A nurse manager and a newly licensed nurse are engaged in an interview with a client. The newly licensed nurse tells the client, "You look like my sister. I love my sister and would do anything for her." Which of the following actions should the nurse manager take?
Inform the newly licensed nurse that they are successfully building trust and rapport.
Ask the newly licensed nurse if they are comfortable providing care to the client.
Record that the newly licensed nurse is able to maintain professional nurse-client boundaries.
Assign the newly licensed nurse to a different client.
The Correct Answer is D
A. Inform the newly licensed nurse that they are successfully building trust and rapport. While therapeutic communication is essential, personalizing the interaction in this way crosses professional boundaries. Comparing a client to a family member can create unrealistic expectations and blur the nurse-client relationship. Maintaining professional distance ensures objective and ethical care.
B. Ask the newly licensed nurse if they are comfortable providing care to the client. While assessing a nurse’s comfort level is important, it does not address the boundary violation. The concern is not about the nurse's comfort but about maintaining professionalism in client interactions. Direct intervention is needed to correct the inappropriate statement and reinforce professional conduct.
C. Record that the newly licensed nurse is able to maintain professional nurse-client boundaries. The statement made by the newly licensed nurse demonstrates a boundary issue rather than professionalism. Nurses should establish rapport without over-identification with clients. Documenting that the nurse maintained boundaries would be inaccurate and fail to address the issue.
D. Assign the newly licensed nurse to a different client. The statement suggests an emotional attachment that may interfere with objective care. Reassigning the nurse prevents further boundary issues and allows for education on maintaining professionalism. Ensuring appropriate nurse-client relationships promotes ethical practice and patient-centered care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Serotonin. Serotonin plays a crucial role in regulating sleep, memory, and concentration. Low serotonin levels are associated with sleep disturbances, cognitive impairments, and mood disorders such as depression, which can further exacerbate difficulties with memory and focus.
B. Histamine. Histamine primarily regulates wakefulness and alertness but is not the primary neurotransmitter involved in sleep dysregulation, memory, and concentration. While histamine imbalance can contribute to sleep disturbances, it is more commonly linked to allergic responses and arousal states.
C. Dopamine. Dopamine is involved in motivation, reward, and motor control. While dopamine dysfunction can lead to cognitive issues, it is more closely associated with disorders such as Parkinson’s disease and schizophrenia rather than sleep dysregulation and poor memory.
D. Norepinephrine. Norepinephrine is a key neurotransmitter in the body's stress response and alertness regulation. While it influences attention and arousal, its dysregulation is more commonly linked to anxiety and hypervigilance rather than the described symptoms.
Correct Answer is C
Explanation
A. "Do you need any more resources or information?" This question focuses on offering additional resources rather than encouraging the client to explore their emotions. While it is useful for providing support, it does not promote self-reflection or invite the client to clarify their feelings. Therapeutic communication should aim to encourage deeper discussion rather than just addressing practical needs.
B. "Do you understand your next step in treatment?" Although this question ensures the client comprehends their treatment plan, it does not foster emotional expression or self-awareness. Understanding the next steps in care is important, but therapeutic communication should focus on exploring the client’s internal experiences rather than just confirming information. Encouraging open-ended reflection is more effective for clarifying emotions.
C. "You feel like you have the support needed to be successful." This statement encourages self-reflection and allows the client to clarify their feelings about their support system. It promotes therapeutic communication by inviting the client to assess their emotional needs and level of confidence. Open-ended statements like this help build trust and provide insight into the client’s concerns and perceptions.
D. "Tell me what kind of coping skills you have." While this question assesses the client's coping strategies, it does not directly facilitate emotional clarification. Asking about coping skills is useful for intervention planning, but it does not specifically address the client’s feelings. A more effective therapeutic approach would involve asking how the client feels about their ability to manage stress.
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