# Situation: A nurse supervises nursing students on the psychiatric ward of a general hospital. The clients include adults with mood disorders, psychotic disorders, and neurocognitive disorders. Before each shift, the nurse reviews communication skills with the students. After the review, the nurse asks the students how they would respond in several situations. Which student statement shows a need for **FURTHER** teaching?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630150  
> 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 supervises nursing students on the psychiatric ward of a general hospital. The clients include adults with mood disorders, psychotic disorders, and neurocognitive disorders. Before each shift, the nurse reviews communication skills with the students.

After the review, the nurse asks the students how they would respond in several situations. Which student statement shows a need for **FURTHER** teaching?

## 보기

1. "If a client praises me and blames other staff, I won't take either side."
2. "If a client says he is worthless, I'll remind him how his family values him." **✔ 정답**
3. "If a client in panic cannot focus, I'll stay and use short, simple sentences."
4. "If a manic client jumps between topics, I'll ask brief, concrete questions."

**정답: 2**

## 해설

Reminding a client who feels worthless of how others value him is a gentle-sounding form of false reassurance: it disputes the feeling instead of accepting it and closes the topic. The nurse should accept and explore the feeling, for example, "You're feeling worthless. What has happened that makes you feel this way?" The other statements match recommended approaches.

## 심화 해설

Which statement needs further teaching
The student who says, "If a client says he is worthless, I'll remind him how his family values him," needs further teaching. The statement sounds kind, but it is a gentle form of false reassurance. It disputes the client's feeling instead of accepting it, and it implies that the feeling is wrong and should be dropped. When a client expresses worthlessness, the nurse accepts and explores the feeling rather than arguing with it.

Why reassurance and arguing do not help
Feelings of worthlessness are a core symptom of depression, and they are not changed by logic or by listing reasons the client should feel otherwise. When the nurse counters the feeling, the client usually concludes that the nurse does not understand, and the topic closes. It can also deepen guilt: the client may think, "My family values me and I still feel this way, so something is wrong with me." A therapeutic response reflects and explores, for example, "You're feeling worthless. What has happened that makes you feel this way?" This keeps communication open and helps the nurse assess hopelessness and suicide risk.

Why the other statements are correct
The remaining statements match recommended approaches for specific client presentations, which is why they do not show a need for further teaching.

| Situation | Student plan | Why it is appropriate |
| --- | --- | --- |
| Splitting and idealization | Not taking either side | The nurse refuses special status and does not join in blaming other staff; consistency among staff is maintained |
| Panic-level anxiety | Stay with the client; short, simple sentences | Perception is severely narrowed, so the nurse provides safety and gives brief, direct statements |
| Mania with flight of ideas | Brief, concrete questions | Calm, concrete questions help a distractible client keep to realistic thinking |
| Feeling worthless | Remind him how his family values him | Disputes the feeling; this is the statement that needs correction |

Recognizing false reassurance in disguise
Watch out! False reassurance is not always as obvious as "Everything will be fine" or "Don't worry." Any reply that tries to talk the client out of a feeling, such as reminding him of his blessings, comparing him with others who are worse off, or praising him to cancel his self-criticism, belongs to the same family. These replies are often chosen because they feel supportive to the nurse. The test is whether the response accepts the feeling as real for the client and invites more talk, or whether it closes the topic.

Exam takeaway
Key point! In "need for further teaching" items, look for the statement that sounds caring but blocks communication. Disputing or reassuring away a feeling is nontherapeutic; accepting and exploring the feeling is therapeutic. Match the approach to the condition: neutrality with splitting, short simple statements in panic, and brief concrete questions in mania.

## 임상 시나리오

Responding to WorthlessnessSpotting false reassurance in student plans
Reminding a client who feels worthless of how others value him is gentle false reassurance. It disputes the feeling and closes the topic.

Accept and explore instead: "You're feeling worthless. What has happened that makes you feel this way?" This keeps the client talking and supports assessment of hopelessness.

Correct plans: stay neutral with splitting, stay with a client in panic using short sentences, and use brief concrete questions with a manic client.

CautionWorthlessness and hopelessness can accompany suicidal thinking. Exploring the feeling, not dismissing it, is how the nurse learns whether the client is at risk.

## 핵심 개념

- **False reassurance** — A reply that dismisses or disputes a client's feeling, implying it is unfounded, and closes further discussion.
- **Splitting** — Viewing people as all good or all bad, such as idealizing one nurse and blaming others.
- **Panic-level anxiety** — The most severe level of anxiety, with disorganized thinking and a markedly narrowed perceptual field.
- **Flight of ideas** — Rapid speech that jumps from one topic to another, typical of a manic episode.
- **Further teaching** — An exam cue asking for the statement that shows the learner misunderstood the content.

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