A nurse is caring for a client who lost all his possessions in a house fire and states, "I have no idea what I am going to do. I cannot think right now." Which of the following actions should the nurse take?

Identify other housing options and sources of transportation.

Notify the facility chaplain to request scheduling an appointment.

Confirm that everything will be all right because belongings can be replaced.

Maintain eye contact with the client and summarize the client's feelings.

Answer and Explanation

The Correct Answer is D

Answer is d. Maintain eye contact with the client and summarize the client’s feelings.

a. Identify other housing options and sources of transportation: While it is essential to address practical needs such as housing and transportation for clients who have experienced a crisis like a house fire, it is not the immediate priority when the client is in acute emotional distress. In this scenario, the client is expressing emotional distress and may not be ready to focus on practical solutions. Therefore, addressing the client's emotional needs should take precedence over addressing practical concerns.

b. Notify the facility chaplain to request scheduling an appointment: While spiritual support can be beneficial for individuals coping with trauma or loss, it should not be the immediate response when a client is in acute emotional distress. While the chaplain's support may be sought later as part of the client's holistic care, it should not precede addressing the client's immediate emotional needs.

c. Confirm that everything will be all right because belongings can be replaced: This option is incorrect because it offers false reassurance and dismisses the client's feelings about their loss. While it is true that belongings can be replaced, the emotional impact of losing possessions, especially in a traumatic event like a house fire, should not be trivialized. The client's feelings of distress and uncertainty are valid and should be acknowledged and addressed by the nurse.

d. Maintain eye contact with the client and summarize the client’s feelings: Correct. This action demonstrates therapeutic communication, which is crucial in providing an atmosphere of support and safety for the client. Maintaining eye contact shows empathy, support, and advocacy, indicating to the client that their feelings are being heard and validated. Summarizing the client's feelings allows the nurse to demonstrate active listening and understanding, fostering trust and rapport between the nurse and client. By prioritizing the client's emotional needs, the nurse can help the client begin to process their feelings and move towards coping and problem-solving.

In summary, the correct answer is d because maintaining eye contact with the client and summarizing their feelings demonstrates therapeutic communication, which is essential in providing support and validation for the client's emotional distress. This approach allows the nurse to establish rapport and trust with the client, facilitating further therapeutic interventions and support.

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Correct Answer is B

Explanation

The correct answer is choice B: "I am powerless against my addiction to alcohol."

Choice B rationale:

This statement reflects an understanding of one of the fundamental principles of Alcoholics Anonymous (AA), which is the acknowledgment of powerlessness over alcohol. The concept of powerlessness is a cornerstone of the 12-step program and encourages individuals to recognize that attempting to control their addiction often leads to negative consequences. This admission is crucial for clients in recovery, as it opens the door to seeking support and relying on the fellowship and guidance of AA.

Choice A rationale:

While identifying triggers for alcoholism is important, this statement does not directly capture the essence of AA's principle. The focus on identifying causes does not fully encompass the concept of powerlessness over the addiction.

Choice C rationale:

Responsibility for one's alcoholism is not a core principle of AA. Instead, the program encourages individuals to take responsibility for their actions and their commitment to recovery, but not for causing their addiction in the first place.

Choice D rationale:

AA is a peer support program that emphasizes personal responsibility and self-accountability. While counseling might be beneficial, the statement implies external responsibility for recovery, which contradicts the self-help nature of AA.

A. Maturational. B. Adventitious. C. Internal. D. Situational.

Correct Answer is D

Explanation

Answer is d. Situational.

a. Maturational crisis: This type of crisis occurs in response to life transitions or developmental stages, such as marriage, parenthood, retirement, or aging. It involves challenges related to adjusting to new roles, responsibilities, or expectations. However, the client's denial of a new HIV diagnosis and refusal of treatment do not align with the characteristics of a maturational crisis, as it pertains to planned life events rather than unexpected health crises.

b. Adventitious crisis: Adventitious crises are caused by events that are unplanned, unexpected, and often traumatic, such as natural disasters, accidents, or crimes. These crises can affect individuals, families, or communities and may result in significant psychological distress and disruption. However, the client's denial of an HIV diagnosis does not fit the criteria for an adventitious crisis, as it is a personal health issue rather than an external event affecting a broader population.

c. Internal crisis: While internal struggles and conflicts can contribute to a person's overall crisis experience, "internal crisis" is not a recognized category within the context of nursing crises. Internal factors such as psychological distress, unresolved trauma, or maladaptive coping mechanisms may exacerbate crisis situations, but they are typically addressed within the framework of other crisis categories such as situational, maturational, or existential crises.

d. Situational crisis: Correct. A situational crisis arises from an external event or situation that the individual finds overwhelming, threatening, or challenging to cope with. In this scenario, the client's denial of their HIV diagnosis and refusal of treatment represent a situational crisis as it stems from the unexpected news of their health condition. The client's perception of the diagnosis as threatening or inconceivable leads to emotional distress and maladaptive coping mechanisms, which can hinder their ability to accept and manage their medical condition effectively.

In summary, the correct answer is d because the client's denial of their HIV diagnosis and refusal of treatment align with the characteristics of a situational crisis, which arises from an external event that the individual perceives as overwhelming or threatening. Understanding the nature of the crisis can guide the nurse in providing appropriate support, education, and intervention to help the client navigate through this challenging time and make informed decisions regarding their healthcare.

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A nurse is caring for a client who lost all his possessions in a house fire and states, "I have no idea what I am going to do. I cannot think right now." Which of the following actions should the nurse take?

Nursing Test Bank

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A nurse is providing teaching to a client who has alcohol use disorder about Alcoholics Anonymous (AA). Which of the following client statements indicates an understanding of the program's basic concepts?

Correct Answer is B

Explanation

Correct Answer is D

Explanation

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