The PMHNP has been working with a 28-year-old unmarried male client who has been late for his last three appointments. At this appointment, the nurse practitioner tells him he will need to reschedule if he runs late again. The client becomes upset and says this is why he has a hard time trusting medical professionals. “It's all about money, you don't really care about your patients.” What is the most appropriate response?
“If everyone ran late, I would never get to go home and see my family.”
“I must maintain a set schedule so that I can care for all of my patients.”
“This all goes back to your issues with being abandoned as a child.”
“The next time you are late, I will have to cut your appointment short.”
The Correct Answer is B
Choice A reason: This response shifts the focus to the clinician’s personal life and may come across as dismissive or lacking empathy. It does not validate the client’s concerns or maintain therapeutic boundaries.
Choice B reason: This response is professional, empathetic, and maintains boundaries. It explains the rationale for scheduling without being defensive or judgmental. It also communicates fairness and respect for all clients, which helps preserve the therapeutic alliance.
Choice C reason: This response is overly interpretive and risks pathologizing the client’s behavior without adequate context. It may feel intrusive and could damage rapport.
Choice D reason: This response is punitive and lacks empathy. It may reinforce the client’s mistrust and escalate the situation rather than de-escalate it.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Locked roles refer to rigid, repetitive patterns of behavior within family systems that limit flexibility and growth. While they may be present, they do not specifically describe the shifting alliances or coalitions seen in this scenario.
Choice B reason: Triangles are a concept from Bowenian family therapy describing a three-person relationship system. When tension arises between two people, a third is often drawn in to stabilize the relationship. The described alliances—mother and daughter vs. father, and father and son vs. mother—are classic examples of triangulation used to manage family stress.
Choice C reason: Intergenerational dysfunction refers to patterns of behavior, trauma, or relational issues passed down through generations. While it may underlie the current dynamics, it does not specifically describe the immediate alliance patterns observed in the session.
Choice D reason: Enactments are therapeutic techniques where family members act out roles or scenarios to reveal underlying dynamics. The alliances described are not enactments initiated by the therapist but naturally occurring relational patterns.
Correct Answer is B
Explanation
Choice A reason: While melatonin is generally considered safe for short-term use, it has clinically significant interactions with several medications, including immunosuppressants. It can stimulate immune function, which may counteract the effects of immunosuppressive therapy. Therefore, this response is overly dismissive and potentially unsafe.
Choice B reason: Melatonin can interfere with immunosuppressive therapy by enhancing immune activity, which is counterproductive in conditions like rheumatoid arthritis where immunosuppression is often necessary. This makes it contraindicated or at least a cautionary supplement in such contexts. The PMHNP should recognize this and advise accordingly.
Choice C reason: While deferring to the primary care provider may seem prudent, the PMHNP is qualified to assess drug interactions and should take responsibility for evaluating the safety of melatonin in this context. This response lacks clinical assertiveness.
Choice D reason: Suggesting a benzodiazepine as a replacement for melatonin without assessing the client’s full psychiatric and medical profile is inappropriate. Benzodiazepines carry risks of dependence and sedation and are not a direct substitute for melatonin in most cases.
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