A nurse is interviewing a client who states, "I am at a total loss and don't know what to do anymore. I feel hopeless." Which of the following responses should the nurse make?
"If you do not like your medications, would you like to try an alternative?"
“You feel like you have no remaining options and are struggling to find a solution."
"Would you like to speak to a therapist after treatment?"
“You would like more information. I will get that for you right away."
The Correct Answer is B
A. "If you do not like your medications, would you like to try an alternative?" This response shifts focus away from the client's emotional state and does not validate their feelings.
B. "You feel like you have no remaining options and are struggling to find a solution." This response uses therapeutic communication by reflecting the client’s emotions, validating their feelings, and encouraging further discussion.
C. "Would you like to speak to a therapist after treatment?" While therapy may be beneficial, this response does not acknowledge the client's feelings in the present moment.
D. "You would like more information. I will get that for you right away." This response assumes the client is seeking information rather than expressing distress.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. The nurse describes what happened by providing general and broad details. Incident reports should be factual, objective, and specific, not general or vague.
B. The nurse includes the client's own words when describing what happened. Including direct quotes from the client ensures accuracy and avoids interpretation or bias.
C. The nurse describes what happened subjectively. Incident reports must be objective, avoiding personal opinions or assumptions.
D. The nurse includes the opinions of other team members. Only document observable facts and direct quotes—opinions should not be included.
Correct Answer is C
Explanation
A. “Clients must always have a family member present during treatment to ensure their rights are protected.” Clients have the right to privacy and do not require a family member’s presence for treatment unless legally mandated (e.g., minors).
B. "Clients cannot be discharged without their consent, even if they are no longer a risk to themselves or others." Clients can be discharged when they are no longer a risk, even if they disagree, unless under a legal hold.
C. "Clients have the right to refuse medication unless a court order mandates it." Clients have the right to refuse treatment unless a court order requires medication for safety or competency.
D. "All client interactions must be recorded, even if they are informal and unrelated to their care plan." Only relevant, objective, and care-related information should be documented, as excessive documentation can violate privacy.
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