A charge nurse is discussing the care of a client who has a substance use disorder with a staff nurse.
Which of the following statements by the staff nurse should the charge nurse identify as countertransference?
"The client asked me to go on a date with him, but I refused.”.
"The client needs to accept responsibility for his substance use.”.
"The client is just like my brother who finally overcame his habit.”.
"The client generally shares his feelings during group therapy sessions.”.
The Correct Answer is C
Choice A rationale:
"The client asked me to go on a date with him, but I refused.”. This statement does not demonstrate countertransference. It is a clear example of professional boundaries being maintained, as the staff nurse refused the client's request for a date, which is appropriate in the context of the nurse-client relationship.
Choice B rationale:
"The client needs to accept responsibility for his substance use.”. This statement does not indicate countertransference. It reflects a common and appropriate therapeutic goal, which is to help clients take responsibility for their actions and substance use disorder.
Choice C rationale:
"The client is just like my brother who finally overcame his habit.”. This statement represents countertransference. Countertransference occurs when a healthcare professional's emotions, attitudes, or past experiences influence their perceptions and interactions with a client. In this case, the staff nurse is making a connection between the client and their own brother, suggesting a personal bias based on past experiences. This can hinder the staff nurse's ability to provide objective care.
Choice D rationale:
"The client generally shares his feelings during group therapy sessions.”. This statement does not demonstrate countertransference. It is a straightforward observation of the client's behavior during group therapy sessions and does not involve any emotional or personal bias on the part of the staff nurse.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice B rationale:
Offering the client food and fluids every 2 hours is not the most appropriate action in this situation. When a client has been placed in seclusion due to physical aggression, their safety and the safety of the staff must be the top priority. It is essential to monitor the client's behavior and document it regularly to ensure they do not pose a threat to themselves or others.
Choice C rationale:
Monitoring the client's vital signs every 4 hours is not the highest priority when a client has become physically aggressive and is placed in seclusion. Vital sign monitoring is important for the overall assessment of a client's health, but it may not address the immediate safety concerns associated with aggressive behavior. Regular observation and documentation of the client's behavior are more critical in this situation.
Choice D rationale:
Obtaining the provider's prescription within 60 minutes is an important step, but it is not the most immediate priority. While it is essential to have a healthcare provider's order for seclusion, the safety of the client and staff takes precedence. Documenting the client's behavior every 15 minutes allows for ongoing assessment of their condition and ensures their well-being during the time leading up to obtaining the provider's order.
Correct Answer is C
Explanation
A nurse is assessing a client who has anorexia nervosa and began treatment 1 month ago. Which of the following findings indicates the client's adherence to the treatment plan? The correct answer is choice C: The client states that she knows she can't be perfect.
Choice A rationale:
The client reports following various cooking blogs. Following cooking blogs does not necessarily indicate adherence to an anorexia nervosa treatment plan. The client might still engage in disordered eating behaviors while having an interest in cooking.
Choice B rationale:
The client's potassium level is 3.2 mEq/L. A potassium level of 3.2 mEq/L is below the normal range (3.5-5.0 mEq/L) and indicates electrolyte imbalance. This finding suggests inadequate adherence to the treatment plan, as it may result from continued restrictive eating.
Choice D rationale:
The client's current BMI is 14. A BMI of 14 is significantly below the normal range and is indicative of severe malnutrition. It suggests non-adherence to the treatment plan and ongoing weight loss, which is common in anorexia nervosa.
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