The nurse is concerned that a depressed client may be displaying a nonverbal suicidal threat when he presents another client with his favorite shirt as a 'gift.' The nurse's initial intervention is to:

Correct Answer: B

Rationale: The correct answer is B because asking the client directly about suicidal ideations with a plan to hurt himself is the most immediate and appropriate intervention to assess the client's safety. This approach allows the nurse to directly address the potential risk of suicide and initiate appropriate interventions if necessary. Placing the client on suicide precautions (choice A) without assessing the client's thoughts may be premature and intrusive. Supporting the client about the shirt (choice C) does not address the underlying concern of suicidal behavior. Simply documenting the behavior (choice D) without taking immediate action to assess and address the risk is insufficient in ensuring the client's safety.

Correct Answer: A

Rationale: Beta blockers are given for anxiety as they help slow heart rate and decrease blood pressure, reducing physical symptoms of anxiety like palpitations and sweating. This is achieved by blocking the effects of adrenaline on the heart and blood vessels. Ataxia, sexual dysfunction, and urinary retention are not typical side effects of beta blockers and are not relevant to their use in treating anxiety.

Correct Answer: A

Rationale: Correct Answer: A Rationale: 1. BuSpar is an anxiolytic medication that may take weeks to reach full effectiveness. 2. Patient education is crucial to manage expectations and ensure compliance. 3. Informing the patient about the delayed onset helps prevent premature discontinuation. Summary: B: Alternative medications - Not relevant to informing the patient before discharge. C: Severe headache - Not a common side effect of BuSpar. D: Urinary retention - Not a common side effect of BuSpar.

Correct Answer: A

Rationale: The correct answer is A: Gastrointestinal disturbances. Celexa (citalopram) is known to commonly cause gastrointestinal side effects such as nausea, diarrhea, and indigestion. This is important for the nurse to inform the patient about to manage expectations and potential discomfort. Choices B, C, and D are incorrect because sexual dysfunction, thyroid function, and tachycardia are not common side effects associated with Celexa. Overall, it is crucial for the nurse to educate the patient on the most common side effects to ensure proper monitoring and management.

Correct Answer: A

Rationale: The correct answer is A: Tricyclic antidepressants (TCAs). TCAs are not frequently used due to their high lethality in overdose. They have a narrow therapeutic index, leading to severe toxicity even at slightly higher doses. In overdose, TCAs can cause life-threatening cardiovascular and central nervous system effects. SSRIs (B) are safer in overdose compared to TCAs. GI upset (C) is a common side effect of many medications, not specifically antidepressants. Divalproex (D) is not an antidepressant medication, but rather a mood stabilizer primarily used in bipolar disorder.