A client who has depression is admitted to treatment on a voluntary basis. While in the hospital, the client makes several comments about wanting to 'end it all.' The client decides one day to leave against medical advice. Which of the following would be the most appropriate action by the nursing staff?

Correct Answer: C

Rationale: In this scenario, the most appropriate action by the nursing staff is option C, contacting the psychiatrist for initiation of commitment proceedings. This is the correct choice because the client is expressing suicidal ideation, which poses a serious risk to their safety. Initiating commitment proceedings can help ensure the client's safety and provide the necessary mental health support and treatment. Option A is incorrect because detaining the client without proper evaluation and legal procedures can violate their rights and trust, potentially escalating the situation. Option B is also incorrect as allowing the client to leave without addressing their suicidal ideation puts them at risk of harm. Option D is not the best choice as the family may not be equipped to handle the situation effectively and promptly. From an educational perspective, this scenario highlights the critical importance of assessing and managing clients with suicidal ideation. It emphasizes the duty of healthcare professionals to prioritize client safety, follow legal and ethical guidelines, and involve appropriate mental health professionals in decision-making processes to provide optimal care for clients in crisis.

Correct Answer: B

Rationale: Nonmaleficence is the requirement to do no harm to others either intentionally or unintentionally. Safe take-down techniques are used to avoid unintentional harm to the client. Veracity is the duty to be honest or truthful. Justice refers to fairness, that is treating all people fairly and equally without regard for social or economic status, race, sex, marital status, religion, ethnicity, or cultural beliefs. Autonomy refers to the person's right to self-determination and independence.

Correct Answer: C

Rationale: Successful termination involves closure through reflection and evaluation of the relationship’s progress, as in Option C. This validates the experience for both parties. Option A avoids closure, Option B maintains dependency, and Option D blurs boundaries into a social relationship, all of which are non-therapeutic.

Correct Answer: A

Rationale: The correct answer is option A) "How do you feel about that?" because it promotes a nonjudgmental and therapeutic communication approach. This response allows the patient to express their feelings openly without fear of being criticized or judged. It shows empathy and understanding, fostering a trusting nurse-patient relationship. Option B) "I am glad that you realize this." could be seen as slightly judgmental as it implies a sense of approval, which may not be conducive to open communication in this context. It does not encourage further exploration of the patient's thoughts and feelings. Option C) "That’s not a good way to behave." is judgmental and may make the patient feel defensive or ashamed, hindering effective communication and potentially damaging the nurse-patient relationship. Option D) "Have you outgrown that type of behavior?" is presumptive and may imply that the behavior is in the past or that the patient should have already changed, which can be invalidating and unhelpful. It does not invite the patient to explore their current feelings or experiences. Educationally, it is crucial for nurses to practice nonjudgmental communication to create a safe space for patients to share their thoughts and emotions. By using open-ended questions like the one in option A, nurses can facilitate deeper discussions, gain insights into the patient's perspective, and provide more effective care tailored to the patient's needs. This approach is foundational in building therapeutic relationships and promoting patient-centered care.

Correct Answer: B

Rationale: The most therapeutic response by the nurse is option B) "It sounds like you’re concerned about your privacy." This response validates the patient's feelings and demonstrates empathy, which is crucial in building a therapeutic nurse-patient relationship. By acknowledging the patient's concern without dismissing it, the nurse shows understanding and encourages further discussion, leading to a better understanding of the patient's perspective. Option A) "Let’s talk about something other than the CIA" avoids addressing the patient's underlying fear and may come across as dismissive. This response does not acknowledge or validate the patient's feelings, potentially leading to increased distress. Option C) "The CIA is prohibited from operating in health care facilities" provides a factual statement but does not address the patient's underlying fear or delusion. It may come across as confrontational and does not promote therapeutic communication. Option D) "You have lost touch with reality, which is a symptom of your illness" is stigmatizing and may alienate the patient. It does not show empathy or understanding of the patient's experience, hindering effective communication and trust-building in the therapeutic relationship. In an educational context, it is essential for healthcare providers to practice empathy, active listening, and validation when communicating with patients experiencing delusions or hallucinations. Understanding the patient's perspective, even if it differs from reality, is key to providing person-centered care and fostering a trusting therapeutic relationship.