# A nurse is assessing a 45-year-old client who was recently discharged from the hospital after a hip replacement. Which assessment finding would be most concerning regarding the client's psychosocial adaptation to home recovery? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541798 > language: ko > subject: Growth & Development ## 문제 A nurse is assessing a 45-year-old client who was recently discharged from the hospital after a hip replacement. Which assessment finding would be most concerning regarding the client's psychosocial adaptation to home recovery? ## 보기 1. The client asks multiple questions about facility routines and meal times 2. The client refuses to leave their room and states "I just want to go home and die" **✔ 정답** 3. The client appears anxious when family members leave after visiting 4. The client has difficulty remembering staff names and room locations **정답: 2** ## 해설 Refusing to leave room and stating 'I just want to go home and die' indicates severe depression and possible suicidal ideation, requiring immediate safety intervention. Other findings (questions, anxiety, memory difficulty) are common in adaptation and less concerning. ## 심화 해설 Clinical Reasoning and Psychosocial Assessment The most concerning finding is the client's statement, "I just want to go home and die," which represents an overt expression of suicidal ideation. This is a psychiatric emergency that requires immediate intervention, not simply a maladaptive coping response. In the context of a postoperative recovery, this statement signals a profound disruption in psychosocial adaptation and a direct threat to patient safety, which is the highest priority in the nursing assessment framework. While anxiety upon family departure (option 3) or difficulty with orientation (option 4) can be expected during a vulnerable post-surgical period, they do not carry the same immediate risk of self-harm. Questioning routines (option 1) is a normal adaptive behavior indicating engagement, albeit with some dependency needs. The critical distinction lies in the expression of a desire to die, which moves the clinical picture from a potential adjustment disorder to a life-threatening psychiatric crisis. The link between orthopaedic surgery and new-onset psychiatric conditions is well-documented. A large retrospective cohort study on spinal surgery patients found that new-onset depression and suicidal ideation are significant postoperative complications that can emerge during the recovery period, even in patients with no prior psychiatric history [1]. This research underscores that major musculoskeletal surgery is a physiological and psychological stressor capable of triggering severe mood disturbances. The timing of this client's presentation — recently discharged after a hip replacement — aligns with the high-risk window identified for the development of these disorders [1]. Furthermore, research in orthopaedic populations confirms that suicidal ideation is a critical concern that is often under-recognized. A study on pediatric orthopaedic patients demonstrated that those with musculoskeletal conditions have a significantly elevated risk for suicidal ideation compared to their healthy peers, emphasizing the need for routine screening in this patient population [2]. Although this client is an adult, the principle that physical impairment and the stress of recovery from an orthopaedic condition can precipitate suicidal thoughts is directly transferable. The feeling of being a burden, loss of independence, and uncontrolled pain are powerful psychosocial stressors that can erode a patient's will to recover. From a qualitative perspective, the experience of care for musculoskeletal conditions like hip osteoarthritis — the precursor to a hip replacement — is often suboptimal and can leave patients feeling unheard and unsupported . If a patient's care journey has been marked by frustration or a perceived lack of empathy, the postoperative period can become a breaking point where hopelessness crystallizes into a desire to die. The nurse's role is to recognize this statement not as a fleeting complaint, but as a sentinel event requiring immediate, focused assessment of the client's suicide risk, ensuring constant one-to-one observation, and activating the appropriate emergency psychiatric response protocol. The statement directly expresses a wish for death, which is the most extreme and dangerous manifestation of failed psychosocial adaptation. References (research sources) - [1]New-Onset Psychiatric Disorders After Lumbar Fusion: Predictors, Timing, and Risk Stratification.Research articleBallatori AM, Shahrestani S, Ton A, Chen XT, Buser Z, Wang J. (2026) · DOI: 10.1177/21925682251400284 - [2]Suicidal Ideation in Pediatric Orthopaedic Patients.Research articleHerge WM, Hartman RL, Fairweather A, Rathbun JP, Carlos C, Robinson A, Jo CH, Riccio AI. (2026) · DOI: 10.2106/jbjs.oa.25.00325 ## 임상 시나리오 Postoperative Suicidal Ideation AssessmentImmediate Response to a Psychiatric Emergency Any statement expressing a desire to die, such as "I want to go home and die," must be treated as a psychiatric emergency. This overt suicidal ideation takes absolute priority over other psychosocial or cognitive assessments. The primary intervention is to ensure one-to-one constant observation and maintain a safe environment by removing all potentially harmful objects. The healthcare provider must be notified immediately for a formal psychiatric evaluation. CautionMajor surgeries like hip replacement are a significant physiological stressor. New-onset depression and suicidal ideation can emerge postoperatively even in patients with no prior psychiatric history. Do not dismiss such statements as normal adjustment difficulty. ## 핵심 개념 - **Suicidal Ideation** — Thoughts about, or an unusual preoccupation with, ending one's own life, ranging from fleeting considerations to detailed planning. - **Psychosocial Adaptation** — The process of adjusting psychologically and socially to a major life change or health alteration, such as recovering from surgery. - **Psychiatric Emergency** — An acute disturbance in thought, behavior, mood, or social relationship that requires immediate intervention to prevent harm to the patient or others. ## 같은 주제 문제 - [A 90-year-old client in a long-term care facility has been exhibiting increased confusion,…](https://mymerci.kr/pages/nclex_q.php?qn_id=541796) - [An 82-year-old client in a long-term care facility has been increasingly withdrawn and ref…](https://mymerci.kr/pages/nclex_q.php?qn_id=541797) - [A 70-year-old client living alone at home has been exhibiting increased confusion, agitati…](https://mymerci.kr/pages/nclex_q.php?qn_id=541799) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._