Nokea
Which measure is critical to achieving desired outcomes in the nurse-client relationship? The nurse:
- A. develops trust in the client.
- B. uses autodiagnosis.
- C. relies on the client liking the nurse rather than limit-setting to achieve structure.
- D. analyzes the relationships among biologic, familial, and sociocultural factors that contributed to the client's disorder.
Correct Answer: B
Rationale: The correct answer is B: uses autodiagnosis. Autodiagnosis is critical in the nurse-client relationship as it involves self-awareness and reflection by the nurse to understand their own biases, emotions, and reactions. This self-awareness allows the nurse to effectively manage their responses, maintain professionalism, and provide quality care to the client. By being aware of their own thoughts and feelings, nurses can better empathize with the client, build trust, and communicate effectively. This approach helps prevent potential conflicts and misunderstandings, leading to better outcomes in the nurse-client relationship.
Summary:
A: Developing trust in the client is important but not the most critical measure.
C: Relying on the client liking the nurse is not professional and may compromise boundaries.
D: Analyzing biologic, familial, and sociocultural factors is important but not as critical as self-awareness through autodiagnosis.
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A patient with borderline personality disorder has been hospitalized several times after self-injurious behavior and suicide attempts. The patient has entered dialectical behavior therapy on an outpatient basis. During therapy, the advanced practice nurse has been counseling her regarding self-harm behavior management. Today the patient called the nurse and reported 'feeling empty and anxious' and wants to cut herself. Which response would best help in this situation?
- A. Arrange for an emergency admission to a crisis unit.
- B. Arrange for an emergency admission to an inpatient unit.
- C. Assist the patient to identify and choose a coping strategy.
- D. Advise the patient to take an anxiolytic, then go to sleep.
Correct Answer: C
Rationale: The correct response is C: Assist the patient to identify and choose a coping strategy. This choice is the best because it involves helping the patient develop healthy coping mechanisms to manage her distress. This empowers the patient to take control of her emotions and actions in a positive way. Emergency admissions (choices A and B) may not address the underlying issues and could potentially reinforce maladaptive behaviors. Advising medication (choice D) without addressing the emotional distress directly may not provide long-term solutions. In summary, choice C focuses on empowering the patient and addressing the root of the problem, making it the most appropriate response in this scenario.
The following condition is an indication for electroconvulsive therapy (ECT)
- A. Serene depression
- B. Schizophrenia
- C. Autistic disorders
- D. Tourettes syndrome
Correct Answer: A
Rationale: Severe (likely intended as 'serene') depression, especially when treatment-resistant, is a primary indication for ECT due to its rapid efficacy.
The nurse is explaining to the family of a patient diagnosed with schizophrenia that the disorder is considered to have neurobiological origins. When the patient's mother asks, 'What part of the brain is dysfunctional?' the nurse should reply, 'Research has implicated the:
- A. medulla and cortex.'
- B. cerebellum and cerebrum.'
- C. hypothalamus and medulla.'
- D. prefrontal and limbic cortices.'
Correct Answer: D
Rationale: The correct answer is D: prefrontal and limbic cortices. The prefrontal cortex is involved in decision-making, problem-solving, and social behavior, functions that are often impaired in schizophrenia. The limbic cortex is responsible for emotions and memory, both of which are affected in schizophrenia. Research has shown abnormalities in these brain regions in individuals with schizophrenia, supporting the neurobiological origins of the disorder. Choices A, B, and C are incorrect as they do not specifically address the brain regions known to be involved in schizophrenia.
A client, age 70, was brought into the Emergency Department by family members who reported a fall. During the assessment the nurse became suspicious that the client had suffered physical abuse. The client denied that she had been abused. Her denial is most likely based on her:
- A. Strong belief that nothing could be done to help her
- B. Fear of the possibility of being removed from her family
- C. Feeling that she deserved the physical abuse
- D. Lack of trust that the situation could be changed
Correct Answer: B
Rationale: The correct answer is B: Fear of the possibility of being removed from her family. This is because elderly individuals who are experiencing abuse may fear being separated from their family if they disclose the abuse. This fear of losing their support system can lead them to deny or minimize the abuse. This choice is the most likely reason for the client's denial in this scenario.
Choice A: Strong belief that nothing could be done to help her is incorrect because the client's denial is not based on a belief that nothing could be done, but rather on a fear of being removed from her family.
Choice C: Feeling that she deserved the physical abuse is incorrect as victims of abuse often do not feel they deserve the abuse, but rather may feel ashamed or fearful.
Choice D: Lack of trust that the situation could be changed is incorrect because the client's denial is more likely based on a fear of losing her family, rather than a lack of trust in the situation changing.
A supervisor observes inconsistency in the psychiatric-mental health nurse's behavior toward a patient; the nurse is unreasonably concerned, overly kind, or irrationally hostile. The most appropriate explanation is that the nurse is displaying:
- A. countertransference
- B. empathic resonance
- C. splitting behavior
- D. transference
Correct Answer: A
Rationale: Countertransference involves the nurse's emotional reactions to the patient based on personal unconscious feelings, leading to inconsistent behavior.