James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for the day shift and anxiously reports, 'Last night, demons came to my room and tried to rape me.' Which response would be most therapeutic?

Correct Answer: C

Rationale: Response C is the most therapeutic as it shows empathy and encourages the patient to express their feelings and share more about their experience. By actively listening and inviting the patient to talk, the nurse creates a supportive environment that can help the patient feel heard and understood, which is essential in building trust and rapport in therapeutic communication with individuals experiencing schizophrenia.

Correct Answer: D

Rationale: Diagnosing mental illness in young children can be complex due to their limited language skills, cognitive development, and emotional development. However, parental denial does not directly affect the child's inherent challenges, making it the factor that does not apply to the difficulty of diagnosis.

Correct Answer: C

Rationale: The lack of resources in pediatric mental health leads to underserved populations, increased stress in the family unit, and premature termination of services. However, markedly increased funding does not align with the negative consequences of resource shortages; instead, it would be a potential solution to address the lack of resources and providers in pediatric mental health.

Correct Answer: C

Rationale: Christopher's positive outlook, strong school performance, and forming a bond with the neighbor indicate resilience. Resilience refers to the ability to adapt and thrive despite facing adversity, such as being removed from his parents' home due to neglect. His ability to maintain a positive attitude and excel in school despite the challenging circumstances highlights his resilience.

Correct Answer: B

Rationale: The correct choice is B because the scenario clearly demonstrates that time-out has lost its intended therapeutic effect for April. The key indicators are her increasing agitation and loss of self-control in the day room, coupled with the mother's report of excessive use (20 times/day). Time-out, when used appropriately, is meant to be a brief, infrequent intervention that helps a child regulate emotions—not a habitual or punitive measure. Here, its overuse has likely led to desensitization, making it ineffective for promoting self-reflection or behavioral change. The nurse's recognition that time-out is no longer working aligns with evidence-based practice, which emphasizes adapting interventions when they fail to meet therapeutic goals. Choice A is incorrect because it misinterprets the mother's reliance on time-out as a "baseline" discipline rather than recognizing its misuse. While time-out can be part of a structured discipline plan, its excessive application (20 times/day) suggests it has become counterproductive. Baseline discipline should be consistent and effective, not a repetitive, futile cycle that exacerbates dysregulation. The question explicitly states April is losing self-control, which contradicts the idea that time-out is serving a functional role in her care. Choice C is incorrect because it assumes April's behavior is goal-directed (seeking alone time) without evidence. The scenario describes escalating dysregulation, not intentional behavior to gain solitude. Time-out is typically aversive for children; enjoyment would be atypical and inconsistent with the presentation of worsening agitation. The rationale also ignores the mother's overuse of the strategy, which is the more plausible explanation for its ineffectiveness. Choice D is incorrect because it escalates to restrictive measures (seclusion/restraint) without justification. Restraint should only be used as a last resort for imminent safety risks, not as a replacement for a failed behavioral intervention. The nurse’s role is to de-escalate, not intensify, restrictive practices. The scenario does not indicate aggression or harm, so jumping to seclusion/restraint violates the principle of least restrictive intervention and overlooks alternative strategies like positive behavioral support or environmental modifications. The core issue is the misapplication of time-out, not the need for more extreme measures. Effective nursing judgment involves recognizing when an intervention fails and exploring alternatives, not doubling down on punitive approaches. The correct answer (B) reflects this clinical reasoning, while the other choices either justify the status quo (A), misinterpret behavior (C), or propose an unethical overcorrection (D).