A nurse assesses a confused older adult. The nurse experiences sadness and reflects, “The patient is like one of my grandparents… so helpless.” What feelings does the nurse describe?

Defensive coping reaction

The presence of countertransference

The presence of transference

Catastrophic reaction

Answer and Explanation

The Correct Answer is B

Choice A reason: Defensive coping involves mechanisms like denial to manage stress, not personal emotional connections to a patient. The nurse’s sadness reflects personal feelings, not a defense against anxiety. This term does not apply to the nurse’s emotional response to the patient’s condition or perceived helplessness.

Choice B reason: Countertransference occurs when a nurse projects personal feelings, like sadness, onto a patient due to similarities with personal experiences (e.g., grandparents). This emotional response can influence care if not managed, as it stems from the nurse’s unresolved feelings, making it the accurate description of the situation.

Choice C reason: Transference involves the patient projecting feelings onto the nurse, not the nurse’s emotions about the patient. The scenario describes the nurse’s feelings, not the patient’s, making transference inapplicable. The nurse’s sadness reflects personal emotional involvement, not a patient-driven dynamic.

Choice D reason: Catastrophic reaction refers to a patient’s exaggerated emotional response to stress, often in dementia, not the nurse’s feelings. The nurse’s sadness is a personal emotional reaction, not a patient behavior, making this term irrelevant to the described situation of the nurse’s emotional reflection.

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Correct Answer is C

Explanation

Choice A reason: Informing the client about potential nurse reprimands is coercive and inappropriate, as it prioritizes the nurse’s interests over patient autonomy. This approach fails to explore the client’s reasons for refusal, which may involve side effects or mistrust, and does not support therapeutic communication or ethical care.

Choice B reason: Documenting refusal is necessary but not the first action. Exploring the reason for refusal allows the nurse to address concerns, potentially resolving issues like misunderstanding or side effects. Documentation follows after attempts to understand and educate, ensuring a therapeutic approach before recording the refusal.

Choice C reason: Asking the reason for refusal respects autonomy and initiates therapeutic communication. It identifies barriers like side effect fears or lack of understanding, enabling education or alternative solutions. This approach aligns with patient-centered care, addressing underlying issues to promote adherence while respecting the client’s rights.

Choice D reason: Stating that refusal is not permitted is coercive and violates autonomy. Clients have the right to refuse medication unless under involuntary treatment orders. This approach damages trust, escalates resistance, and contradicts ethical principles, making it an inappropriate initial response to medication refusal.

A. Supporting neighborhood watch programs B. Taking meals at the food bank C. Participation in treatment D. Safe living environment

Correct Answer is C

Explanation

Choice A reason: Neighborhood watch programs enhance community safety but do not directly address mental health needs. They lack therapeutic components to manage symptoms or prevent decompensation, which are critical for preventing readmission in clients with mental health disorders, making this factor less relevant to sustained community stability.

Choice B reason: Taking meals at a food bank addresses nutritional needs but does not directly support mental health stability. While nutrition is important, it does not provide the therapeutic interventions or coping strategies needed to manage mental health disorders and prevent relapse or hospital readmission.

Choice C reason: Participation in treatment, such as therapy or medication adherence, directly addresses mental health symptoms, improving coping skills and emotional regulation. Consistent treatment reduces relapse risk, enhances stability, and supports community integration, making it the most effective factor for preventing readmission in clients with mental health disorders.

Choice D reason: A safe living environment reduces stress and safety risks but is secondary to active treatment. Without ongoing therapy or medication, environmental safety alone cannot manage symptoms or prevent decompensation, making it less critical than treatment participation for maintaining community stability and avoiding readmission.

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A nurse assesses a confused older adult. The nurse experiences sadness and reflects, “The patient is like one of my grandparents… so helpless.” What feelings does the nurse describe?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assigned to administer oral medications to a client. Which action will the nurse do first if a client refuses to take prescribed oral medications?

Correct Answer is C

Explanation

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Correct Answer is C

Explanation

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A nurse assesses a confused older adult. The nurse experiences sadness and reflects, “The patient is like one of my grandparents… so helpless.” What feelings does the nurse describe?