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?"

"Is there anyone you would like involved in your care?"

"Has anyone in your family committed suicide?"

"Are you thinking about ending your life?" .

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Asking about past coping mechanisms can provide valuable information, but in this situation, where the client is expressing thoughts of hopelessness, it's crucial to assess the immediate risk of suicide. Therefore, this choice is not the best option in this context.

Choice B rationale:

Involving significant others in the client's care is important, but it doesn't address the client's current emotional state and suicidal ideation. This choice does not take priority in this scenario.

Choice C rationale:

While exploring family history, including suicide, is relevant, it's not the first question to ask. Assessing the client's current thoughts and feelings should be the priority before delving into family history. Therefore, this choice is not the best option at this moment.

Choice D rationale:

(Correct Choice) This is the most appropriate question to ask first. Assessing the client's suicidal ideation is crucial for ensuring their safety. If the client expresses suicidal thoughts, the nurse can take immediate steps to keep the client safe, such as involving a mental health professional or initiating a suicide risk assessment.

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Correct Answer is B

Explanation

Choice A rationale:

Acknowledging the difficulty of caring for a terminally ill person is empathetic, but it doesn't offer a solution to the son's problem. The nurse should provide practical assistance or information to help alleviate the son's stress and fatigue.

Choice B rationale:

(Correct Choice) Offering information about respite care is appropriate in this situation. Respite care provides temporary relief to caregivers, allowing them to take a break from their caregiving responsibilities. Providing information about available resources can empower the son to make decisions that support his well-being and the well-being of his mother.

Choice C rationale:

Suggesting a sleeping pill before bed might not be appropriate without a healthcare provider's assessment. Additionally, relying on medication alone might not address the underlying stress and fatigue the son is experiencing.

Choice D rationale:

Praising the son for his caregiving efforts is supportive, but it doesn't offer a solution to his lack of sleep. While encouragement and recognition are important, addressing the son's immediate need for rest and support should be the priority.

A. Tachycardia. B. Hypotension. C. Narrowed pulse pressure. D. Increasingly severe headache.

Correct Answer is D

Explanation

The correct answer is choice d. Increasingly severe headache.

Choice A rationale:

Tachycardia is not typically associated with increased intracranial pressure (ICP). In fact, bradycardia (a slower heart rate) is more commonly seen as part of Cushing’s triad, which indicates increased ICP.

Choice B rationale:

Hypotension is not a common sign of increased ICP. Instead, hypertension (high blood pressure) is often observed as the body attempts to maintain cerebral perfusion pressure.

Choice C rationale:

Narrowed pulse pressure is not a typical indicator of increased ICP. Widened pulse pressure (the difference between systolic and diastolic blood pressure) is more commonly associated with increased ICP.

Choice D rationale:

Increasingly severe headache is a classic symptom of increased ICP. As pressure within the skull rises, it can cause significant pain and discomfort, making this a key indicator to monitor in patients with traumatic brain injury.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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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?