NCLEX RN Exam Review Answers - Nurselytic

Questions 39

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Extract:


Question 1 of 5

Gio told his nurse that the FBI is monitoring and recording his every movement and that microphones have been placed in the unit walls. Which action would be the most therapeutic response?

Correct Answer: B

Rationale: The most therapeutic response in this situation is to acknowledge Gio's feelings of fear and validate his experience by expressing empathy ('this must seem frightening to him'). By reassuring Gio that he is safe in the current environment, the nurse can help reduce his anxiety and build trust.
Choice A is not recommended as directly confronting delusional beliefs may lead to increased distress and resistance.
Choice C delays addressing Gio's concerns and may not provide immediate support.
Choice D of isolating Gio can worsen his feelings of paranoia and distrust in the treatment setting.

Question 2 of 5

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Question 3 of 5

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Question 4 of 5

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Question 5 of 5

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