At the last contracted visit in the crisis, intervention clinic, an adult says "I’ve emerged from this a stronger person,You helped me get life back in balance. The nurse responds,"I think we should have two or more sessions to explore why your reactions were so intense." Which analysis applies?
The nurse is having difficulty terminating the relationship
The patient is experiencing transference
The patient demonstrates need for continuing support
The nurse is empathizing with the patient's feelings of dependency
The Correct Answer is A
Reasoning:
Choice A reason: The patient’s statement indicates that they have reached the goals of crisis intervention: achieving balance and a sense of strength. By suggesting more sessions to explore "why" (which is long-term therapy, not crisis intervention), the nurse is likely experiencing countertransference and struggling with the planned termination of the relationship.
Choice B reason: Transference occurs when a patient displaces feelings for a significant person from their past onto the nurse. There is no evidence in the patient’s statement of inappropriate emotional displacement; the patient is expressing healthy gratitude and a successful resolution of the crisis, which is the goal of treatment.
Choice C reason: The patient's statement actually suggests the opposite of a need for continuing support. Phrases like "emerged a stronger person" and "back in balance" signal that the patient has regained their pre-crisis level of functioning and is ready to move forward independently, without further clinical intervention.
Choice D reason: The nurse's response does not demonstrate empathy. Instead, it pathologizes the patient's past reactions and attempts to extend the relationship unnecessarily. Empathy would involve validating the patient’s sense of growth and confirming that they are indeed ready to manage their life without further sessions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Reasoning:
Choice A reason: Anorexia nervosa is characterized by restricted energy intake leading to significantly low body weight, an intense fear of gaining weight, and behaviors like wearing layered clothing to hide weight loss or stay warm. Cooking for others while not eating is a common compensatory psychological behavior.
Choice B reason: Eating Disorder Not Otherwise Specified (EDNOS) or Other Specified Feeding or Eating Disorder (OSFED) is used when a patient's symptoms cause significant distress but do not meet the full clinical criteria for anorexia or bulimia. Given the massive weight loss and specific behavioral markers, anorexia is the more precise diagnosis.
Choice C reason: Bulimia nervosa involves recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting or laxative abuse. While weight can fluctuate, bulimic patients typically maintain a weight within or above the normal range, unlike the severe emaciation and 42 kg weight described in this scenario.
Choice D reason: While major depressive disorder can cause significant weight loss due to anorexia (loss of appetite), the specific behavioral patterns of cooking for others and wearing layered clothing to conceal the body are classic hallmark signs of the distorted body image and weight preoccupation found in anorexia nervosa.
Correct Answer is D
Explanation
Reasoning:
Choice A reason: While voluntary patients have the right to request discharge, this response is premature and ignores the nurse's responsibility to assess the patient's safety. Simply allowing them to leave without a formal process or assessment could lead to self-harm or neglect of necessary psychiatric stabilization.
Choice B reason: This statement is technically inaccurate and paternalistic. In most jurisdictions, a voluntary patient has a legal right to request release forms and initiate the discharge process. The nurse cannot unilaterally block access to these forms based solely on the absence of a doctor’s prior permission.
Choice C reason: This response is too passive and fails to perform a necessary clinical assessment. Before initiating discharge paperwork, the nurse must engage the patient to determine if they are experiencing an acute crisis, a change in mental status, or if they pose a danger to themselves or others.
Choice D reason: This is the best response because it acknowledges the patient's legal right to the forms while fulfilling the nurse's clinical role. It allows for a therapeutic dialogue to explore the patient's reasons for leaving, evaluate their current mental status, and ensure they are safe for discharge.
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