A community mental health nurse has worked for months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and could no longer afford prescribed medications. The patient says, Only a traitor would make me go to the hospital. Select the nurses best initial intervention.

Correct Answer: A

Rationale: Hospitalization may damage the nurse-patient relationship, even if it provides an opportunity for rapid stabilization. If medication is restarted, the patient may possibly be stabilized in the home setting, even if it takes a little longer. Programs are available to help patients who are unable to afford their medications. A homeless shelter is inappropriate and unnecessary. Hospitalization may be necessary later, but a less restrictive solution should be tried first, since the patient is not dangerous. A yes/no question is non-therapeutic communication.

Correct Answer: A

Rationale: Asian Americans commonly express psychological distress as a physical problem. The patient may believe psychological problems are caused by a physical imbalance. Treatment will likely be short. The patient will probably respond best to a therapist who is perceived as giving. Asian Americans usually have strong family ties and value hope more than truth.

Correct Answer: B

Rationale: In this scenario, the correct nurse to lead a psychoeducational session on medication management for a culturally diverse group of patients, predominantly from minority cultures, is the newly licensed registered nurse (option B). The rationale for this choice lies in the fact that a newly licensed nurse is likely to have received the most up-to-date education and training on cultural competence, diversity, and medication management practices. This nurse would be more familiar with current evidence-based practices and would bring a fresh perspective to the session. The other options are not as suitable for leading this session: - A very young registered nurse (option A) may lack the experience and confidence needed to effectively lead a group discussion on such a complex and sensitive topic. - An older, mature registered nurse (option C) may have outdated knowledge or be less open to new approaches, potentially hindering effective communication and engagement with the diverse group. - A registered nurse who is very thin (option D) is irrelevant to the task at hand and does not impact their ability to lead the session effectively. In an educational context, it is essential to consider the knowledge, skills, and attitudes that a nurse brings to a specific clinical situation. In this case, the newly licensed nurse is best suited to facilitate a discussion that requires a combination of cultural competence, medication management expertise, and effective communication skills to meet the diverse needs of the group.

Correct Answer: B

Rationale: Therapeutic communication techniques, such as reflection, restatement, and clarification, help the nurse to send empathetic messages to the client. The nurse must understand the difference between empathy and sympathy (feelings of concern or compassion one shows for another). Sympathy often shifts the emphasis to the nurse's feelings, hindering the nurse's ability to view the client's needs objectively.

Correct Answer: C

Rationale: In the context of adult behavioral health nursing, the most therapeutic response for the nurse to make in this situation is option C: "Since ours is a professional relationship, let's explore other opportunities in your life for friendship." This response acknowledges the client's feelings while setting appropriate boundaries. Option A is incorrect because it dismisses the client's feelings and does not address the therapeutic nature of the relationship. Option B, while acknowledging trust, blurs the boundaries between a therapeutic relationship and personal friendship, which can be detrimental to the client's progress. Option D is also incorrect as it is cold and dismissive, potentially damaging the trust and rapport established with the client. In an educational context, it is crucial for nurses to understand the importance of maintaining professional boundaries in therapeutic relationships. By acknowledging and respecting the client's feelings while redirecting the focus to appropriate avenues for support, nurses can foster a trusting and therapeutic environment that promotes the client's well-being.