A nurse is assessing a newly admitted client who states that they do not want to live anymore and plan to end their life.
Which of the following actions should the nurse take?.
Ask the client about the lethality of their plan
Encourage the client to focus on the positive aspects of life.
Reassure the client that everything is going to work out.
Allow the client time alone to self-reflect.
The Correct Answer is A
Choice A rationale:
Asking the client about the lethality of their plan is the most appropriate action. This allows the nurse to assess the immediate risk to the client’s safety.
Choice B rationale:
Encouraging the client to focus on the positive aspects of life may be helpful in some situations, but it does not address the immediate safety concern.
Choice C rationale:
Reassuring the client that everything is going to work out may provide temporary relief, but it does not address the immediate safety concern.
Choice D rationale:
Allowing the client time alone to self-reflect is not appropriate in this situation as it could increase the risk of self-harm.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale:
A necklace is not a risk as it does not pose a threat to the client’s safety.
Choice B rationale:
Lace-up tennis shoes are allowed as they do not pose a risk to the client’s safety.
Choice C rationale:
Nylon socks are allowed as they do not pose a risk to the client’s safety.
Choice D rationale:
Cotton underwear is allowed as it does not pose a risk to the client’s safety.
Choice E rationale:
A glass-framed picture should be taken back home as it can be broken and potentially used to harm oneself.
Correct Answer is D
Explanation
Choice A rationale:
Separation anxiety disorder is characterized by excessive fear or anxiety about separation from those to whom the individual is attached.
Choice B rationale:
Agoraphobia involves marked fear or anxiety about two or more of the following: using public transportation, being in open spaces, being in enclosed places, standing in line or being in a crowd, or being outside of the home alone.
Choice C rationale:
Panic disorder is characterized by recurrent unexpected panic attacks, which are abrupt surges of intense fear or discomfort that reach a peak within minutes.
Choice D rationale:
Generalized anxiety disorder is characterized by excessive anxiety and worry about a number of events or activities. The individual finds it difficult to control the worry.
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