A nurse is contributing to the plan of care for a client who has major depressive disorder.

Which of the following recommendations should the nurse include in the plan of care?

Suggest the client exercise before going to bed.

Recommend the client spend time alone in his room.

Encourage the client to use positive self-talk.

Offer the client low-protein snacks throughout the day.

Answer and Explanation

The Correct Answer is C

Helping the client develop positive self-talk and challenging negative thoughts can be beneficial in managing depressive symptoms. Assisting the client in recognizing negative self-perceptions and replacing them with more positive and realistic thoughts can help improve mood and self-esteem.

Exercise has been shown to have mood-enhancing effects and can help alleviate symptoms of depression. However, exercise should be done earlier in the day rather than right before bedtime, as it can have stimulating effects that may interfere with sleep.

It is important to encourage the client to engage in activities and spend time with others. Isolation and spending excessive time alone can exacerbate depressive symptoms. However, it is also important to respect the client's need for privacy and personal space.

While diet does play a role in overall well-being, there is no specific evidence to support the use of low-protein snacks for the treatment of major depressive disorder. It is important to provide the client with a well-balanced diet that includes a variety of nutrients to support overall health.

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Correct Answer is ["B"]

Explanation

a. Asking other group members to limit their speaking may place unnecessary pressure on the quiet client and make them feel singled out. The goal is to create a supportive environment where the client feels comfortable contributing when they are ready. Limiting the other group members' participation does not address the individual needs of the client who is silent.

b.Some clients may need extra time to process information or formulate their responses, particularly in a group setting where they might feel overwhelmed or anxious. Allowing the client extra time respects their pace and encourages participation without pressuring them.

c.Appointing the client to lead the discussion if they cannot contribute are not appropriate actions. These approaches can increase the client's discomfort and create a negative atmosphere, which goes against the principles of group therapy. It is important to foster an inclusive and supportive environment that encourages participation at each person's pace.

d.Telling a client to leave the group if they cannot contribute is not appropriate action. These approaches can increase the client's discomfort and create a negative atmosphere, which goes against the principles of group therapy.

A. Release the client's restraints every 4 hr. B. Check the client's status every hour. C. Document the client's behavior leading to the initiation of the restraints. D. Obtain written consent by the client for the placement of the restraints.

Correct Answer is C

Explanation

Document the client's behavior leading to the initiation of the restraints: Accurate and comprehensive documentation is essential in the client's medical record. This includes documenting the client's behavior or actions that necessitated the use of restraints. It is important to document the reason, duration, and type of restraint used.

Release the client's restraints every 2 hours or as per institutional policy: It is important to periodically release the restraints to assess the client's circulation, skin integrity, and overall well-being. Restraints should never be kept on continuously without intermittent release. Check the client's status every 15 minutes: The nurse should closely monitor the client's vital signs, level of comfort, and any signs of distress or complications. Frequent assessment ensures early identification and intervention if any issues arise.

Obtain informed consent: While obtaining consent is necessary for many procedures or treatments, including the use of restraints, it is not applicable in situations where there is an imminent risk of harm to the client or others. The use of restraints in mental health units is based on legal and ethical guidelines, prioritizing the client's safety and the safety of others.

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A nurse is contributing to the plan of care for a client who has major depressive disorder. Which of the following recommendations should the nurse include in the plan of care?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assisting with a group therapy session and notes a client who remains silent. Which of the following actions should the nurse take?

Correct Answer is ["B"]

Explanation

Correct Answer is C

Explanation

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A nurse is contributing to the plan of care for a client who has major depressive disorder.

Which of the following recommendations should the nurse include in the plan of care?