Nurse Tuan worked with a client three weeks ago to get them set up with a community-based mental health-care treatment plan to help with the client's diagnosis of major depressive disorder. Tuan decides to make a follow-up call to the client to ask them how they're doing. What step in the nursing process does Tuan's action represent?

Correct Answer: B

Rationale: The correct answer is B: evaluation. Evaluation is the step in the nursing process where the nurse assesses the client's response to the implemented plan of care to determine if the goals were met and if any modifications are needed. In this scenario, Nurse Tuan is following up with the client to assess how they are doing after the community-based mental health-care treatment plan was put in place. This action allows Tuan to evaluate the effectiveness of the plan and make any necessary adjustments. Incorrect Choices: A: Assessment is the step where data is collected and analyzed to identify the client's problems and needs. This step precedes the implementation of the treatment plan. C: Implementation is the step where the nurse puts the plan of care into action. Tuan has already implemented the plan and is now assessing its effectiveness. D: Planning is the step where the nurse develops a comprehensive plan of care based on the assessment data. Tuan has already completed this step by setting up the community-based mental health-care

Correct Answer: A

Rationale: The correct answer is A: Rapport. Rapport is crucial in building a therapeutic nurse-client relationship. It involves creating a connection based on acceptance, warmth, and a nonjudgmental attitude, which helps in establishing trust and communication. Building rapport fosters a positive environment for effective care and understanding between the nurse and client. Trust (B) is built on rapport and is a result of it. Respect (C) and professionalism (D) are important in nursing practice but do not directly address the specific characteristic described in the question.

Correct Answer: C

Rationale: The correct answer is C because maintaining contact and assuring the client that seclusion will maintain their safety is the priority nursing intervention for a client deemed a danger to others. This intervention helps build trust, reduce anxiety, and promote a therapeutic relationship. A: Having little contact with the client may increase feelings of isolation and exacerbate the client's distress. B: Providing privacy is important, but in this case, ensuring the client's safety is the priority over maintaining confidentiality. D: Teaching relaxation techniques and coping strategies is beneficial, but it is not the immediate priority when the client is in seclusion due to being a danger to others.

Correct Answer: A

Rationale: Step-by-step rationale for why choice A is correct: 1. Safety of all individuals is paramount in an inpatient setting. 2. Least restrictive intervention aligns with ethical principles and respects individual autonomy. 3. It prioritizes de-escalation techniques over coercive measures. 4. Emphasizes the importance of promoting patient dignity and minimizing harm. 5. Encourages collaborative problem-solving and empowerment of the individual. Summary of why other choices are incorrect: B. Swift intervention may escalate the crisis and disregard patient autonomy. C. Majority rule does not justify violating individual rights in a mental health setting. D. Allowing patients to regain control without intervention can pose risks to themselves and others.

Correct Answer: B

Rationale: The correct answer is B because it indicates a personal connection and emotional reaction from the nurse due to her past experiences with alcoholic parents, suggesting countertransference. Choice A focuses on the patient's denial, not the nurse's reaction. Choice C pertains to the patient's lack of goals, not the nurse's feelings. Choice D relates to the patient's comment about the nurse, not the nurse's emotional response. In summary, B is correct as it directly reflects the nurse's personal history impacting her feelings towards the patient, while the other choices do not address the nurse's emotional reaction.