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 A
Explanation
Choice A rationale:
Adherence to medication, especially after the resolution of acute psychosis, is crucial when taking an antipsychotic like clozapine. This is because discontinuation can lead to a relapse of symptoms.
Choice B rationale:
There’s no specific need to limit fluid intake when taking an antipsychotic.
Choice C rationale:
While routine blood cell count laboratory work is important, it’s not specific to red blood cells but rather to monitor for agranulocytosis, a potential side effect of clozapine.
Choice D rationale:
Avoiding foods that contain tyramine is typically associated with monoamine oxidase inhibitors, not antipsychotics like clozapine.
Correct Answer is {"A":{"answers":"B"},"B":{"answers":"C"},"C":{"answers":"C"},"D":{"answers":"A"}}
Explanation
Ventricular fibrillation: The correct electricity is Defibrillation. Ventricular fibrillation is a life-threatening condition that requires immediate medical attention. Defibrillation is the process of delivering an electric shock to the heart to stop the fibrillation and allow the heart’s normal rhythm to resume4.
PVC-run ventricular tachycardia with a pulse: The correct electricity is Synchronized Cardioversion. This is used when the patient is hemodynamically stable. It involves the delivery of a therapeutic dose of electrical current to the heart at a specific moment in the cardiac cycle5.
Atrial Flutter: The correct electricity is Synchronized Cardioversion. Atrial flutter is a type of abnormal heart rhythm, or arrhythmia. It can be treated with synchronized cardioversion, in which a controlled electric shock is delivered to the heart to restore normal rhythm5.
Bradycardia: The correct electricity is Transcutaneous Pacing. This is a temporary means of pacing a patient’s heart during a medical emergency. It should be undertaken by healthcare providers who are trained in the procedure5.
So, the correct answer is Defibrillation for Ventricular fibrillation, Synchronized Cardioversion for PVC-run ventricular tachycardia with a pulse and Atrial Flutter, and Transcutaneous Pacing for Bradycardia, after analyzing all choices.
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