A nurse is caring for a client whose child died from cancer. The client states, "It's hard to go on without him." Which of the following questions should the nurse ask the client first?
"What has helped you through difficult times in the past?"
"Has anyone in your family committed suicide?"
"Are you thinking about ending your life?"
"Is there anyone you would like involved in your care?"
The Correct Answer is C
A. "What has helped you through difficult times in the past?": Important but not the priority in a potential crisis.
B. "Has anyone in your family committed suicide?": Relevant but not the first question.
C. "Are you thinking about ending your life?": Directly assesses the client's safety and risk for suicide.
D. "Is there anyone you would like involved in your care?": Supports coping but is not urgent.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","D","E"]
Explanation
Easier to breathe and less short of breath: The client reports improvement in breathing, stating it is easier to breathe and they are less short of breath. This suggests that the respiratory status is improving, which is a key indicator of progress.
Lung sounds still diminished with crackles, but no wheezes detected: While lung sounds are still diminished and crackles remain, the absence of wheezes indicates that the client’s condition is stabilizing. Wheezing would be concerning for bronchospasm or worsening respiratory distress, so the absence of this finding is a positive development.
Oxygen saturation 92%: The client’s oxygen saturation has improved from 88% on room air (Day 1) to 92% on 1 L/min of oxygen. Although still slightly below the target of 94%–98%, this improvement is a sign that oxygenation is improving with the current treatment.
Pleuritic chest pain reduced to 3/10: The client's report of pleuritic chest pain has decreased from 6/10 to 3/10. This reduction in pain indicates a positive response to treatment and the improvement of the underlying infection.
Increased oral intake (drinking 2 L/day): The client is drinking 2 L of fluids per day, which indicates adequate hydration and may help with recovery, particularly in the context of respiratory and infection management.
Normal urine output (200 mL of clear yellow urine): The client’s urine output appears adequate, and the urine is clear and yellow, which suggests proper hydration and normal renal function, supporting overall recovery.
Correct Answer is C
Explanation
A. Storing oxygen tanks under the bed is not safe due to limited ventilation and fire hazards.
B. The oxygen gauge should be checked daily, not weekly, to monitor levels.
C. The oxygen tank should be placed away from curtains or drapes to reduce the risk of fire.
D. The oxygen tank wrench should be readily accessible in case of emergencies.
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