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Difficulty: Very hardTherapeutic Communication

A practical nurse is providing care for a client admitted with major depressive disorder and psychotic features. During the shift, the client exhibits several distinct behaviors and makes specific statements. Match each client behavior or statement to the most therapeutic initial nursing response. (Note: Some responses are non-therapeutic and will not be used).

  • "My internal organs have rotted away, leaving only an empty shell.""That sounds like a terrifying feeling to experience."
  • The client hands the nurse a prized watch and says, "I don't need this anymore. I won't be here to wear it tomorrow.""Are you having thoughts about taking your own life?"
  • The client turns away toward the wall and says, "Everyone pretends to care, but you all wish I would just disappear.""I have some time right now, and I will sit here with you for a while."
  • "Do you believe I deserve to be punished for the pain I've caused my parents?""You are focusing a lot on your parents. Tell me more about what happened."

Answer

The correct matches pair the somatic delusion with empathy for the feeling, the covert suicide threat with a direct safety assessment, the expression of hopelessness with offering self, and the feelings of guilt with open exploration.
Each correct match applies a validated therapeutic communication technique (translating into feelings/empathy, direct questioning for safety, offering self, and exploring) tailored to the specific psychiatric needs of the client. These responses avoid common communication blocks and maintain the therapeutic alliance.

Step-by-Step Solution

1
Analyze the client's statement about their internal organs rotting.
Identify this as a somatic delusion.
Requires responding to the underlying emotion (terror/fear) using empathy rather than attempting to logically disprove the fixed false belief.
2
Evaluate the client giving away a prized watch with a morbid statement.
Recognize this as a covert suicidal behavior.
Direct safety assessment for self-harm is the highest priority when lethality cues are present.
3
Assess the client turning away and expressing that staff want them to disappear.
Identify this as profound hopelessness and testing behavior.
Offering self provides unconditional support and presence without dismissing their feelings with false reassurance.
4
Review the client's question about deserving punishment.
Identify profound guilt and seeking of external validation.
Exploring the topic encourages communication, while avoiding judgmental or probing non-therapeutic approaches.

Key Concept

Therapeutic Communication Techniques in Psychiatric Settings
Estimated Time:2m 30s
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Topics

Therapeutic Communication

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