The nurse is having a therapeutic conversation with a client in a locked inpatient psychiatric unit. The client states,"Please don't tell anyone about my sexual abuse." Which is the appropriate nursing response?

Correct Answer: B

Rationale: The correct answer is B because in an inpatient psychiatric unit, patient safety and treatment planning are the top priorities. By informing the healthcare team about the client's history of sexual abuse, they can provide appropriate care and interventions. Confidentiality cannot always be guaranteed in a psychiatric setting due to the duty to protect the client and others. Choice A is incorrect as it guarantees confidentiality, which may not be feasible in this situation. Choice C is incorrect as it challenges the client's decision and may breach trust. Choice D is incorrect as it focuses solely on the client's feelings without addressing the need for treatment planning by the healthcare team.

Correct Answer: D

Rationale: The correct answer is D because offering to sit with the patient shows empathy and a willingness to provide support. By expressing a desire to help the patient feel comfortable and open up, the nurse is effectively using the communication technique of "offering self." This approach creates a safe space for the patient to share their feelings and concerns. Choice A is incorrect because sharing personal experiences can shift the focus away from the patient's needs. Choice B is incorrect as it focuses on the patient's thoughts without offering support or empathy. Choice C is incorrect because it lacks personal engagement and does not actively offer the nurse's presence for support.

Correct Answer: C

Rationale: The correct answer is C: Clinics supplemented by general hospital units. The Joint Commission on Mental Illness and Health recommended an increase in community-based mental health services, including clinics supplemented by general hospital units, to provide more accessible and comprehensive care for individuals with mental health issues. This shift in focus from institutional care to community-based services aimed to improve overall mental health care delivery and outcomes. Incorrect choices: A: Numbers of mental health hospitals - The report actually recommended a decrease in reliance on mental health hospitals. B: State funding for mental health care - While funding is important, the report focused more on the type and delivery of mental health services rather than just funding. D: Use of psychotherapy by psychiatrists - While psychotherapy is a valuable treatment modality, the report focused on broader system-level recommendations rather than specific treatment methods.

Correct Answer: D

Rationale: The correct answer is D: Ego. The ability to form mutually satisfying relationships is a function of the ego in Freud's personality structure. The ego mediates between the id's instinctual drives and the superego's moral constraints, allowing individuals to interact with others in a socially acceptable manner. The ego helps balance personal desires with societal norms, enabling individuals to navigate relationships effectively. Incorrect Choices: A: Defense mechanisms - Defense mechanisms are strategies used by the ego to manage anxiety and protect the individual from distressing thoughts or feelings. While defense mechanisms play a role in coping with conflicts, they are not directly responsible for forming satisfying relationships. B: Unconscious - The unconscious contains repressed thoughts, memories, and desires that influence behavior. Although the unconscious plays a significant role in shaping personality, the ability to form satisfying relationships is not solely attributed to the unconscious. C: Id - The id represents innate, primal drives seeking immediate gratification. While the id influences behavior and desires, it is

Correct Answer: C

Rationale: The most appropriate response by the nurse is C: "These are the results of the drug that can be treated; your illness is not getting worse." This response acknowledges the side effects of the antipsychotic medication (extrapyramidal symptoms) while reassuring the patient that these symptoms can be managed without indicating a worsening of their condition. It demonstrates empathy, provides accurate information, and offers hope for improvement. Explanation of other choices: A: This response is dismissive and invalidates the patient's experience, which can be harmful to the therapeutic relationship. B: Allergy is not the cause of extrapyramidal symptoms, so changing medication based on this assumption is incorrect and may lead to unnecessary changes. D: Blaming sunlight for the symptoms is inaccurate and does not address the underlying issue of medication side effects, potentially causing confusion for the patient.