As the discharge date for a client to leave gets closer, the client states, “I’m afraid to leave here. I’m afraid for my well-being and safety.” Which nursing statement is most supportive?

“This is a difficult transition. Let’s formulate a plan to keep you feeling safe.”

“It’s the policy that patients can only live here for 30 days. Let’s try to extend it.”

“You’ve had a month to come up with a plan to work on your well-being.”

“Hopefully you learned from being in counseling. I’m sure this will work out fine.”

Answer and Explanation

The Correct Answer is A

Choice A Reason:

“This is a difficult transition. Let’s formulate a plan to keep you feeling safe.”

This response is the most supportive because it acknowledges the client’s feelings and offers a proactive solution. By recognizing the difficulty of the transition and suggesting a plan to ensure the client’s safety, the nurse provides reassurance and practical support. This approach helps to build trust and shows empathy, which is crucial in a therapeutic relationship.

Choice B Reason:

“It’s the policy that patients can only live here for 30 days. Let’s try to extend it.”

While this response acknowledges the client’s fear, it focuses on policy rather than addressing the client’s immediate emotional needs. Extending the stay might not be feasible or beneficial in the long term. The primary goal should be to empower the client to feel safe and supported outside the facility.

Choice C Reason:

“You’ve had a month to come up with a plan to work on your well-being.”

This response can come across as dismissive and unsupportive. It implies that the client should have already resolved their fears, which may increase their anxiety and feelings of inadequacy. The focus should be on providing immediate support and reassurance rather than criticizing the client’s progress.

Choice D Reason:

“Hopefully you learned from being in counseling. I’m sure this will work out fine.”

This response is overly optimistic and does not address the client’s current fears. It provides false reassurance without offering any concrete support or solutions. The client needs to feel heard and supported, not just reassured that everything will be fine.

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Correct Answer is ["600"]

Explanation

Step 1: Identify the total volume to be infused.

Total volume = 250 mL

Step 2: Identify the total time for infusion.

Total time = 25 minutes

Step 3: Calculate the rate in mL per minute.

Rate = Total volume ÷ Total time
Rate = 250 mL ÷ 25 minutes
Rate = 10 mL per minute

Step 4: Convert the rate to mL per hour.

Since there are 60 minutes in an hour, multiply the rate by 60.
Rate per hour = 10 mL per minute × 60
Rate per hour = 600 mL per hour

The nurse should program the pump to infuse at a rate of 600 mL per hour.

A. I may consider dating you once you have fully recovered. B. It’s against hospital policy for me to date clients. C. This is a professional relationship, and we need to be clear on that. D. I’m sorry, but I’m married and not interested in dating.

Correct Answer is C

Explanation

Choice A Reason:

This response is inappropriate as it blurs the professional boundaries between the nurse and the client. Nurses are expected to maintain a professional relationship with their clients to ensure that care is provided in an ethical and unbiased manner. Suggesting a potential future relationship can lead to misunderstandings and compromise the therapeutic relationship.

Choice B Reason:

While this response correctly states hospital policy, it does not address the underlying issue of maintaining professional boundaries. It is important for the nurse to communicate the need for a professional relationship clearly and directly. Simply citing policy may not fully convey the importance of these boundaries to the client.

Choice C Reason:

This response is the most appropriate because it clearly establishes the professional nature of the nurse-client relationship. It helps the client understand that the nurse’s role is to provide care and support within a professional framework. This clarity is essential for maintaining trust and ensuring that the therapeutic relationship remains effective and ethical.

Choice D Reason:

Although this response sets a personal boundary, it does not address the professional aspect of the nurse-client relationship. The nurse’s marital status is irrelevant to the professional boundaries that need to be maintained. It is more important to emphasize the professional nature of the relationship rather than personal reasons for declining the request.

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As the discharge date for a client to leave gets closer, the client states, “I’m afraid to leave here. I’m afraid for my well-being and safety.” Which nursing statement is most supportive?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A patient with fluid volume deficit must receive a 250 mL IV bolus of NS over 25 minutes via a peripherally inserted central line (PICC) on an IV pump. At what rate will the nurse program the pump? Round to the nearest whole number. Do not use trailing zeros.

Correct Answer is ["600"]

Explanation

A young client asks the nurse for their telephone number, with the intent of calling to schedule a date. Which of the following responses would be most appropriate?

Correct Answer is C

Explanation

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