Susan, the nurse is caring for a client who states "I plan to commit suicide." Which of the following assessments should the nurse identify as the priority?
Lethality of the method and availability of means
Client's educational and economic background
Client's insight into the reasons for the decision.
Quality of the client's social support
The Correct Answer is A
A. Lethality of the method and availability of means. Assessing the method and means helps determine the immediacy and seriousness of the threat. Knowing the lethality of the method and whether the means are readily available informs the level of intervention needed to keep the client safe.
B. Client's educational and economic background: While socioeconomic factors can influence mental health, they are not immediate priorities in a suicidal crisis.
C. Client's insight into the reasons for the decision: Insight is important for understanding motivations but is secondary to immediate safety concerns.
D. Quality of the client's social support: Social support is crucial but is secondary to assessing imminent risk of harm.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A"]
Explanation
A. Areas of ecchymosis on the torso. Ecchymosis on the torso, especially in non-ambulatory children, can be concerning for abuse. Unexplained bruises in unusual locations or patterns are red flags for physical abuse.
B. Mismatched clothing: Typically not an indicator of abuse but could suggest neglect.
C. Abrasions on knees: Common in active children and not specific to abuse.
D. Abdominal rebound tenderness: Could indicate abdominal pathology but not necessarily abuse.
E. Round burn marks on forearms: Could suggest burns but not specific to abuse without further context.
Correct Answer is ["22"]
Explanation
Dobutamine infusion calculation:
- Client weight: 220 pounds
- Dobutamine dose ordered: 5.5 mcg/kg/min
- Dobutamine concentration: 750 mg in 500 mL
- Conversion factor: 1 mg = 1000 mcg
- 1 kg = 2.2 pounds
Calculations:
- Convert client weight to kg: 220 lbs / 2.2 lbs/kg = 100 kg
- Calculate mcg/min: 5.5 mcg/kg/min × 100 kg = 550 mcg/min
- Calculate mcg/hr: 550 mcg/min × 60 min/hr = 33000 mcg/hr
- Calculate mL/hr: Dobutamine concentration is 750 mg/500 mL, which equals 1500 mcg/mL.
- mL/hr = 33000 mcg/hr / 1500 mcg/mL = 22 mL/hr
Answers:
- mcg/min: 550 mcg/min
- mcg/hr: 33000 mcg/hr
- mL/hr: 22 mL/hr
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