A nurse is caring for patients receiving clozapine, lithium, fluoxetine, and venlafaxine. Which patient should the nurse be most alert for problems associated with fluid and electrolyte imbalance?

Choice A reason: Trust versus mistrust occurs in infancy (0–1 year), focusing on trust in caregivers. Failure leads to suspicion, not regret over life accomplishments. This stage is irrelevant to a 52-year-old’s reflections on life achievements, making this choice incorrect for the described crisis.

Choice B reason: Generativity versus stagnation (middle adulthood, 40–65 years) involves contributing to society versus feeling unproductive. While related, the woman’s regret over past accomplishments aligns more with reflecting on life’s meaning, typical of a later stage, making this choice less precise.

Choice C reason: Integrity versus despair (late adulthood, 65+ years, but relevant in late middle age) involves reflecting on life’s achievements. Failure leads to despair and regret, matching the woman’s statement about unaccomplished goals, making this the correct choice for her psychosocial crisis.

Choice D reason: Industry versus inferiority (6–12 years) focuses on competence in tasks. Failure leads to feelings of inadequacy in skills, not regret over life’s broader accomplishments. This stage is irrelevant to the woman’s current reflections, making this choice incorrect.

Choice A reason: A neutral attitude in psychiatric nursing maintains professional boundaries and objectivity, preventing bias or emotional entanglement. This fosters a therapeutic environment, allowing patients to express feelings without judgment, aligning with principles of therapeutic communication and mental health care, making this the correct choice.

Choice B reason: Brief check-ins, while useful, may not provide the depth needed for therapeutic care in mental health settings. Consistent, meaningful engagement is more effective for building trust and addressing complex emotional needs, making this approach less optimal compared to maintaining neutrality.

Choice C reason: Discussing a patient’s feelings with another individual risks breaching confidentiality unless authorized by the patient or legally required. This violates ethical standards in mental health care, which prioritize privacy, making this approach non-therapeutic and incorrect for supporting patient care.

Choice D reason: Sharing personal mental health information blurs professional boundaries, potentially shifting focus from the patient’s needs to the nurse’s experiences. This undermines therapeutic communication and objectivity, risking patient trust and care quality, making this approach inappropriate and incorrect.