A nurse is caring for a client who is experiencing suicidal thoughts.
Which of the following actions should the nurse take?.
Place the client on 12-hour observation.
Remove harmful objects from the client's room.
Encourage visitors for the client at any time.
Encourage visitors to bring items to the client.
The Correct Answer is B
Choice A rationale:
Placing the client on 12-hour observation may not be sufficient as suicidal thoughts can persist beyond this timeframe.
Choice B rationale:
Removing harmful objects from the client’s room is a crucial step in ensuring the safety of a client experiencing suicidal thoughts. This action helps to minimize the risk of self-harm.
Choice C rationale:
While social support can be beneficial, it’s important to regulate visitors as they could unintentionally bring harmful objects or substances.
Choice D rationale:
Encouraging visitors to bring items could pose a risk as they might unknowingly bring in objects that could be used for self-harm.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
This statement is confrontational and may make the client defensive.
Choice B rationale:
This statement provides the client with a choice, promoting autonomy and encouraging self-care.
Choice C rationale:
This statement is forceful and does not respect the client’s autonomy.
Choice D rationale:
Ignoring the client’s lack of self-care does not address the issue and could potentially harm the client.
Correct Answer is D
Explanation
Choice A rationale:
Stopping medication can be a sign of non-compliance or dissatisfaction with treatment, but it is not a direct warning sign of suicide.
Choice B rationale:
Requesting an appointment to discuss depression is a positive step towards seeking help and managing mental health.
Choice C rationale:
Sleeping 12 hours a day could indicate depression or other mental health issues, but it is not a specific warning sign of suicide.
Choice D rationale:
Giving away possessions can be a warning sign of suicide as it might indicate that the person is putting their affairs in order, which is a serious suicide warning sign.
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