A nurse is interviewing a client who states, "I am at a total loss and don't know what to do anymore. I feel hopeless." Which of the following responses should the nurse make?

"If you do not like your medications, would you like to try an alternative?"

“You feel like you have no remaining options and are struggling to find a solution."

"Would you like to speak to a therapist after treatment?"

“You would like more information. I will get that for you right away."

Answer and Explanation

The Correct Answer is B

A. "If you do not like your medications, would you like to try an alternative?" This response shifts focus away from the client's emotional state and does not validate their feelings.

B. "You feel like you have no remaining options and are struggling to find a solution." This response uses therapeutic communication by reflecting the client’s emotions, validating their feelings, and encouraging further discussion.

C. "Would you like to speak to a therapist after treatment?" While therapy may be beneficial, this response does not acknowledge the client's feelings in the present moment.

D. "You would like more information. I will get that for you right away." This response assumes the client is seeking information rather than expressing distress.

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Correct Answer is B

Explanation

A. Cultural humility involves recognizing and respecting differences in beliefs and values while maintaining self-awareness. It does not explain erratic emotional responses.

B. Countertransference occurs when a nurse projects personal emotions onto a client, leading to overinvolvement (excessive kindness) or negative reactions (hostility). This can affect professional boundaries and care.

C. Transference occurs when a client unconsciously transfers feelings about past relationships onto the nurse (e.g., treating the nurse as a parental figure). This is the reverse of countertransference.

D. Professional competency refers to maintaining clinical skills and ethical behavior. Displaying inconsistent emotional responses toward a client is not an example of competency.

A. “You only need to provide a copy to your family." B. "Advance directives are not needed for individuals who have a mental illness." C. "Giving you legal advice about advance directives is outside my scope of practice." D. "You should provide a copy to your providers, family members, and lawyer."

Correct Answer is D

Explanation

A. "You only need to provide a copy to your family." While family members should have a copy, they are not the only ones who need it. Healthcare providers and legal representatives should also have access.

B. "Advance directives are not needed for individuals who have a mental illness." Clients with mental illness can and should have advance directives, especially regarding psychiatric treatment preferences.

C. "Giving you legal advice about advance directives is outside my scope of practice." While nurses cannot provide legal advice, they can educate clients on the importance of advance directives and who should receive a copy.

D. "You should provide a copy to your providers, family members, and lawyer." Advance directives should be shared with healthcare providers, family members, and legal representatives to ensure they are followed in case of a crisis.

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A nurse is interviewing a client who states, "I am at a total loss and don't know what to do anymore. I feel hopeless." Which of the following responses should the nurse make?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A supervisor observes inconsistency in the psychiatric-mental health nurse's behavior toward a patient; the nurse is unreasonably concerned, overly kind, or irrationally hostile. The most appropriate explanation is that the nurse is displaying:

Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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