A nurse assesses a confused older adult. The nurse experiences sadness and reflects, 'This patient is like one of my grandparents "¦ so helpless.' Which response is the nurse demonstrating?

Correct Answer: B

Rationale: The correct answer is B) Countertransference. Countertransference occurs when a healthcare provider projects their own feelings, attitudes, or unresolved issues onto a patient. In this scenario, the nurse is experiencing sadness and making a personal connection to the patient, which indicates countertransference. Option A) Transference involves the patient projecting feelings onto the nurse based on their past experiences. This is not occurring in the scenario provided. Option C) Catastrophic reaction involves an extreme response to stress or trauma, which is not evident in the nurse's feelings of sadness. Option D) Defensive coping reaction refers to strategies individuals use to protect themselves from unpleasant emotions or situations, which is not the case in the given scenario. In an educational context, understanding countertransference is crucial for healthcare providers, especially in behavioral health settings where emotional connections with patients are common. Recognizing and managing countertransference can help nurses maintain professional boundaries and provide effective care without letting personal emotions interfere with their judgment or care delivery. This scenario highlights the importance of self-awareness and emotional regulation in nursing practice.

Correct Answer: A

Rationale: Restating allows the patient to validate the nurse's understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Close-ended questions such as 'Did you feel angry?' ask for specific information rather than showing understanding. When the nurse simply states that he or she understands the patient's words, the patient has no way of measuring the understanding.

Correct Answer: D

Rationale: When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto the patient. Telling the patient that interview time should be used to discuss patient concerns refocuses discussion in a neutral way. Telling patients not to ask about the nurse's personal life shows indignation. Saying that nurses prefer to direct the interview reflects superiority. 'Why' questions are probing and nontherapeutic.

Correct Answer: B

Rationale: In caring for a patient diagnosed with bipolar disorder in the manic phase, the priority nursing intervention is to select option B, which is to set firm boundaries and limit the patient's ability to make impulsive decisions. This is crucial because individuals in the manic phase of bipolar disorder often lack the ability to control their impulses and may engage in risky behaviors that can be harmful to themselves or others. By setting firm boundaries, the nurse can help maintain a safe environment for the patient and prevent potential negative outcomes. Option A, encouraging the patient to express their feelings and engage in social activities, may not be the priority in this situation as the patient's impulsivity and risk-taking behavior need to be addressed first to ensure safety. Option C, providing medications to control symptoms, is important but may not address the immediate need to manage the impulsive behavior. Option D, offering reassurance and allowing the patient to make their own decisions, could potentially worsen the situation by enabling further impulsive behavior without appropriate limits. Educationally, understanding the priority interventions in managing patients with bipolar disorder is essential for nurses working in behavioral health settings. This scenario highlights the importance of safety and boundary-setting when caring for individuals experiencing manic episodes, emphasizing the need for proactive and structured interventions to promote patient well-being.

Correct Answer: B

Rationale: In this scenario, the best nursing response is option B: "I understand that you are feeling fearful, but I don't see anyone following you." This response demonstrates empathy towards the patient's feelings of fear without validating the delusion. It acknowledges the patient's emotions while providing a reality-based perspective in a non-confrontational manner. Option A is incorrect because it directly denies the patient's delusion, which can lead to increased distress and potential breakdown of trust between the nurse and patient. Option C is a good response as well, but it does not address the patient's immediate emotional state or provide reassurance. Option D is inappropriate as it dismisses the patient's concerns and fails to address the underlying issue. In an educational context, nurses must learn to effectively communicate with patients experiencing delusions in a way that shows empathy, maintains therapeutic rapport, and gently guides the patient towards a shared understanding of reality. This approach is crucial in providing holistic care for individuals with mental health disorders and promoting a trusting nurse-patient relationship.