A client with borderline personality disorder says to the nurse, "I feel so comfortable talking with you. You seem to have a special way about you that really helps me." Which would be the most appropriate response by the nurse?
"I'm glad you feel comfortable with me."
"I am sorry I cannot be your friend."
"You feel other's don't understand you?"
"I'm here to help you just as all the staff members are."
The Correct Answer is D
D. It acknowledges the client’s comfort while emphasizing the nurse’s professional role. It sets clear boundaries and reinforces that the nurse’s primary purpose is to provide care and support within the therapeutic context.
A. This response acknowledges the client’s feelings but does not set clear boundaries. It may
inadvertently encourage the client to view the nurse as a friend rather than a professional caregiver.
B. While this response establishes boundaries, it may come across as abrupt or cold. It lacks empathy and understanding.
C. This response reflects empathy and encourages further exploration of the client’s feelings. However, it does not address the professional boundaries explicitly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
C. Tardive dyskinesia is a movement disorder characterized by repetitive, involuntary movements of the face, tongue, and sometimes other parts of the body. These movements can include lip smacking, tongue protrusion, grimacing, and rapid eye blinking. Tardive dyskinesia is a well-known adverse effect associated with long-term use of antipsychotic medications, particularly first- generation antipsychotics such as chlorpromazine.
A. Neuroleptic Malignant Syndrome is a rare but serious adverse reaction to antipsychotic medications, characterized by symptoms such as severe muscle rigidity, high fever, altered mental status (e.g., confusion), autonomic instability (e.g., fluctuations in blood pressure, heart rate), and elevated creatine phosphokinase (CPK) levels.
B. Dysthymia is a chronic mood disorder characterized by persistent feelings of sadness, hopelessness, and low self-esteem. Dysthymia is not directly related to the involuntary movements described in the scenario and is unlikely to be the cause of the client's symptoms.
D. Akathisia is a movement disorder characterized by inner restlessness and the inability to sit still. Akathisia is a common side effect of antipsychotic medications and can be distressing for affected individuals. However, the symptoms described in the scenario, specifically involuntary movements of the tongue and face, are more indicative of tardive dyskinesia rather than akathisia.
Correct Answer is B
Explanation
B. Anxiolytics are prescribed to reduce symptoms of anxiety, such as nervousness or restlessness, which can interfere with problem-solving and decision-making abilities. By alleviating anxiety symptoms, the medication can help the client focus more effectively on addressing underlying issues or stressors.
A. While anxiolytics can be effective in managing acute symptoms of anxiety, they are not typically intended for long-term use.
C. Many anxiolytic medications, particularly benzodiazepines, carry a risk of dependence and addiction if used improperly or for an extended period.
D. While anxiolytics can help alleviate symptoms of anxiety, they may not completely eliminate anxiety in all situations.
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