A patient diagnosed with major depressive disorder expresses a desire to commit suicide. What is the nurse's priority intervention?

Correct Answer: C

Rationale: In the scenario where a patient diagnosed with major depressive disorder expresses a desire to commit suicide, the nurse's priority intervention is option C: Ensure the patient is in a safe environment and not at risk for harm. This intervention takes precedence as it addresses the immediate safety and well-being of the patient. Ensuring the patient is in a safe environment involves removing any potential means for self-harm, closely monitoring the patient, and possibly initiating the appropriate interventions such as suicide precautions or involving the mental health team for further assessment and management. Option A, reassuring the patient that they are not alone, and option B, encouraging the patient to express their feelings and emotions, are important aspects of therapeutic communication and support in mental health nursing. However, in a situation where there is an imminent risk of harm, ensuring the patient's safety must take precedence over these interventions. Option D, asking the patient to sign a no-suicide contract, is not an appropriate intervention in this critical situation. No-suicide contracts do not guarantee safety or prevent suicide attempts. They should not be used as a substitute for proper risk assessment and safety planning. In an educational context, it is crucial for nurses to prioritize patient safety in mental health crises. Understanding the hierarchy of interventions and the importance of immediate risk assessment and management is essential for providing effective and safe care to patients experiencing suicidal ideation. Effective communication skills and therapeutic interventions play a vital role in supporting these patients, but safety always comes first in such critical situations.

Correct Answer: B

Rationale: Assessing cognition involves determining a patient's judgment and decision making. In this case, the nurse would expect a response of 'Call my doctor' if the patient's cognition and judgment are intact. If the patient responds, 'I would stop eating' or 'I would just wait and see what happened,' the nurse would conclude that judgment is impaired. The other options refer to other aspects of the examination.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Nutritional deficiencies and electrolyte imbalances. This is the priority concern for the nurse because individuals with bulimia nervosa often engage in binge eating followed by purging behaviors like self-induced vomiting, which can lead to severe consequences such as electrolyte imbalances (e.g., hypokalemia) and nutritional deficiencies (e.g., low levels of vitamins and minerals). These complications can have serious implications on the patient's physical health, potentially leading to cardiac arrhythmias, muscle weakness, and other life-threatening conditions. Option B) Impulsivity and emotional dysregulation, while important factors in understanding and treating bulimia nervosa, are not the immediate priority in this case. Addressing nutritional deficiencies and electrolyte imbalances takes precedence due to their acute and potentially life-threatening nature. Option C) Distorted body image and low self-esteem are common psychosocial issues in individuals with bulimia nervosa but do not pose an immediate threat to the patient's physical health compared to the risks associated with electrolyte imbalances and nutritional deficiencies. Option D) Excessive exercise and weight loss are more commonly associated with anorexia nervosa rather than bulimia nervosa. While these behaviors can co-occur in some cases, they are not the primary concern in a patient presenting with binge eating and purging behaviors. Educationally, it is crucial for nurses and healthcare providers to prioritize the management of acute physical health concerns in individuals with eating disorders to prevent serious complications. Understanding the hierarchy of concerns allows for appropriate triaging and intervention to address the most critical issues first, ensuring the safety and well-being of the patient.

Correct Answer: B

Rationale: In behavioral nursing, after formulating nursing diagnoses for a new patient, the nurse's next action should be determining the goals and outcome criteria (Option B). This step is crucial as it sets the direction for the plan of care. By establishing clear goals and outcome criteria, the nurse can develop a targeted and effective care plan that addresses the patient's specific needs and helps in evaluating the success of the interventions over time. Option A, designing interventions, is premature without clearly defined goals. Without specific goals, interventions may not be aligned with the desired outcomes, leading to ineffective care. Option C, implementing the nursing plan of care, should only occur after goals are established to ensure that interventions are purposeful and tailored to the patient's needs. Option D, completing the spiritual assessment, is important but typically falls within the assessment phase and may not be the immediate next step after formulating nursing diagnoses. It is essential for holistic care but may not directly follow the formulation of nursing diagnoses in the care planning process. Understanding the sequential nature of the nursing process is essential for providing efficient and effective care. By prioritizing goal setting after formulating nursing diagnoses, nurses can ensure that their interventions are focused, measurable, and aligned with the patient's needs, ultimately leading to better patient outcomes.

Correct Answer: D

Rationale: The correct answer is D) Differing values are reflected in the two statements. In this scenario, it is essential to understand that both the patient and the nurse are expressing their personal values and beliefs regarding the sensitive topic of suicide. The patient's perspective advocates for autonomy and individual choice over one's life, while the nurse's response reflects a perspective that values life preservation and intervention to prevent harm. The patient's viewpoint emphasizes the importance of respecting an individual's autonomy and right to make decisions about their own life, even in situations as complex as suicide. On the other hand, the nurse's response reflects a duty to uphold the sanctity of life and intervene to prevent harm, aligning with the ethical principle of beneficence in nursing. This interchange highlights the significance of recognizing and respecting diverse perspectives and values in healthcare settings. Nurses must navigate these differences with empathy, respect, and understanding while upholding professional ethics and standards of care. It also underscores the importance of effective communication and active listening in addressing sensitive and challenging topics with patients to provide holistic and patient-centered care.