Difficulty: Medium
Average Score: 86%
Simulated
A nurse is caring for a client whose partner died in a fire that destroyed their home. Which of the following actions should the nurse take first?
Correct answer
C
Rationale
The correct answer is C: Determine if the client has thoughts about self-harm. This is the first action the nurse should take as it addresses the immediate safety and well-being of the client. Assessing for thoughts of self-harm is crucial in this situation to prevent any potential harm to the client. It allows the nurse to identify any suicidal ideation and take appropriate measures to ensure the client's safety.
Choice A is incorrect as empowering the client, while important, is not the most urgent need in this situation. Choice B is also incorrect as finding temporary shelter is important but ensuring the client's mental health and safety takes precedence. Choice D is incorrect as reviewing the social support system can be done after addressing the immediate safety concerns. The priority is to assess the client's mental state first.
Choice A is incorrect as empowering the client, while important, is not the most urgent need in this situation. Choice B is also incorrect as finding temporary shelter is important but ensuring the client's mental health and safety takes precedence. Choice D is incorrect as reviewing the social support system can be done after addressing the immediate safety concerns. The priority is to assess the client's mental state first.