The nurse is assessing a client's mental health competence and ...

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The nurse is assessing a client's mental health competence and decision-making ability. Which activity will best provide the needed information to the nurse?
 
  A) Ask the client to read and discuss a passage from a pamphlet.
  B) Ask the client what if questions to determine level of thought organization.
  C) Ask the client to review his medical health history to assess for the level of organization of his thought processes.
  D) Discuss with the client's family any concerns about his mental stability.

Question 2

A nurse is completing an intake assessment. The nurse notes that an older adult male client appears to have bruises in varying stages of healing. Which action by the nurse indicates an understanding of her responsibilities?
 
  A) The nurse should notify the primary care physician about the bruises.
  B) The nurse should contact the facility's social services department.
  C) The nurse should question the client about the source of the bruises.
  D) The nurse should request permission from the client to photograph the bruises.

[xMRAZ]

Answer to Question 1

Ans: B
Feedback:
When revewing mental health and level of decision-making ability, the best method is to ask the client what if type of questions. Assessing the client's reading ability and understanding of passages read will not provide the needed information. Asking the client to discuss his medical history will provide some information but will not provide information on his ability to reason and make clear decisions. Questioning the family provides only a secondary source of information and will not be as effective.

Answer to Question 2

Ans: C
Feedback:
The initial action by the nurse would be to determine the source of the bruises. If suspicion remains, the nurse should question the client. If the nurse feels there is potential abuse the nurse is obligated to report it.

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Gracias!

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