A client with major depression visits the mental health clinic and tells the nurse that he has recently started using marijuana quite frequently. The nurse determines that the manifestation of the client's co-occurring disorder reflects which of the following?

Correct Answer: A

Rationale: The correct answer is A: Primary mental illness with subsequent substance use. In this scenario, the client's major depression is the primary mental illness, and the use of marijuana is a secondary behavior or coping mechanism. The client is using marijuana as a way to self-medicate or alleviate symptoms of depression. It is important to address the underlying mental health issue (major depression) as the primary concern. Choice B is incorrect because it suggests that substance abuse is the primary disorder with subsequent psychopathologic consequences, which is not the case in this scenario. Choice C is incorrect as it implies that both major depression and substance use are primary diagnoses, which is not the most accurate interpretation of the situation presented. Choice D is incorrect because it suggests a common cause for both conditions, which is not supported by the information provided.

Correct Answer: B

Rationale: The correct answer is B because asking about a specific plan to end their life assesses the client's level of risk for immediate harm. It helps determine the seriousness of their suicidal thoughts and the need for immediate intervention. Choices A, C, and D are incorrect because they do not directly address the client's suicidal ideation or assess their immediate risk. Option A focuses on the client's perception of life but does not assess their immediate safety. Option C seeks clarification but does not address the urgency of the situation. Option D emphasizes trust but does not assess the client's immediate risk.

Correct Answer: D

Rationale: The correct answer is D: A potential symptom of traumatization. This behavior of playacting as a police officer and causing fear in other children can be a red flag for trauma. Trauma can manifest in various ways in children, including through aggressive or controlling behaviors. The boy may be reenacting a traumatic event he witnessed or experienced, using the role of a police officer to process his feelings of powerlessness or fear. It is important for the nurse to consider the possibility of trauma and address it appropriately. Choices A, B, and C are incorrect because they do not directly address the concerning behavior displayed by the child. The behavior is not simply about the need to dominate others, inventing traumatic events, or developing close relationships. Instead, it suggests deeper psychological distress that requires a trauma-informed approach for intervention.

Correct Answer: B

Rationale: The correct answer is B: Arrange shelter. Priority is to address the immediate physical needs of the patient first. Providing shelter ensures safety and basic human needs are met. This intervention takes precedence over other options. A: Reducing anxiety is important but not the priority. C: Contacting family is not urgent for immediate safety. D: Hospitalization is a last resort and should only be considered if there is imminent danger to the patient's life.

Correct Answer: A

Rationale: Milieu therapy is the correct answer as it involves creating a therapeutic environment where clients interact with others, allowing nurses to observe their behaviors and relationships. This setting offers a holistic approach to assessment, considering how clients engage in various interactions. Electrical impulse therapy (B) is not focused on observing relationships and behaviors. Talk therapy (C) and individual therapy (D) primarily involve one-on-one interactions, limiting the nurse's ability to assess clients in diverse relationship contexts. Milieu therapy stands out for its comprehensive assessment opportunities within a dynamic social environment.