A mental health nurse is caring for a client who has schizophrenia and generalized anxiety disorder (GAD). The client has a prescription for lorazepam 2 mg PO every 6 hr PRN anxiety.
For which of the following client statements should the nurse consider administering lorazepam?

Choice A: Giving opinion: While sharing your opinions might seem helpful, it can actually shut down communication and make the patient feel judged or invalidated. Therapeutic communication focuses on understanding the patient's perspective, not imposing your own views.

Choice B: Asking why: Asking "why" can often come across as accusatory or judgmental, putting the patient on the defensive and hindering open communication. Instead, use open-ended s or clarifying statements to encourage the patient to elaborate on their feelings and experiences.

Choice C: Silence: In some situations, silence can be a powerful tool. It can provide a safe space for the patient to process their emotions, gather their thoughts, or initiate conversation themselves. However, be sure to use silence actively, paying close attention to nonverbal cues and ensuring the patient feels comfortable with the pause.

Choice D: Change the subject: While there may be times when it's appropriate to redirect the conversation, abruptly changing the subject can leave the patient feeling unheard and dismissed. It's important to acknowledge the patient's concerns and validate their feelings before moving on to another topic.

Choice E: Reflecting: Reflecting involves rephrasing the patient's words or statements in a way that acknowledges and emphasizes their emotions and experiences. This helps the patient feel heard and understood, promoting trust and openness in the communication. For example, if a patient says "I feel so alone," you could reflect by saying "It sounds like you're feeling isolated and disconnected."

Choice F: Clarification: Clarifying statements are a helpful way to ensure you understand the patient correctly. This can involve repeating parts of what they said, summarizing their message, or asking for specific details. For example, if a patient says "I just can't take it anymore," you could clarify by saying "You mentioned you're feeling overwhelmed. Can you tell me more about what's been difficult for you?"

By utilizing techniques like silence, reflecting, and clarification, nurses can create a safe and supportive environment for their patients in the mental health unit, fostering therapeutic communication that promotes healing and recovery.

Choice A, "Do you think your anxiety is worse than everyone else's?", is invalidating and minimizes the client's experience. Comparing their anxiety to others is unhelpful and could further distress the client.

Choice B, "It doesn't appear as though you are feeling anxious.", is dismissive and ignores the client's self-report. This dismissive response could damage the therapeutic relationship and discourage the client from sharing openly.

Choice D, "I think you should see a therapist and a doctor tomorrow.", is directive and potentially premature. While suggesting mental health resources can be helpful, it's crucial to first understand the client's situation and preferences before making recommendations. Additionally, suggesting both a therapist and a doctor without further assessment might overwhelm the client.

Choice C, "Tell me what has been happening lately.", is an open-ended and validating that encourages the client to share their experiences and concerns. This shows the nurse is actively listening and creates a safe space for the client to explore their anxiety. By understanding the context and potential triggers, the nurse can then provide more tailored support and guidance.

Further rationale for Choice C:

Open-ended s are key tools in therapeutic communication. They promote client engagement, facilitate exploration of thoughts and feelings, and gather valuable information needed for assessment and planning.

Validating the client's experience is crucial in building trust and rapport. Recognizing and acknowledging their anxiety shows the nurse cares and is taking their concerns seriously.

This initial allows the client to guide the conversation, focusing on aspects they feel most comfortable sharing. This empowers the client and promotes autonomy.

Following the client's lead in the conversation also helps the nurse gather specific details about the nature and severity of the anxiety, informing subsequent assessment and intervention strategies.

In conclusion, Choice C, "Tell me what has been happening lately.", is the most appropriate response for a mental health nurse to use when assessing a client who reports an increase in anxiety. It demonstrates active listening, validates the client's experience, encourages engagement, and provides a foundation for further assessment and support.