Which assessment finding most clearly indicates that a client may be experiencing a mental illness?

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

Telling the interrupting patient, "I am not available to talk with you at the present time," abruptly dismisses their expressed need. While setting boundaries is important for maintaining the therapeutic contract with the current patient, this response fails to acknowledge the interrupting patient's concern or provide a clear expectation for when the nurse will be available, which can escalate their anxiety or distress. It lacks therapeutic closure.

Choice B rationale

Inviting the interrupting patient to join the current session immediately violates the established therapeutic contract and the confidentiality of the current patient-nurse relationship. The current patient is entitled to their privacy and uninterrupted time. The unexpected introduction of a third party fundamentally alters the therapeutic environment, potentially halting any progress made toward developing trust or communication with the patient who has been mostly silent.

Choice C rationale

Ending the unproductive session prematurely and spending time with the interrupting patient completely violates the principle of fidelity to the existing therapeutic relationship with the current patient. Even if the current session has been mostly silent, the nurse is committed to the agreed-upon time frame. Terminating early teaches the current patient that their time is disposable and that their needs can be easily overridden by others, damaging therapeutic trust.

Choice D rationale

Stating, "This session has 5 more minutes; then I will talk with you," is the most appropriate response as it simultaneously maintains therapeutic boundaries and fidelity to the current patient's remaining time while also acknowledging the interrupting patient's expressed need. This response sets a clear, immediate expectation and time boundary for the interrupting patient, reducing anxiety and validating their concern without violating the contract with the current patient.