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: Trust versus mistrust, Erikson's first psychosocial stage (0–1 year), focuses on developing trust in caregivers for basic needs. Failure leads to fear and suspicion, not feelings of worthlessness or insignificance. These symptoms do not align with the adult’s statements about opinions not counting, making this choice scientifically inaccurate for the described crisis.

Choice B reason: Autonomy versus shame and doubt, Erikson’s second stage (1–3 years), involves gaining independence in actions like self-care. Failure results in shame and self-doubt about autonomy, not a broader sense of worthlessness or lack of influence. This stage is unrelated to the adult’s expressed feelings, rendering this choice incorrect.

Choice C reason: Initiative versus guilt, the third stage (3–6 years), centers on initiating activities and asserting control. Failure leads to guilt over actions, not a diminished sense of self-worth or influence. The adult’s statements reflect identity struggles, not guilt from initiative, so this choice does not fit the psychosocial crisis described.

Choice D reason: Identity versus role confusion, Erikson’s fifth stage (12–18 years), involves forming a cohesive self-identity. Failure leads to role confusion, low self-esteem, and feelings of insignificance, directly aligning with the adult’s statements about having no answers and opinions not counting. This unresolved crisis persists into adulthood, making this the correct choice.

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.