The nurse is caring for a client diagnosed with borderline personality disorder. The nurse has instructed the client about using the communication triad. The nurse determines that the client has understood this technique when he states which of the following?

Correct Answer: A

Rationale: Correct Answer: A Rationale: 1. "I should start by stating my feelings as an 'I' statement" is correct because using 'I' statements helps the client express their feelings without blaming others. 2. By starting with their own feelings, the client takes ownership of their emotions and promotes effective communication. 3. This approach also helps in avoiding conflict and promotes empathy and understanding between the client and the other person. Summary: - Option B is incorrect because starting with describing the situation may lead to blaming or accusing the other person. - Option C is incorrect because starting with what the client wants to change may come across as demanding or aggressive. - Option D is incorrect because starting with what triggered the emotion may focus on external factors rather than the client's feelings.

Correct Answer: B

Rationale: The correct answer is B (5). The Geriatric Depression Scale short form ranges from 0 to 15, with higher scores indicating more severe depression. A score of 5 falls within the mild depression range (0-9), suggesting the client is mildly depressed. Scores of 3 (A), 8 (C), and 13 (D) would indicate minimal or no depression (0-4), moderate depression (10-14), and severe depression (15), respectively. Therefore, choice B is the most appropriate score to suspect mild depression in this case.

Correct Answer: C

Rationale: The correct answer is C because not investigating the crime details will help the nurse maintain unbiased attitudes towards the client and provide care without being influenced by personal opinions or judgments. By avoiding learning about the crime, the nurse can focus on the client's health needs and promote a therapeutic relationship based on trust and respect. A: This choice is incorrect because the nurse's personal feelings of fear should not dictate the decision-making process in providing care for the client. B: This choice is incorrect because protecting the nurse from anxiety is not the primary reason for not investigating the crime details. The focus should be on providing effective care for the client. D: This choice is incorrect because maintaining professional boundaries is important, but the primary reason for not investigating the crime details is to ensure impartiality and quality care for the client.

Correct Answer: D

Rationale: The correct answer is D: I have the right to refuse treatment. This statement indicates an understanding of advance directives as it acknowledges the client's autonomy in making decisions about their healthcare, including the option to refuse treatment. This aligns with the purpose of advance directives, which is to allow individuals to express their healthcare preferences in advance. Explanation of incorrect choices: A: I can't change my instructions once a minute - This statement is incorrect because individuals have the right to update or change their advance directives at any time. B: My doctor will need to approve my advance directives - This is incorrect as advance directives are the patient's own preferences and do not require approval from the doctor. C: I need an attorney to witness my signature on the advance directives - While having a witness is recommended, it does not necessarily have to be an attorney. This choice implies a misunderstanding of the requirements for advance directives.