Author Question: The most helpful response for the nurse to make when a client being treated as an outpatient states ... (Read 54 times)

wenmo · **on:** Jul 19, 2018

The most helpful response for the nurse to make when a client being treated as an outpatient states I
am considering committing suicide is

a. I am glad you shared this. There is nothing to worry about. We will handle it
together..
b. We need to talk about the things you have to live for..
c. I think you should admit yourself to the hospital to get help with this..
d. Bringing this up is a very positive action on your part..

Question 2

A client admitted for treatment of trauma sustained in a fall while intoxicated believes bugs are
crawling on the bed. The client is anxious, agitated, and diaphoretic. A nursing diagnosis of high
priority that should be developed is

a. ineffective health maintenance.
b. ineffective coping.
c. ineffective denial.
d. risk for injury.

Eazy416 · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

D
This response gives the client reinforcement and validation for making a positive response rather
than acting out the suicidal impulse. It gives neither advice nor false reassurance, and it does not
imply stereotypes such as You have a lot to live for.. It uses the client's ambivalence and sets the
stage for more realistic problem solving.

Answer to Question 2

D
The client's clouded sensorium, sensory perceptual distortions, and poor judgment put him at risk
for injury. The scenario does not provide data to support the other diagnoses.