Which standardized rating scale will the nurse specifically include in the assessment of a newly admitted patient diagnosed with major depressive disorder? (Select all that apply)

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.

Choice A rationale

The working phase is the central phase of the therapeutic relationship, dedicated to problem identification, exploration of stressors, and the development and testing of new coping mechanisms. It is during this phase that the patient's identified issues are intensely explored and resolved as the nurse and patient work collaboratively towards achieving established goals.

Choice B rationale

The preorientation phase occurs before the first face-to-face encounter. The nurse's activities involve data gathering and self-assessment, such as reviewing the patient's chart, understanding the clinical context, and examining their own feelings, to prepare for the interaction. No direct patient issues are explored or resolved here.

Choice C rationale

The orientation phase is the initial period focused on establishing rapport, clarifying roles, setting goals, and establishing a contract for the relationship. While issues are identified, the in-depth work of exploring and resolving those issues has not yet begun; the foundation is merely being laid.

Choice D rationale

The termination phase is the final stage, focusing on summarizing goals achieved, reviewing the experience, and preparing for separation. The primary goal is to conclude the relationship therapeutically and ensure the patient can maintain gains, not to introduce or resolve new major issues.