A client diagnosed with schizophrenia, on an inpatient unit, approaches a nurse, stating, "Someone took my dinner! People need to respect others, and you need to do something about this now!" Which response by the nurse is guided by the basic assumption of the therapeutic milieu?
"I can see that you are upset. Let's talk about ways to resolve this."
I'll fix this right away. You need to calm down."
"Let's find a way to avoid this conflict in the future."
"You should bring this up during group therapy later this week."
The Correct Answer is A
a. "I can see that you are upset. Let's talk about ways to resolve this." This is correct because it validates the client's feelings, encourages problem-solving, and maintains the therapeutic milieu's principles of respect and support.
b. "I'll fix this right away. You need to calm down." This response does not encourage the client’s participation in resolving the issue and does not foster the therapeutic milieu's goal of client empowerment.
c. "Let's find a way to avoid this conflict in the future." While this promotes future problem-solving, it does not address the immediate concern or validate the client's current feelings.
d. "You should bring this up during group therapy later this week." This delays addressing the client's immediate concerns and might make the client feel unheard.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
a. Altered thought processes; call an emergency treatment team meeting. While altered thought processes are present, the urgent concern is the command hallucination directing the client to harm the psychiatrist. An emergency treatment team meeting may not provide the immediate intervention required.
b. Command hallucinations; warn the psychiatrist. This is correct because the client is experiencing command hallucinations that pose a direct threat to the psychiatrist. The nurse has a duty to warn the potential victim and ensure the safety of both the client and others.
c. Persecutory delusions; orient the client to reality. Persecutory delusions are present, but the immediate danger from the command hallucinations takes precedence. Orienting the client to reality does not address the urgent safety issue.
d. Magical thinking; administer an antipsychotic medication. Magical thinking is not the correct symptom here. Administering medication is part of treatment but does not address the immediate safety concern.
Correct Answer is A
Explanation
a. Recovery from anorexia nervosa is a marathon, not a sprint. Setting small, achievable goals like understanding the importance of nutrition is crucial for initial progress.
b. Aiming for immediate, perfect dietary adherence is unrealistic and can be discouraging. Building healthy eating habits takes time and support.
c. Unrealistic weight gain goals can be demotivating and potentially harmful. Weight gain should be gradual and monitored by a healthcare professional.
d. A sudden high-calorie diet can be overwhelming for someone with a restricted eating pattern and could lead to gastrointestinal distress.
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