The nurse is attempting to establish a therapeutic relationship with an angry, depressed client on a psychiatric unit. Which is the most appropriate nursing intervention?

Correct Answer: C

Rationale: The correct answer is C because showing respect that is not based on the client's behavior is essential in establishing a therapeutic relationship. This approach conveys unconditional positive regard, helping the client feel valued and accepted regardless of their current emotional state. Choice A of establishing a friendship may blur boundaries and hinder the professional therapeutic relationship. Choice B of using humor may not be appropriate for a client experiencing anger and depression. Choice D of sympathizing with the client's sad feelings may be seen as pity rather than genuine understanding, which can be counterproductive. Overall, choice C demonstrates empathy, understanding, and a non-judgmental attitude, which are crucial in building trust and rapport with the client.

Correct Answer: D

Rationale: The correct answer is D because hearing evil voices indicating potential psychosis or severe mental health issues requiring immediate attention. This statement suggests possible hallucinations and command hallucinations that pose a risk to the individual and others. It should be the priority focus for the plan of care. A: Trusting family is important but does not indicate immediate safety concern. B: Perception of bad luck may be relevant but not as urgent as potential hallucinations. C: Concern about betrayal is significant but does not pose an immediate risk compared to hearing evil voices.

Correct Answer: C

Rationale: The correct answer is C: Severe anxiety. The person's symptoms indicate severe anxiety. Nausea, dizziness, tachycardia, and hyperventilation are all physical manifestations of severe anxiety. Additionally, the person's statement of feeling like something awful is going to happen, along with an inability to focus, also point towards severe anxiety. Mild anxiety typically wouldn't cause such intense physical symptoms. Moderate anxiety may cause some physical symptoms but not to the extent described in the scenario. Panic level of anxiety would usually involve more extreme symptoms such as a full-blown panic attack, which is not explicitly mentioned in the scenario.

Correct Answer: B

Rationale: The correct answer is B: Public stigma. The nurse's action of addressing the receptionist's derogatory comment about a patient as 'really psycho' indicates an attempt to address public stigma. Public stigma refers to the negative attitudes and beliefs held by society towards individuals with mental health conditions. By discussing the inappropriate language used by the receptionist, the nurse is addressing the perpetuation of negative stereotypes and discrimination against individuals with mental health issues. Incorrect Choices: A: Lack of knowledge - This choice would imply that the nurse is addressing a lack of knowledge about mental health conditions, which is not the main issue in this scenario. C: Label avoidance - This choice would imply that the nurse is avoiding using stigmatizing labels, which is not the main focus of the scenario. D: Self-stigma - This choice would imply that the nurse is addressing the internalized stigma experienced by individuals with mental health conditions, which is not the main issue being addressed in this scenario.

Correct Answer: D

Rationale: The correct answer is D. During termination, patients may bring up resolved issues as new concerns to prolong the nurse-patient relationship. This behavior can be a sign of attachment or fear of separation. Patients may unconsciously try to maintain connections as a means of security. Choice A is incorrect because it assumes the patient is angry, which is not necessarily the case. Choice B is incorrect as it makes an assumption about the patient's needs without evidence. Choice C is incorrect as it assumes dissatisfaction with therapy, which may not be the reason for the patient's behavior.