A nurse on an inpatient mental health unit is assisting with the admission of a client who reports feeling depressed, sad, moody, and overly anxious. Which of the following assessments should the nurse make first?

Suicide risk

Coping abilities

Psychiatric history

Support systems

Answer and Explanation

The Correct Answer is A

When assisting with the admission of a client who reports feeling depressed, sad, moody, and overly anxious, the nurse should prioritize assessing the client's suicide risk. This is because the client's symptoms, particularly feelings of depression and anxiety, can indicate a higher risk for self-harm or suicide. Assessing suicide risk is crucial to ensure the client's safety and provide appropriate interventions if needed.

incorrect:

B. Coping abilities: While assessing coping abilities is important to understand how the client manages stress and emotional challenges, it is secondary to assessing suicide risk. Coping abilities can be explored in subsequent assessments to determine the client's resilience and available resources for support.

C. Psychiatric history: Although understanding the client's psychiatric history is relevant for comprehensive care, it may not be the most immediate concern during the admission process. Assessing suicide risk takes precedence to ensure the client's safety.

D. Support systems: While assessing the client's support systems is valuable for understanding the available network of support, it should not take priority over assessing suicide risk. The client's immediate safety and potential need for intervention require immediate attention.

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Correct Answer is D

Explanation

The response "You are feeling drawn in two different directions" acknowledges the daughter's conflicting feelings and validates her emotions. It demonstrates empathy and understanding of her situation. It can help the daughter feel heard and supported and opens up an opportunity for further conversation about her concerns and possible solutions.

The other options are less appropriate:

A- "Don't worry. We'll take good care of your father while you are gone." While this response reassures the daughter about her father's care, it does not address her emotional conflict or provide support for her own needs and concerns.

B- "Perhaps you could stay here and just call your family to see how they are doing." This response minimizes the daughter's situation and does not fully acknowledge her need to be with her own family. It may overlook the emotional strain and responsibilities she may have outside of the hospital.

C-"There's nothing you can do here. You should go home to your family." This response dismisses the daughter's feelings and implies that her presence is not necessary or valuable. It does not consider her desire to support her father or the importance of maintaining a connection with him during his hospitalization.

A. “I know you will do well living out in the community." B. "I will send you a note in a few weeks." C. "Aren't you excited about being discharged today?" D. "How do you feel about being discharged?"

Correct Answer is D

Explanation

Asking the client how they feel about being discharged encourages open communication and provides an opportunity for the client to express their emotions and thoughts about leaving the

hospital. It shows that the nurse values the client's perspective and allows for further discussion and support if needed. This response promotes client-centered care and acknowledges the client's experience during the hospitalization.

The other options are less appropriate:

A. "I know you will do well living out in the community" assumes the client's feelings and may not accurately reflect their experience or emotions about the discharge.

B. "I will send you a note in a few weeks" focuses on the nurse's future action rather than actively engaging with the client's expression of gratitude.

C. "Aren't you excited about being discharged today?" assumes the client's emotional state and may not consider the potential range of emotions the client could be experiencing.

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A nurse on an inpatient mental health unit is assisting with the admission of a client who reports feeling depressed, sad, moody, and overly anxious. Which of the following assessments should the nurse make first?

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Naxlex Comprehensive Predictor Exams

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Explanation

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Explanation

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