A nurse in a mental health facility is caring for a client who is upset about the loss of privileges due to repetitive negative behavior. Which of the following statements by the nurse demonstrates the effective use of assertive communication?

"Why did you make the choice to behave negatively?”

"You need to calm down and forgive me before discussing this matter any further.”

"You were made aware of the consequences of negative behavior so you better go to your room.”

"I understand that you are angry. However, I followed the appropriate protocol.”

Answer and Explanation

The Correct Answer is D

Choice A rationale:

This response uses a confrontational tone and places blame on the client for their behavior, which is not an example of assertive communication. It can potentially escalate the situation and hinder effective communication.

Choice B rationale:

This statement is authoritarian in nature, using phrases like "you need to" and "forgive me," which can further upset the client and create a power struggle. It lacks empathy and understanding, making it ineffective for assertive communication.

Choice C rationale:

While this response acknowledges the consequences of the client's negative behavior, it uses commanding language ("you better go to your room"), which can be perceived as aggressive and may escalate the situation instead of facilitating effective communication.

Choice D rationale:

This statement is the most effective example of assertive communication. It acknowledges the client's feelings ("I understand that you are angry") while also asserting the nurse's adherence to protocol. This response demonstrates empathy, understanding, and a willingness to address the client's emotions in a non-confrontational manner.

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Correct Answer is D

Explanation

Choice A rationale:

Administering medication to sedate the client is not the appropriate initial action. The client's confusion and restlessness could be due to various factors, and administering sedative medication without identifying the cause of these symptoms could lead to adverse effects or mask underlying issues.

Choice B rationale:

Calling the family to stay with the client might provide emotional support, but it doesn't directly address the client's safety needs. The client's increasing confusion and restlessness require a more immediate intervention to ensure their safety.

Choice C rationale:

Applying wrist and leg restraints should be a last resort and is not the appropriate initial action in this situation. Restraints should only be used if less restrictive interventions have failed and the client's safety is at risk. Restraints can lead to complications such as decreased mobility, skin breakdown, and increased agitation.

Choice D rationale:

Correct Choice Moving the client to a room closer to the nurses' station is the most appropriate action in this scenario. This intervention helps to increase the client's visibility and proximity to nursing staff, making it easier to monitor and address their needs promptly. It also promotes a safer environment while allowing the healthcare team to assess the underlying causes of the restlessness and confusion.

A. Services aimed at reducing the residual defects that are associated with severe and persistent mental illness. B. Interventions aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of the illness. C. Services aimed at reducing the incidence of mental disorders within the population. D. Accomplished through early identification of problems and prompt initiation of effective treatment.

Correct Answer is C

Explanation

Choice A rationale:

This choice describes tertiary prevention, which focuses on minimizing the consequences of an existing disorder or preventing further deterioration. It is not directly related to primary prevention, which addresses the prevention of the onset of disorders.

Choice B rationale:

This choice corresponds to secondary prevention, which involves early intervention to minimize the impact of an illness that has already begun. It aims to reduce the prevalence and duration of the illness but is not the primary focus of primary prevention.

Choice C rationale:

The correct choice. Primary prevention focuses on reducing the incidence of mental disorders within the population. It involves strategies that target the entire population or specific high-risk groups to prevent the initial development of mental health issues. These strategies may include public health campaigns, education, and interventions to promote mental well-being and resilience.

Choice D rationale:

This choice describes the process of early identification and initiation of treatment, which is a component of secondary prevention. It aims to prevent the progression of existing problems rather than preventing the initial development of mental disorders.

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A nurse in a mental health facility is caring for a client who is upset about the loss of privileges due to repetitive negative behavior. Which of the following statements by the nurse demonstrates the effective use of assertive communication?

Nursing Test Bank

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