Hildegard Peplau came up with the phases of the nurse-patient relationship. What does the nurse address during the orientation phase with a patient diagnosed with a psychiatric disorder?

Choice A reason: A provider giving a telephone order is a standard practice in healthcare, not inherently requiring reporting unless the order is unsafe. It does not indicate negligence or ethical violations, unlike impaired practice or boundary issues, making it incorrect for mandatory intervention and reporting.

Choice B reason: A peer under the influence of alcohol compromises patient safety due to impaired judgment and coordination, a serious ethical and professional violation. Nurses are obligated to report such behavior to protect patients, aligning with nursing ethics and safety protocols, making this a correct choice.

Choice C reason: Violating relationship boundaries with a patient, such as inappropriate personal interactions, breaches ethical standards and risks patient harm. Nurses must report this to ensure patient safety and maintain professional integrity, aligning with mental health care ethics, making this a correct choice.

Choice D reason: A licensed provider prescribing medication is a routine clinical action, not requiring reporting unless the prescription is unsafe or inappropriate. This choice does not inherently indicate a need for intervention, unlike impaired practice or boundary violations, making it incorrect.

Choice A reason: Electroconvulsive therapy (ECT) is reserved for severe, treatment-resistant depression or acute suicidal ideation, not general hopelessness. It involves significant risks and requires specialist oversight, making it inappropriate as a first-line intervention for this symptom, which can be addressed with less invasive methods.

Choice B reason: Cognitive behavioral therapy (CBT) targets negative thought patterns, such as hopelessness, by restructuring cognitions, a core feature of depression. Evidence-based for mood disorders, CBT reduces symptoms through structured interventions, making it the most appropriate choice for addressing hopelessness in a mental health assessment.

Choice C reason: High-dose benzodiazepines treat acute anxiety or agitation, not hopelessness, which is a depressive symptom. They risk sedation and dependence without addressing cognitive distortions, making them inappropriate for this symptom and contrary to evidence-based psychiatric nursing practice.

Choice D reason: Avoiding social interactions may worsen hopelessness by increasing isolation, a risk factor for depression. Evidence-based practice encourages social engagement to improve mood and support networks, making this intervention counterproductive and incorrect for addressing the patient’s reported symptom.