Which remark by a patient indicates passage from the orientation phase to the working phase of a nurse-patient relationship?

“I don’t have any problems.”

“I don’t know how talking about things twice a week can help.”

“I want to find a way to deal with my anger without becoming violent.”

“It is so difficult for me to talk about my problems.”

Answer and Explanation

The Correct Answer is C

Choice A reason: Denying problems reflects resistance, typical in the orientation phase, where trust is not yet established. Anger management, linked to amygdala-driven impulsivity, requires a therapeutic alliance. This statement indicates avoidance, not readiness for the working phase’s collaborative problem-solving.

Choice B reason: Questioning therapy’s value shows skepticism, common in the orientation phase. The working phase involves active goal-setting, like managing anger tied to serotonin dysregulation. This statement reflects a lack of engagement, not the transition to collaborative therapeutic work, making it incorrect.

Choice C reason: Expressing a goal to manage anger indicates readiness for the working phase, where collaborative problem-solving occurs. Anger, linked to amygdala hyperactivity and serotonin deficits, requires active intervention. This statement shows commitment to addressing neurobiological issues, marking the transition to the working phase.

Choice D reason: Difficulty discussing problems reflects orientation phase challenges, where trust is building. The working phase involves active engagement, like addressing anger’s neurobiological basis. This statement indicates discomfort, not readiness for collaborative work, making it incorrect for the phase transition.

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Correct Answer is A

Explanation

Choice A reason: Paroxetine, an SSRI, is first-line for GAD, enhancing serotonin in the amygdala and prefrontal cortex, reducing excessive worry. Its efficacy and tolerability, with minimal dependence risk, align with evidence-based guidelines for long-term anxiety management, making it the preferred choice.

Choice B reason: Imipramine, a tricyclic antidepressant, affects serotonin and norepinephrine but has significant anticholinergic side effects, reducing tolerability. It is not first-line for GAD due to slower onset and side effect profile compared to SSRIs, which better target anxiety’s neurobiological basis.

Choice C reason: Hydroxyzine, an antihistamine, reduces anxiety via histamine receptor blockade, causing sedation. It is used as needed, not for chronic GAD management. SSRIs, like paroxetine, offer sustained serotonin modulation, making hydroxyzine a less effective, non-first-line option for long-term treatment.

Choice D reason: Alprazolam, a benzodiazepine, enhances GABA activity, providing rapid anxiety relief but carries high dependence risk. It is not first-line for GAD, as SSRIs offer safer, long-term serotonin-based treatment, making alprazolam unsuitable for chronic management due to addiction potential.

A. Intervening when a self-mutilating patient attempts to harm self B. Exploring alternative options with a patient regarding medications C. Suggesting that two patients who are fighting be restricted to the unit D. Staying with a patient who is demonstrating a high level of anxiety

Correct Answer is B

Explanation

Choice A reason: Intervening in self-harm prioritizes beneficence, ensuring safety, over autonomy. Self-mutilation, often linked to dysregulated serotonin or impulsivity, requires immediate action to prevent harm, overriding patient choice. Autonomy is secondary when safety is at risk, making this an incorrect application of the principle.

Choice B reason: Exploring medication options respects autonomy by involving patients in decisions, aligning with their values. This considers individual neurobiological responses (e.g., serotonin reuptake variations) and preferences, empowering informed choice. Autonomy emphasizes patient control over treatment, making this the correct approach for ethical psychiatric care.

Choice C reason: Restricting patients for fighting prioritizes safety and unit order, not autonomy. Conflict may stem from emotional dysregulation or neurotransmitter imbalances, but restricting movement limits patient choice. This action reflects beneficence or justice, not autonomy, making it an incorrect choice for this ethical principle.

Choice D reason: Staying with an anxious patient supports emotional regulation, possibly linked to GABA deficits, but emphasizes beneficence over autonomy. While supportive, it does not involve patient decision-making. Autonomy requires empowering patient choice, not just presence, making this an incorrect application of the ethical principle.

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Which remark by a patient indicates passage from the orientation phase to the working phase of a nurse-patient relationship?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which medication would be considered a first-line medication therapy for generalized anxiety disorder (GAD)?

Correct Answer is A

Explanation

How does a psychiatric nurse best implement the ethical principle of autonomy?

Correct Answer is B

Explanation

Which of the following options best describes the basic elements of the communication model?

A client is newly prescribed a medication that will block the effects of histamine for the treatment of a mental health disorder. The client asks, “What side effects should I anticipate with this new medication?” Which response by the nurse is accurate?

A nursing student says, “Little of what takes place on the behavioral health unit seems to be theory-based.” A nurse educates the student by identifying which is a common use of Sullivan’s theory on the inpatient psychiatric unit?

At one point in an assessment interview, a nurse asks, “Does your faith help you in stressful situations?” What assessment topic does this question fall under?

Which neurotransmitter is associated with the hallucinations, delusions, and bizarre behavior seen in schizophrenia?

A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?

Planning for patients diagnosed with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for a patient presenting with what characteristic?

Your patient sometimes forgets to eat. In which part of the nursing care plan would the nurse expect to find this statement: “Offer snacks and finger foods frequently”?