Sunday, September 26, 2010

NCLEX type question Week of 9-26-10

A 40-year-old homemaker presents to the triage area of an emergency department with uncontrollable crying and anxiety. She states her husband of 18 years has recently asked for a divorce. The client is observed fidgeting in a chair and wringing her hands. Which response by the nurse is most therapeutic?

1. "You must stop crying so we can discuss your feelings about the divorce."
2. "Once you find a job, you will feel better and more secure in your new life."
3. "I can see how upset you are. Let's sit here and talk about how you're feeling."
4. "Once you have a lawyer looking out for your interests, you will feel better."
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1 comment:

  1. D. JamesSeptember 26, 2010 at 9:54 AM

    Answer. 3

    In this response, the nurse validates the client's distress and provides her an opportunity to talk about her feelings. Because the client is in crisis, decision making is difficult, even for simple tasks, therefore the nurse must be directive as well as supportive. The other responses do not address the client's needs. They reflect the nurse's agenda.

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