Brian is seeking treatment for PTSD following his tour of duty in a combat zone. He reports to the assessment nurse that he has been smoking marijuana and drinking alcohol daily for the past 4 days because he just can't stand feeling depressed all the time. Which of these assessments is the nurse's highest priority?
Suicide risk assessment
Neurological assessment
Amount of current cannabis use
Marital status
The Correct Answer is A
Choice A reason: Given Brian's recent substance use and expression of not being able to tolerate depressive feelings, a suicide risk assessment is the highest priority to ensure his immediate safety.
Choice B reason: While a neurological assessment may be relevant, it is not the highest priority when there is a potential risk of suicide.
Choice C reason: Assessing the amount of current cannabis use is important but secondary to evaluating the risk of suicide.
Choice D reason: Marital status may inform social support but is not the highest priority in the context of potential self-harm.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["B","D","F"]
Explanation
Choice A reason: Increasing dietary fiber can help manage constipation, which is a common side effect of antipsychotic medications. The normal range for dietary fiber intake in adults is 25 to 30 grams per day from food, not supplements.
Choice B reason: Antipsychotic medications can increase photosensitivity, making the skin more susceptible to sunburn. Using sunscreen can help protect the skin when outdoors.
Choice C reason: While laxatives can be used to manage constipation, they should be used sparingly and only as needed to avoid dependence and potential electrolyte imbalances.
Choice D reason: Regular physical activity can help counteract weight gain, another potential side effect of antipsychotic medications. It's recommended to engage in at least 150 minutes of moderate-intensity exercise per week.
Choice E reason: Doubling the dose at the next scheduled time for missed doses is not recommended as it can lead to an overdose and exacerbate side effects.
Choice F reason: Drinking plenty of fluids, including fruit juice, can help prevent dehydration. However, it's important to monitor sugar intake from fruit juices due to the risk of weight gain.
Correct Answer is ["A","B","D"]
Explanation
Choice A reason: This statement reflects a justification of the spouse's behavior, which can enable the continuation of abuse.
Choice B reason: Providing money for drugs, even if to prevent theft, is enabling the substance abuse to continue.
Choice C reason: Encouraging rehab is not enabling; it is an attempt to address the problem.
Choice D reason: Calling in sick for the spouse to cover for their potential job loss due to substance abuse is an enabling behavior.
Choice E reason: This is a protective behavior. Both are healthy responses to dealing with a partner’s destructive behavior.
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