Chapter 7 NCLEX Mental Health

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A 17-year-old patient confides to the nurse that they have been thinking of ways to kill a peer. What response should the nurse give when the patient states, "you have to keep it a secret because its confidential information"?

"Issues of this kind have to be shared with the treatment team and your parents."

Which response should the nurse provide a client who asks, "Why you need to conduct an assessment interview"?

"We will be able to form a relationship together where we can discuss the current problems and come up with goals and a plan for treatment."

A 26-year-old patient is brought to the emergency room by a friend. The patient is unable to give any coherent history. Which response should the nurse provide when the patient's friend offers to provide information regarding the patient?

"Yes, I will be happy to get any information and history that you can provide.

The nurse is conducting an admission interview with a client who was raped 2 weeks ago. When asked about the rape, the client becomes very anxious and upset and begins to sob. What should be the nurse's response to the client's reaction?

Acknowledge that the topic of the rape is upsetting and reassure the client that it can be discussed at another time when she feels more comfortable.

A 43-year-old client being seen in the mental health clinic states, "I have always been a practicing Jew, but in the past few months I am questioning everything. I just don't know if I believe in it anymore." Which of the following nursing diagnoses best describes the client's comment?

Spiritual distress


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