# Situation: A nurse on the psychiatric ward of a general hospital is assigned to a 34-year-old woman admitted for major depressive disorder. The nurse will hold one-to-one sessions with her three times a week during her expected 4-week stay. Three days before her planned discharge, she tells the nurse that she feels hopeless again and asks whether the nurse can keep visiting her at home. Her mood rating scores this week are unchanged from last week, she sleeps 7 hours a night, and she denies thoughts of self-harm. What should the nurse do?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629999  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A nurse on the psychiatric ward of a general hospital is assigned to a 34-year-old woman admitted for major depressive disorder. The nurse will hold one-to-one sessions with her three times a week during her expected 4-week stay.

Three days before her planned discharge, she tells the nurse that she feels hopeless again and asks whether the nurse can keep visiting her at home. Her mood rating scores this week are unchanged from last week, she sleeps 7 hours a night, and she denies thoughts of self-harm. What should the nurse do?

## 보기

1. Explore her feelings about ending and review goals she met **✔ 정답**
2. Give her the nurse's mobile number for support after discharge
3. Agree to a few home visits to ease her move back to the community
4. Report the return of symptoms so that discharge can be postponed

**정답: 1**

## 해설

A return of old complaints near the end of the relationship, with no objective change, is a common regression in response to separation. In the termination phase the nurse helps the client express feelings about ending, reviews progress together, and connects her to aftercare rather than extending the relationship.

## 심화 해설

Separation reactions at the end of the relationship
Three days before discharge, the client says she feels hopeless again and asks whether the nurse can keep visiting her at home. Yet her mood rating scores are unchanged from last week, she sleeps 7 hours a night, and she denies thoughts of self-harm. A return of old complaints near the end of the relationship, with no objective change, is a common regression in response to separation. In the termination phase, the nurse helps her express her feelings about ending, reviews the goals she has met, and connects her with aftercare.

Tasks of the termination phase
Termination is planned from the start of the relationship, and the nurse reminds the client of the ending date well in advance. Its tasks are to review progress and the goals achieved, to help the client express feelings about separation, which may include sadness, anger, or anxiety, and to plan how she will continue to use her new coping skills. Aftercare services, such as outpatient follow-up and community support, provide continuing help without extending the personal relationship with the nurse.

| Response | Assessment |
| --- | --- |
| Explore feelings about ending and review goals met | Correct: core termination tasks |
| Give the nurse's mobile number | Blurs professional boundaries |
| Agree to a few home visits | Extends the relationship and fosters dependency |
| Report symptoms so discharge is postponed | Data show no relapse; complaint reflects separation |

Why the other responses are wrong
Giving her the nurse's personal mobile number or agreeing to home visits extends a therapeutic relationship into a personal one, which blurs boundaries and keeps her from building independent coping. Postponing discharge would be appropriate if there were a true relapse, but her objective data are stable and she denies self-harm, so the complaint reflects anxiety about separation rather than worsening depression. The nurse still documents her statement and continues to monitor safety.

Watch out! Always check objective data before concluding that a symptom represents relapse. Here the mood scores, sleep, and safety assessment are unchanged, which points to a separation reaction.

Exam takeaway
Key point! In termination, discuss feelings about ending, review progress together, and link the client to aftercare rather than extending the relationship. Regression near discharge is common and is handled within the termination tasks.

## 임상 시나리오

Termination PhaseRegression in response to separation
Feeling hopeless again near discharge, with unchanged mood scores, 7 hours of sleep, and no self-harm thoughts, suggests a separation reaction, not relapse.

Help her express feelings about ending, review the goals she has met, and plan how she will use her coping skills at home.

Connect her with aftercare services for continuing support.

CautionPersonal phone numbers or home visits blur professional boundaries and foster dependency.

## 핵심 개념

- **Termination phase** — The final phase of the nurse-client relationship, focused on reviewing progress and ending the relationship.
- **Regression** — A return to earlier behaviors or complaints, often in response to anxiety such as an approaching separation.
- **Professional boundaries** — Limits that keep the nurse-client relationship therapeutic and focused on the client.
- **Aftercare** — Continuing services after discharge, such as outpatient follow-up and community support.

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