A nurse is caring for a newly admitted female client who has depression and refuses to get out of bed, dress, or participate in group therapy. Which of the following is an appropriate nursing response?

"I will assist you in getting out of bed and getting dressed."

"You can remain in bed until you feel well enough to join the milieu."

"The unit rules state that clients may not remain in bed."

"If you don't participate in your care, you will not get better."

Answer and Explanation

The Correct Answer is A

The response "I will assist you in getting out of bed and getting dressed" demonstrates a supportive and therapeutic approach. It acknowledges the client's current state and offers assistance to engage in self-care activities. By providing support and actively participating in the client's care, the nurse can promote motivation, engagement, and a sense of empowerment.

The response "You can remain in bed until you feel well enough to join the milieu" may enable the client's depressive behaviors and reinforce the avoidance of activities. It does not encourage participation or provide support for the client to engage in therapeutic activities.

The response "The unit rules state that clients may not remain in bed" focuses on enforcing rules rather than addressing the client's underlying emotional state and needs. It may increase resistance and hinder the therapeutic relationship.

The response "If you don't participate in your care, you will not get better" may be perceived as blaming or judgmental. It may increase the client's guilt or sense of failure and does not provide practical support or encouragement.

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Correct Answer is C

Explanation

Involuntary commitment refers to the legal process by which an individual is admitted to a psychiatric facility for treatment against their will. The decision to involuntarily commit someone is typically based on the assessment that their behavior poses a risk of harm to themselves or others. Therefore, it is important for the nurse to inform the client's family that the reason for the involuntary commitment is the client's behavior being a threat to their own safety or the safety of others.

A."A psychiatrist determines that the client's behavior is irrational." This statement is incorrect because irrational behavior alone is not sufficient grounds for involuntary commitment.

Involuntary commitment is typically based on the assessment that the individual's behavior poses a risk of harm to themselves or others, rather than solely on the basis of irrational behavior.

B. "The client is unable to manage the affairs necessary for daily life." While the inability to manage daily affairs may be a factor considered in the overall assessment of a client's condition, it is not the sole criterion for involuntary commitment. Involuntary commitment is primarily focused on the risk of harm posed by the individual's behavior, rather than their ability to manage daily life tasks.

D. "The client has been accused of breaking the law." Accusations of breaking the law are not the basis for involuntary commitment. Involuntary commitment is based on the assessment that the individual's behavior presents a risk of harm to themselves or others. Legal issues are addressed separately through the legal system and are not directly related to the criteria for involuntary commitment.

A. “I know you will do well living out in the community." B. "I will send you a note in a few weeks." C. "Aren't you excited about being discharged today?" D. "How do you feel about being discharged?"

Correct Answer is D

Explanation

Asking the client how they feel about being discharged encourages open communication and provides an opportunity for the client to express their emotions and thoughts about leaving the

hospital. It shows that the nurse values the client's perspective and allows for further discussion and support if needed. This response promotes client-centered care and acknowledges the client's experience during the hospitalization.

The other options are less appropriate:

A. "I know you will do well living out in the community" assumes the client's feelings and may not accurately reflect their experience or emotions about the discharge.

B. "I will send you a note in a few weeks" focuses on the nurse's future action rather than actively engaging with the client's expression of gratitude.

C. "Aren't you excited about being discharged today?" assumes the client's emotional state and may not consider the potential range of emotions the client could be experiencing.

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A nurse is caring for a newly admitted female client who has depression and refuses to get out of bed, dress, or participate in group therapy. Which of the following is an appropriate nursing response?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client who has been admitted Involuntarily for psychiatric treatment. Which of the following Information about involuntary commitment should the nurse provide the client's family?

Correct Answer is C

Explanation

A nurse is caring for a client with whom he has developed a therapeutic relationship and who will be discharged later in the day. The client thanks the nurse for his help during the hospitalization. Which of the following responses should the nurse make?

Correct Answer is D

Explanation

A nurse is caring for a client following the recent, sudden death of his partner. The client says, "I feel paralyzed and can't seem to cope with work or family responsibilities anymore." Which of the following types of crisis is the client demonstrating?

A nurse observes that a client is sitting alone in her room crying. As the nurse approaches, she states, "I'm feeling really down and don't want to talk to anyone right now." Which of the following responses is appropriate for the nurse?

A nurse on a mental health unit is assisting with several group therapy sessions. The nurse should include which of the following Information about using group therapy as a treatment method?

A nurse is helping a client relieve stress through cognitive reframing. Which of the following actions by the client demonstrates effective use of cognitive reframing?

A nurse is assisting with the court-ordered admission of a client to a substance-abuse program. The client states, "You are all angry at me and wish you could go out and have a drink." The client's response is an example of which of the following defense mechanisms?

A nurse is caring for an older adult client who has a fractured hip. The client says, "I guess I've lived long enough and my time is up." Which of the following responses should the nurse make?

A nurse on an inpatient mental health unit is caring for a group of clients. Which of the following actions by the nurse demonstrates the ethical concept of autonomy?