A client with bipolar disorder is exhibiting signs of impaired judgment and poor insight. What should the nurse assess and document about the client's cognitive abilities?

Choice A rationale:

This response is not appropriate as it may come across as confrontational and dismissive of the client's current state. The client's difficulty in concentrating is a symptom of their manic episode, and using such phrasing might increase their agitation and escalate the situation.

Choice B rationale:

"I'm here to listen. Let's try to stick to one topic at a time." This response acknowledges the client's difficulty while providing support and a gentle redirection to stay focused on one topic. It maintains a therapeutic and non-confrontational approach, promoting effective communication with the client.

Choice C rationale:

While it's important to ensure fair participation in group conversations, this response may not address the immediate need of the client in a manic episode. It could potentially trigger further irritability or resistance from the client.

Choice D rationale:

This response may be interpreted as the nurse not making an effort to understand the client's thoughts, which could exacerbate the client's frustration and hinder therapeutic communication. It lacks empathy and a collaborative approach.

Choice C rationale:

The primary goal of establishing a therapeutic nurse-patient relationship in the context of caring for a patient with MDD is to promote trust, rapport, empathy, and communication. This relationship provides a safe and supportive environment for the patient to express their thoughts and feelings, which is essential for effective treatment and recovery.

Choice A rationale:

Providing constant reassurance to the patient oversimplifies the therapeutic relationship. While offering reassurance is part of the nurse's role, the relationship is multidimensional and involves active listening, understanding, and collaborative problem-solving beyond just providing reassurance.

Choice B rationale:

Offering advice and solutions to the patient's problems might be part of the therapeutic process, but it's not the primary goal of the nurse-patient relationship. The relationship focuses on fostering open communication and empowering the patient to explore their feelings and thoughts.

Choice D rationale:

Encouraging the patient to rely solely on the nurse for support is not the goal of the therapeutic relationship. Instead, the nurse aims to empower the patient to develop a network of support and coping strategies, both within and outside the healthcare setting. This approach enhances the patient's long-term resilience.