The nurse is assessing a client who has a history of heavy drinking and who lost his wife to cancer during the previous year. He reports that he isn't getting as much sleep as he used to when he was younger. Which question would be most appropriate to ask the client to determine if the change in his sleep pattern is related to normal aging or depression?

Correct Answer: B

Rationale: The correct answer is B: "Is it hard for you to fall asleep or remain asleep during the night?" This question is most appropriate because it directly addresses the client's current sleep issues and can provide insights into whether he is experiencing symptoms of depression, such as insomnia or disrupted sleep patterns. By focusing on the client's sleep difficulties, the nurse can better assess if the changes are related to normal aging or if they are indicative of an underlying mood disorder like depression. Choice A is incorrect as it does not address the client's current sleep problems. Choice C is not relevant to the client's sleep patterns and focuses on alcohol consumption. Choice D is also irrelevant to the client's sleep issues and does not directly assess potential depressive symptoms.

Correct Answer: B

Rationale: The correct answer is B because it reflects active listening and empathy by summarizing the patient's statement. This statement shows the nurse's attempt to understand the patient's perspective on life's meaning. Choice A is about the nurse's own thought process, not reflecting the patient's feelings. Choice C shows uncertainty, not reflective listening. Choice D is an observation, not reflective of the patient's emotions or thoughts.

Correct Answer: D

Rationale: The correct answer is D because the patient's behavior of being tense, vigilant, pacing, clenching fists, and staring can be indicative of potential aggression. This behavior shows signs of escalating agitation and aggression, which should be addressed promptly for safety. A: Withdrawal typically involves avoiding social interactions and showing disinterest, which does not align with the patient's behavior. B: Working through angry feelings would involve more introspective or expressive behaviors, not outward signs of potential aggression. C: Relaxation strategies would involve more calming and self-soothing behaviors, which are not exhibited by the patient in this scenario.

Correct Answer: C

Rationale: The correct answer is C because in a partial hospitalization program, the nurse's role often includes teaching patients practical skills to support their daily living. Teaching patients how to plan a menu and shop for groceries is important for promoting healthy eating habits and overall wellness. This activity directly aligns with the goal of a partial hospitalization program, which is to help patients develop skills to function independently. Choice A is incorrect because facilitating a drug abuse prevention group is more likely to be part of a substance abuse program, not a partial hospitalization program. Choice B is incorrect because providing spiritual assessment and interventions is typically the role of a spiritual care provider or counselor, not a nurse in a partial hospitalization program. Choice D is incorrect because providing an educational group about the nutritional content of canned foods is not directly related to teaching patients practical skills for daily living, which is the focus of a partial hospitalization program.

Correct Answer: C

Rationale: The correct answer is C because short, time-limited interactions are best for clients experiencing psychosis due to their limited attention span and potential for increased anxiety. Lengthy interactions may overwhelm the client and hinder the development of trust and rapport. A: The relationship typically develops over a short period of time - Incorrect. Building a therapeutic relationship with a client with schizophrenia takes time due to trust issues and symptom severity. B: Decisions about care are the responsibility of interdisciplinary team - Incorrect. While involving the interdisciplinary team is important, the nurse-patient relationship is crucial in promoting recovery. D: Typically, clients with schizophrenia readily engage in a therapeutic relationship - Incorrect. Clients with schizophrenia may have difficulties in engaging due to symptoms such as paranoia and disorganized thinking.