A nurse is obtaining a health history from a client who reports a recent suicide attempt. Which of the following responses should the nurse make?

"You should have asked for help."

"Let's talk about how you were feeling."

"I think you are experiencing guilt."

"Everyone gets discouraged sometimes."

Answer and Explanation

The Correct Answer is B

A.   This response could come across as blaming or judgmental. It implies that the client made a mistake by not seeking help, which can exacerbate feelings of guilt or shame. It does not promote an open dialogue or supportive environment.
B.   This response demonstrates empathy and a willingness to understand the client's emotional state leading up to the suicide attempt. It encourages open communication about the client's feelings and experiences, which is crucial for assessment and intervention planning.
C.   This response suggests that the nurse is making assumptions about the client's emotions without allowing the client to express themselves fully. While guilt may be a common emotion after a suicide attempt, it's important for the nurse to first listen to the client's own description of their feelings.
D.   This response minimizes the seriousness of the client's experience and emotions. It may invalidate the client's feelings of distress or despair that led to the suicide attempt. Such a response does not acknowledge the gravity of the situation or provide the necessary support.

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Correct Answer is C

Explanation

A. This statement describes a visual hallucination (seeing spiders crawling), not a command hallucination. Visual hallucinations involve seeing things that are not actually present.

B. This statement reflects a delusion rather than a hallucination. Delusions are false beliefs that are firmly held despite evidence to the contrary. In this case, the belief in aliens and abduction is not related to hearing voices commanding actions.
C. This statement indicates a command hallucination. The client hears voices instructing them to stop eating. Command hallucinations often involve direct, imperative commands from voices that are perceived as real.
D. This statement reflects paranoia or fear of harm from others, which can be a common symptom in schizophrenia. However, it does not directly indicate a command hallucination.

A. "Tell me what your relationship with your partner was like." B. "I remember how depressed I was after my friend died." C. "You should start participating in your usual activities." D. "Everyone feels depressed during the grieving process."

Correct Answer is A

Explanation

A. This response encourages the client to express their feelings and memories about their relationship with their deceased partner. It allows the client to talk about their emotions, reminisce about positive memories, and potentially share any unresolved issues or feelings of loss. This can be therapeutic as it provides an opportunity for the client to process their grief through storytelling and expression.
B. This response shifts the focus from the client's experience to the nurse's own experience. It can detract from the client's need to talk about their own feelings and may not be perceived as empathetic. While sharing personal experiences can sometimes create rapport, in this context, it may not be the most therapeutic approach as it might minimize the client's unique experience and emotions.
C. This response assumes a directive approach, suggesting what the client "should" do. While encouraging a return to routine activities can be beneficial in some cases, it may not be appropriate immediately after a significant loss. Grieving is a personal process, and the client may not be ready to engage in usual activities right away. It's important to assess the client's readiness and provide support tailored to their current emotional state.
D. This response minimizes the client's feelings by suggesting that their experience is universal. While it's true that many people experience sadness and grief after a loss, each individual's response is unique. This statement may invalidate the client's emotions and fail to acknowledge the depth of their distress. It's important to validate the client's feelings and provide reassurance that their emotions are normal in the context of grief.

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A nurse is obtaining a health history from a client who reports a recent suicide attempt. Which of the following responses should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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