According to Freud's Levels of Awareness, a client experiencing dysfunction of the conscious as part of the mind will have problems with which aspect of memory?

Choice A rationale

The ethical and therapeutic principle of professional boundaries strictly prohibits a nurse from leading a psychotherapy group that a patient in their care attends. The nurse-patient relationship must remain professional; leading a psychotherapy group constitutes a dual relationship, which compromises therapeutic objectivity, introduces conflicts of interest, and violates the ethical standards of professional nursing practice. Such an action requires immediate correction and additional instruction.

Choice B rationale

Daily one-to-one sessions with a psychiatric provider (physician, nurse practitioner) are a common and appropriate component of inpatient psychiatric care. This frequency facilitates daily assessment of mental status, medication effectiveness, and treatment planning adjustments, especially in acute phases. It ensures the provider maintains close oversight of the patient's condition, which is critical for safety and timely intervention in a psychiatric setting.

Choice C rationale

Providing a daily schedule of groups is an expected and therapeutic standard on a psychiatric unit. The structure and predictability of a schedule reduce anxiety and encourage adherence to the therapeutic milieu, which is the purposeful manipulation of the environment to be therapeutic. Group participation is central to learning coping skills and receiving psychoeducation.

Choice D rationale

Active participation in unit activities and groups is a core expectation and a vital aspect of inpatient psychiatric treatment. These activities are designed to facilitate social interaction, improve coping skills, reinforce psychoeducation, and structure the patient's day, aligning with the principles of milieu therapy and recovery-oriented care.

Choice A rationale

While a "no self-harm" contract can be a useful tool for enhancing patient accountability and commitment to safety, it is a secondary intervention. Given the immediate, high-risk behaviors associated with poor judgment and impulsivity in ADHD, a contract alone does not provide the necessary physical protection or immediate external control required to prevent potential harm, which necessitates continuous direct observation.

Choice B rationale

Assigning a staff member to one-to-one observation is the highest priority intervention for an individual with poor judgment, high risk-taking behaviors, and impulsivity, as it provides constant, direct visual monitoring. This crucial measure prevents the adolescent from acting on sudden, uncontrolled urges to self-harm or engage in dangerous behaviors, ensuring immediate physical safety until the risk level is professionally reassessed by the multidisciplinary treatment team.

Choice C rationale

Frequent discussions are valuable for building therapeutic rapport and exploring underlying psychological factors, coping mechanisms, and alternative behaviors. However, this is a longer-term, insight-oriented strategy that is secondary to the immediate need for physical safety. It does not, by itself, mitigate the acute risk posed by severe impulsivity and poor judgment.

Choice D rationale

Locked seclusion is a form of physical restraint and is a last-resort intervention used only when a patient presents an imminent, extreme danger to self or others and less restrictive measures have failed. Given the scenario, continuous observation (Choice B) is a more therapeutic, less restrictive, and highly effective safety measure, making seclusion an inappropriate initial priority.