A nurse is caring for an elderly patient with advanced dementia who is unable to make healthcare decisions independently. The patient’s adult child has been appointed legal guardian. What is the nurse’s best action regarding the patient’s care decisions?

Choice A reason: Labile affect, common in bipolar disorder, involves rapid, unpredictable shifts in emotional expression, such as moving from laughter to crying. This reflects dysregulation in the limbic system and prefrontal cortex, leading to exaggerated emotional responses. The sudden mood swings described align with this condition, making it the correct choice.

Choice B reason: Flat affect describes a severe reduction or absence of emotional expression, often seen in schizophrenia or severe depression. Patients display minimal facial or vocal changes, unlike the rapid emotional shifts in the scenario. This lack of emotional variability does not match the described behavior, making this choice incorrect.

Choice C reason: Restricted affect refers to a limited range of emotional expression, less severe than flat affect, often seen in mood disorders or personality disorders. It does not involve rapid shifts between emotions, as described in the question, but rather a consistently narrowed emotional range, making this choice incorrect.

Choice D reason: Blunted affect involves a reduced intensity of emotional expression, common in schizophrenia or post-traumatic stress disorder. Patients show muted responses, not rapid shifts between intense emotions like laughter and crying. This does not align with the described bipolar disorder behavior, making this choice incorrect.

Choice A reason: Expressing empathy, such as acknowledging the difficulty of the loss, fosters a therapeutic connection. It validates the patient’s emotions, encouraging open expression of grief, which is essential for processing loss and aligns with therapeutic communication principles, making this choice therapeutic.

Choice B reason: Asking the patient to elaborate on their feelings is a therapeutic open-ended question. It promotes exploration of emotions, facilitating grief processing by engaging the patient’s prefrontal cortex in reflecting on their experience, making this a therapeutic response and incorrect for the question.

Choice C reason: Saying “You’ll feel better soon” minimizes the patient’s grief, dismissing their current emotional state. This nontherapeutic response can inhibit emotional expression, as it implies a timeline for grief recovery, potentially disrupting the patient’s natural mourning process, making this the correct choice.

Choice D reason: Offering support and encouraging discussion is therapeutic, as it builds trust and validates the patient’s experience. This response engages the patient in processing grief, supporting emotional regulation through empathetic communication, making it a therapeutic response and incorrect for the question.