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Zorluk: OrtaMental Health Concepts

While assisting a client with major depressive disorder with morning hygiene, the client stares at the floor and states, "I have ruined everything. My family would be so much better off if I were no longer around." Which response by the practical nurse (PN) is the priority?

  1. A
    Why do you feel that you have ruined your family's life?
  2. B
    I know it is difficult right now, but your family wants you to get better.
  3. Are you having thoughts about harming or killing yourself?Cevap
  4. D
    Let us focus on finishing your morning care so you can join the group.

Cevap

The correct answer is to directly ask the client if they are having thoughts of harming or killing themselves.
When a client makes a covert statement indicating they feel like a burden or that others would be better off without them, it is a significant warning sign for suicide. The primary nursing priority is always safety. The practical nurse must directly and unambiguously ask if the client is having thoughts of harming or killing themselves to assess the immediate risk and collaborate with the registered nurse to initiate appropriate safety precautions.

Adım Adım Çözüm

1
Analyze the client's statement.
The phrase 'My family would be so much better off if I were no longer around' is a covert statement indicating feelings of worthlessness and potential suicidal ideation.
Identifying underlying themes and hidden threats in client communication is essential for recognizing safety risks.
2
Determine the priority nursing action based on the identified risk.
The highest priority in mental health nursing is always client safety, requiring an immediate and unambiguous assessment of suicide risk.
Covert statements of self-harm mandate direct questioning to establish intent, determine if there is a plan, and initiate necessary safety precautions.
3
Evaluate the given responses against therapeutic communication standards and safety priorities.
Directly asking about thoughts of self-harm is the only response that addresses the immediate safety risk. The other options utilize non-therapeutic blocks such as probing, offering false reassurance, or changing the subject.
Using direct, specific language regarding suicide clarifies the client's intent without being judgmental, whereas non-therapeutic blocks invalidate the client's feelings and jeopardize safety.

Anahtar Kavram

Assessing for Suicidal Ideation and Safety Priorities
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Konular

Mental Health Concepts

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