipase specifically targets digestive enzyme insufficiency.
Choice D rationale:
Improved absorption of vitamins B and C is not the primary therapeutic effect of pancrelipase. Pancrelipase aids in the absorption of fat-soluble vitamins (A, D, E, and K) rather than water-soluble vitamins like B and C.
Correct Answer is B
Explanation
Choice A rationale:
Limiting the use of familiar objects is not recommended for clients with Alzheimer's disease. Familiar objects can provide comfort and security to these clients and help them maintain a sense of familiarity in their environment.
Choice B rationale:
Making a schedule of daily tasks is a helpful intervention for clients with Alzheimer's disease. Routine and structure can reduce frustration and anxiety in clients with cognitive impairment by providing predictability and a sense of purpose.
Choice C rationale:
Having several family members visit daily may be overwhelming for the client with Alzheimer's disease, leading to increased confusion and agitation. It is essential to balance social interaction with the client's comfort level and needs.
Choice D rationale:
Asking questions that require more than one answer can be confusing for clients with Alzheimer's disease. s should be simple and straightforward to enhance understanding and communication.
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