A patient comes to the crisis clinic after an unexpected job termination. The patient paces, sobs, cringes when approached, and responds to questions with only shrugs or monosyllables. Choose the nurse's best initial comment to this patient.

Correct Answer: B

Rationale: A crisis exists for this patient. The two primary thrusts of crisis intervention are to provide for the safety of the individual and use anxiety-reduction techniques to facilitate use of inner resources. The nurse offers therapeutic presence, which provides caring, ongoing observation relative to the patient's safety, and interpersonal reassurance.

Correct Answer: B

Rationale: In this scenario, the most appropriate nursing diagnosis is B) Powerlessness. Powerlessness refers to the perception of lack of control over a situation, which is evident in the patient's statements expressing uncertainty about their future job prospects and ability to meet financial obligations. The patient's sense of powerlessness is further highlighted by their concerns about providing for their family. Option A, Hopelessness, may not be the most suitable diagnosis in this case as the patient is not expressing a complete loss of hope or a pervasive negative outlook. Option C, Chronic low self-esteem, does not directly address the patient's current situation of job loss and financial stress. Option D, Interrupted family processes, is not applicable as the patient's concerns are primarily related to the impact of job loss on their family's well-being. In an educational context, understanding the nuances of different nursing diagnoses is crucial for nurses working in behavioral health settings. By accurately identifying the patient's underlying issues, nurses can develop targeted care plans to address the individual's specific needs and promote their mental health and well-being. This case underscores the importance of thorough assessment and critical thinking skills in nursing practice, especially in supporting individuals experiencing crisis situations.

Correct Answer: C

Rationale: The correct answer is C) universality. In the context of group therapy, universality refers to the realization that one's experiences and feelings are shared by others in the group. When the patient expresses that they thought they were alone in feeling afraid but now understand that others feel the same way, it demonstrates an awareness of universality. This realization can be a powerful therapeutic tool as it reduces feelings of isolation and promotes empathy and connection within the group. Option A) altruism refers to selflessly helping others, which is not demonstrated in the patient's statement. Option B) ventilation refers to the release of strong emotions or feelings, which is also not the focus of the patient's comment. Option D) group cohesiveness relates to the sense of unity and connection within the group, which is a result of experiencing universality but is not directly reflected in the patient's statement. Understanding the concept of universality in group therapy is essential for nurses working in behavioral health settings. It allows them to facilitate discussions that promote the sharing of experiences, reduce feelings of isolation, and foster a sense of community among group members. This, in turn, can enhance the therapeutic outcomes of group therapy sessions by promoting mutual support and understanding.

Correct Answer: C

Rationale: The member is expressing anger, which is a common response to feeling vulnerable. Labeling the emotion and conveying empathy would be therapeutic. Focusing on members who are likely to be more positive can balance the influence of demoralizing members. "You seem to know a lot "¦" conveys hostility from the leader, who confronts and challenges the member to explain how he came to be readmitted if he was so knowledgeable, implying that he is less knowledgeable than he claims. This comment suggests countertransference and is non-therapeutic. Shifting away from the complaining member to see if others agree seeks to have others express disagreement with this member, but that might not happen. In the face of his anger, they might be quiet or afraid to oppose him, or they could respond in kind by expressing hostility themselves. A rule that only positive exchanges are permitted would suppress conflict, reducing the effectiveness of the therapy group.

Correct Answer: B

Rationale: In this scenario, the nurse should anticipate the cause of the client's symptoms to be prolonged grief (option B). Prolonged grief occurs when a person experiences intense, persistent grief symptoms lasting beyond what is considered a normal grieving period. In this case, the client's symptoms of hopelessness, sadness, sleep disturbances, and frequent crying six months after the death of their grandmother suggest a prolonged and unresolved grief reaction. Option A (Anxiety) is not the most appropriate choice as the client's symptoms align more closely with grief reactions rather than anxiety symptoms such as restlessness, irritability, or excessive worry. Option C (Normal grieving process) is incorrect because the client's symptoms extend beyond what is typically expected in a normal grieving process, indicating a more complex and prolonged response to the loss. Option D (Emotional numbness) does not align with the client's presentation of intense emotions such as sadness, hopelessness, and crying, which are indicative of unresolved grief rather than emotional numbness. Educationally, it is crucial for nurses to differentiate between normal grief reactions and prolonged grief to provide appropriate support and interventions for clients experiencing complicated grief responses. Understanding the nuances of grief reactions can help nurses tailor their care to meet the individual needs of clients experiencing loss and facilitate the grieving process effectively.