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 C

Explanation

Involuntary commitment refers to the legal process by which an individual is admitted to a psychiatric facility for treatment against their will. The decision to involuntarily commit someone is typically based on the assessment that their behavior poses a risk of harm to themselves or others. Therefore, it is important for the nurse to inform the client's family that the reason for the involuntary commitment is the client's behavior being a threat to their own safety or the safety of others.

A."A psychiatrist determines that the client's behavior is irrational." This statement is incorrect because irrational behavior alone is not sufficient grounds for involuntary commitment.

Involuntary commitment is typically based on the assessment that the individual's behavior poses a risk of harm to themselves or others, rather than solely on the basis of irrational behavior.

B. "The client is unable to manage the affairs necessary for daily life." While the inability to manage daily affairs may be a factor considered in the overall assessment of a client's condition, it is not the sole criterion for involuntary commitment. Involuntary commitment is primarily focused on the risk of harm posed by the individual's behavior, rather than their ability to manage daily life tasks.

D. "The client has been accused of breaking the law." Accusations of breaking the law are not the basis for involuntary commitment. Involuntary commitment is based on the assessment that the individual's behavior presents a risk of harm to themselves or others. Legal issues are addressed separately through the legal system and are not directly related to the criteria for involuntary commitment.

A. Suppression B. Intellectualization C. Dissociation D. Projection

Correct Answer is D

Explanation

Projection is a defense mechanism where an individual attributes their own thoughts, feelings, or impulses onto someone else. In this case, the client is attributing the cause of their drug use to their parents not allowing them to get a tattoo. By projecting their desire for a tattoo onto their parents' decision, the client is displacing their own feelings onto an external factor.

Incorrect:

A. Suppression: Suppression involves consciously pushing away or blocking unwanted thoughts, feelings, or impulses. The client's statement does not indicate an attempt to suppress any thoughts or emotions related to their drug use; instead, they are openly discussing the reason for their substance use.

B. Intellectualization: Intellectualization involves using excessive reasoning or logic to avoid acknowledging or experiencing associated emotions. The client's statement does not reflect intellectualization, as they are not overly relying on intellectual processes or attempting to detach themselves from the emotional aspects of their behavior.

C. Dissociation: Dissociation involves a temporary disconnection from thoughts, feelings, or memories to avoid emotional distress. The client's statement does not demonstrate dissociation, as they are connecting their drug use to a specific event and cause.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who has been admitted Involuntarily for psychiatric treatment. Which of the following Information about involuntary commitment should the nurse provide the client's family?

Correct Answer is C

Explanation

Correct Answer is D

Explanation

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