A nurse manager is teaching a newly licensed nurse about pain management for an older adult client. Which of the following statements by the nurse indicates an understanding of the teaching?

Rationale:

• Client has initiated a daily exercise routine: This indicates self-motivation, structured routine, and engagement in positive coping behaviors, all of which are therapeutic goals in managing schizophrenia.
• Client utilizes deep breathing techniques as needed: Use of self-regulation techniques like deep breathing suggests the client is managing anxiety and stress proactively.
• Client has joined a local support group: Participation in social support groups improves social functioning and decreases isolation, a common issue in schizophrenia.
• Client has been reading books about their illness: Demonstrates insight, knowledge-seeking behavior, and a willingness to understand and manage the condition, which aligns with psychoeducation goals.
• Client participates in cognitive-behavioral therapy sessions with their mental health provider: Engagement in CBT is a strong indicator of therapeutic alliance and compliance with structured treatment plans aimed at cognitive restructuring and behavioral management.

Rationale for Incorrect Finding:

• Client reports spending most of their time alone in their apartment: Although some solitude is not unusual, spending most of the time alone may indicate ongoing social withdrawal, a negative symptom of schizophrenia, and a barrier to full community reintegration.
• Client reports drinking 4 to 5 cups of coffee each morning: Excessive caffeine can worsen anxiety, interfere with sleep, and interact with psychiatric medications, so this behavior does not align with optimal treatment outcomes.

Rationale:

A. "Your family disagrees with your decision?": This open-ended response reflects therapeutic communication by encouraging the client to express her feelings without judgment. It invites further discussion and shows the nurse’s support for the client’s autonomy and emotional well-being.

B. "Did you tell your provider that your family doesn't agree with your decision?": This response shifts focus away from the client's emotional conflict and places it on the provider. It may dismiss the client’s current need for support and hinder further emotional exploration.

C. "You are making the same decision I would make.": Personalizing the conversation undermines client autonomy. The nurse’s role is to support the client’s decision-making process, not impose personal opinions or make assumptions about what is best.

D. "You should get your family to agree with your decision before signing the consent.": This response suggests the client must yield to family opinions, which contradicts the principle of informed consent. The decision is ultimately the client’s, and family agreement is not a legal or ethical requirement.