A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, 'I really need to talk to you.' The nurse should

Correct Answer: D

Rationale: When a specific duration for sessions has been set, the nurse must adhere to the schedule. Leaving the first patient would be equivalent to abandonment and would destroy any trust the patient had in the nurse. Adhering to the contract demonstrates that the nurse can be trusted and that the patient and the sessions are important. The incorrect responses preserve the nurse-patient relationship with the silent patient but may seem abrupt to the interrupting patient, abandon the silent patient, or fail to observe the contract with the silent patient.

Correct Answer: C

Rationale: By asking if the patient does not believe that progress has been made, the nurse is reflecting or paraphrasing by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The remaining options are nontherapeutic techniques. Telling the patient not to 'talk that way' is disapproving. Saying that everyone feels that way at times minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring.

Correct Answer: A

Rationale: Giving advice fosters dependence on the nurse and interferes with a patient's right to make personal decisions. It robs the patient of the opportunity to weigh alternatives and develop problem-solving skills. Furthermore, it may contribute to a patient's feelings of personal inadequacy. Giving advice also keeps the nurse in control and feeling powerful.

Correct Answer: A

Rationale: In this scenario, the priority nursing intervention is option A) Ask the patient about their suicidal thoughts and plans. This is the correct choice because the patient's statement, "I don't feel anything anymore. Nothing matters," indicates a sense of hopelessness and emotional numbness, which are common in individuals with major depressive disorder and could be associated with suicidal ideation. By addressing suicidal ideation directly, the nurse can assess the patient's risk of harm to themselves and initiate appropriate interventions to ensure their safety. Suicidal ideation is a critical concern in individuals with major depressive disorder and requires immediate attention to prevent self-harm or suicide attempts. Options B, C, and D are incorrect in this context. Encouraging the patient to participate in activities or reassuring them that their feelings will improve overlook the seriousness of the patient's statement and do not address the potential risk of suicide. Providing support and allowing the patient to express their feelings are important aspects of care but should not take precedence over assessing and addressing suicidal ideation, which is the most urgent concern in this situation. From an educational perspective, this question highlights the essential role of nurses in assessing and managing suicidal ideation in patients with major depressive disorder. It emphasizes the importance of prioritizing safety and implementing appropriate interventions to address the immediate risk of harm. This scenario underscores the critical need for nurses to be vigilant in recognizing warning signs of suicide and taking proactive steps to ensure patient safety and well-being.

Correct Answer: B

Rationale: The most appropriate nursing intervention in this scenario is option B) Provide the patient with a structured meal plan and monitor their eating. This option is correct because individuals with anorexia nervosa often have distorted perceptions of hunger and may resist or deny the need to eat. A structured meal plan helps establish a routine around eating, which is crucial for patients struggling with disordered eating patterns. Monitoring their eating ensures that the patient is consuming adequate nutrition for their physical well-being. Option A) to encourage the patient to eat small meals every few hours may not be effective as it overlooks the need for a structured approach to meal planning and monitoring. Anorexia nervosa patients may struggle with portion sizes, so a structured plan is more beneficial. Option C) allowing the patient to make their own decisions about food intake can be risky as it enables the continuation of maladaptive behaviors related to food restriction. Option D) reassuring the patient that their lack of hunger is normal and will improve is not appropriate as it validates their distorted beliefs and may perpetuate their disordered eating habits. In an educational context, it is essential for psychiatric nurses to understand the complexities of eating disorders like anorexia nervosa and the importance of structured interventions in promoting recovery and better health outcomes for patients. By providing a rationale behind the correct intervention and explaining why the other options are not as effective, nurses can enhance their critical thinking skills and clinical judgment when caring for individuals with eating disorders.