An older adult client who is mourning the death of her spouse ...

[nramada]

An older adult client who is mourning the death of her spouse comes to the health clinic for follow-up care for an irregular heartbeat.
 
  During the examination the client tells the nurse, I don't care about my irregular heartbeat; I will be with my husband soon. The best response by the nurse is,
 
  a. It sounds as if you would like to see your husband again.
  b. Your husband is dead and you have so much to live for.
  c. Your heartbeat was good today. The medication seems to be working.
  d. Have you talked to your children recently about how you're doing?

Question 2

A client is admitted to a psychiatric unit with severe depression and thoughts of suicide. The client is placed on suicide precautions. When caring for this client, the nurse recognizes that
 
  a. people who talk about harming themselves are at less risk.
  b. clients who verbalize or behaviorally demonstrate a weight being lifted off the shoulders are no longer at risk.
  c. once the acute crisis has subsided, the client is no longer at risk.
  d. a major goal in evaluating suicidal risk is to assess for imminent danger of doing harm to self.

[af]

Answer to Question 1

ANS: A
When a nurse responds with It sounds as if you would like to see your husband again, it is an example of a reflective listening response used to identify applicable feelings. Responses that focus on what the client has to live for, the medication, or her children are not examples of therapeutic communication.

Answer to Question 2

ANS: D
A major goal in evaluating suicidal risk is to assess whether the client is imminent danger of doing harm to self. It is a myth that people who talk about harming themselves are at less risk. Clients who verbalize or behaviorally demonstrate a weight being lifted off the shoulders should be watched carefully. Suicidal ideation waxes and wanes, so careful observation is critical even after the acute crisis has subsided.