A mental health nurse is assessing a client who reports an increase in anxiety. Which of the following responses should the nurse make?
"Do you think your anxiety is worse than everyone else's?"
"It doesn't appear as though you are feeling anxious."
"Tell me what has been happening lately."
"I think you should see a therapist and a doctor tomorrow.".
The Correct Answer is C
Choice A, "Do you think your anxiety is worse than everyone else's?", is invalidating and minimizes the client's experience. Comparing their anxiety to others is unhelpful and could further distress the client.
Choice B, "It doesn't appear as though you are feeling anxious.", is dismissive and ignores the client's self-report. This dismissive response could damage the therapeutic relationship and discourage the client from sharing openly.
Choice D, "I think you should see a therapist and a doctor tomorrow.", is directive and potentially premature. While suggesting mental health resources can be helpful, it's crucial to first understand the client's situation and preferences before making recommendations. Additionally, suggesting both a therapist and a doctor without further assessment might overwhelm the client.
Choice C, "Tell me what has been happening lately.", is an open-ended and validating that encourages the client to share their experiences and concerns. This shows the nurse is actively listening and creates a safe space for the client to explore their anxiety. By understanding the context and potential triggers, the nurse can then provide more tailored support and guidance.
Further rationale for Choice C:
Open-ended s are key tools in therapeutic communication. They promote client engagement, facilitate exploration of thoughts and feelings, and gather valuable information needed for assessment and planning.
Validating the client's experience is crucial in building trust and rapport. Recognizing and acknowledging their anxiety shows the nurse cares and is taking their concerns seriously.
This initial allows the client to guide the conversation, focusing on aspects they feel most comfortable sharing. This empowers the client and promotes autonomy.
Following the client's lead in the conversation also helps the nurse gather specific details about the nature and severity of the anxiety, informing subsequent assessment and intervention strategies.
In conclusion, Choice C, "Tell me what has been happening lately.", is the most appropriate response for a mental health nurse to use when assessing a client who reports an increase in anxiety. It demonstrates active listening, validates the client's experience, encourages engagement, and provides a foundation for further assessment and support.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale: Identifying triggers for anxiety reactions is a crucial part of managing chronic anxiety. By recognizing what situations, thoughts, or feelings provoke anxiety, the client can begin to develop coping strategies to handle these triggers effectively. This approach is often used in cognitive-behavioral therapy, which is a common treatment for anxiety disorders.
Choice B rationale: While contacting a crisis counselor can be helpful in acute situations, it may not be necessary for a client with chronic anxiety to do so on a weekly basis. Regular therapy sessions with a mental health professional would likely be more beneficial, as they can provide ongoing support and help the client develop long-term coping strategies.
Choice C rationale: It’s unrealistic and unfeasible to completely eliminate stress and anxiety from daily life. Stress is a normal part of life, and everyone experiences it to some degree. Instead, the focus should be on managing stress and anxiety effectively through techniques such as relaxation exercises, mindfulness, and cognitive-behavioral strategies.
Choice D rationale: Trying to repress feelings of anxiety can actually exacerbate them. It’s important for individuals with anxiety disorders to acknowledge their feelings and learn how to manage them, rather than trying to suppress them. Repression can lead to increased anxiety and other mental health issues over time.
Correct Answer is B
Explanation
Choice A rationale: Dissociation is a defense mechanism where a person disconnects from reality, memory, identity, or perception. It is often a response to trauma and can result in a detachment from emotional and physical experiences. The client’s behavior does not indicate a disconnection from reality or self.
Choice B rationale: Regression is a defense mechanism where an individual reverts to an earlier stage of development in response to stress or anxiety. In this case, the client’s behavior of wanting someone to take care of them can be seen as a regression to a childlike state of dependency, which is a common response to overwhelming stress or anxiety.
Choice C rationale: Introjection is a defense mechanism where a person internalizes the ideas or voices of other people- often authority figures. This is not evident in the client’s behavior.
Choice D rationale: Repression is a defense mechanism where a person unconsciously blocks out distressing thoughts or feelings. In this scenario, the client is expressing their feelings of stress rather than repressing them.
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