Alzheimer’s Delirium and Dementia Q 59
A client with dysthymic disorder reports to a nurse that his life is hopeless and will never improve in the future. How can the nurse best respond using a cognitive approach?
A. Agree with the client’s painful feelings.
B. Challenge the accuracy of the client’s belief.
C. Deny that the situation is hopeless.
D. Present a cheerful attitude.
Correct Answer: B. Challenge the accuracy of the client’s belief
Use of cognitive techniques allows the nurse to help the client recognize that these negative beliefs may be distortions and that, by changing his thinking, he can adopt more positive beliefs that are realistic and hopeful. Assess individual signs of hopelessness. These aids focus attention on aspects of individual needs. These signs may include social withdrawal, decreased physical activity, and comments made by the patient that indicate despair and hopelessness.
Option A: Express hope to the patient with realistic comments about the patient’s strengths and resources. Patients may feel hopeless, but it is helpful to hear positive expressions from others. Allow the patient to express feelings and perceptions. The process of recognizing feelings that underlie and drive behaviors allows the patient to start taking control of their lives.
Option D: Presenting a cheerful attitude is not consistent with a cognitive approach and would not be helpful in this situation. Assist the patient to determine aspects of life that are under his or her control. An individual’s emotional state may interfere with problem-solving. Support may be required to identify areas that are under his or her control and to have clarity about options for taking control.
Option C: Denying the client’s feelings is belittling and may convey that the nurse does not understand the depth of the client’s distress. Aid the patient to determine aspects of life events that are not within his or her ability to control. Discuss feelings related to this lack of control. The patient needs to recognize and resolve feelings related to inability to control certain life situations before acceptance can be achieved and hopefulness becomes possible.