Module 3 - Mental Health Concepts

The nurse is assigned to work with a client who has just been admitted to the mental health unit. Which action should the nurse plan to take in the orientation or introductory phase of the nurse-client relationship? A. Establish a contract with the client B. Increase the client's independence C. Promote the use of constructive coping mechanisms D. Refer and transfer the client to other sources of support

A

A client is told that the computed tomography scan she has just undergone has revealed a pancreatic mass that is most likely cancer. The client becomes upset and anxious on hearing this news and tells the nurse that she feels nauseated. Checking the client's vital signs, the nurse notes that the client's heart rate, respiratory rate, and blood pressure are increased compared with previous readings. The nurse plans interventions to correspond with which stage of Selye's general adaptation syndrome that the client is experiencing? A. Eustress B. Alarm reaction C. Stage of resistance D. Stage of exhaustion

B

During a one-to-one nurse-client session, the client plays with her pack of cigarettes and says, "I just get a couple of DVDs and watch movies so I won't have to look at my husband or talk to him." Which coping mechanism does the nurse recognize in the client's behaviors? A. Self-blame B. Avoidance C. Reframing D. Wishful thinking

B

The nurse is teaching assertiveness training to a client with anger-management issues. Which client statement indicates the client is able to assertively confront someone? A. "I could demonstrate that I understand how the other person feels but state that I still expect the other person to make the changes I need." B. "I can tell the person that the behavior has become intolerable for me and that the behavior must be changed immediately." C. "I will emphasize how much I like the person but insist that the other person make the changes I need." D. "I can ask for private time to talk and point out the facts without being accusatory, then determine areas of mutual misunderstanding and request the changes I need."

D

The hospice nurse is caring for a client with end-stage heart failure. The nurse should monitor the client for which signs of impending death? Select all that apply. A. Diarrhea B. Increased urine output C. Increased pain perception D. Decreasing blood pressure E. Irregular and noisy respirations F. Mottled and cyanotic extremities

D, E, F

A 32-year-old married woman who recently gave birth to her first child by cesarean section says, "My husband and I worry about our baby all the time. We did everything right, yet he had so many problems at birth." Which statement by the nurse would be therapeutic? A. "Can you tell me more about the worrying? What's been happening since you brought your baby home?" B. "Lots of women do everything right but wind up having cesarean sections. Why worry when it won't change anything?" C. "What's been happening since you all came home? As I understand it, the baby is thriving." D. "I'd like to ask you a series of parenting questions to determine your fitness."

A

A 45-year-old fireman says to the nurse, "I've worked at some fires recently that were just devastating, but last week was the worst. I carried this little girl from a fire — she was badly burned and lived just a few minutes after I brought her out, and she said to me, 'Tell my mom and Rudy I love them both very much.' Her mom told me that Rudy is their dog, and he just mopes around the house since the little girl died. I keep thinking about her and just don't know if I can go on." Which response by the nurse would be therapeutic? A. "You're questioning your job because you're upset about the little girl you tried to save. Work stress can be treated and help you cope better. It is so important for you to seek treatment." B. "Maybe you could help the mother find a home for Rudy, and then your troubling thoughts would go away." C. "You've helped victims of some horrific fires lately, and yet you question your calling. Do you feel the need to resign?" D. "Would you listen to yourself? You've seen firemen stress out before. What is your responsibility in all this?"

A

A 61-year-old client whose two sons and daughter-in-law died in a nightclub fire says to the nurse, "We were going to retire early, but now we are the only ones who can care for our two grandchildren." Which response by the nurse would be therapeutic? A. "I am sorry you've had so many losses." B. "Don't you just want to scream at someone when such bad things happen? Do you have to work to support your grandchildren?" C. "Your grandchildren sound as if they will give you a run for your money." D. "I lost my nephew in that nightclub fire, so I understand your sorrow."

A

A client in group therapy says to the two nurses conducting the group, "You two are great at psychoanalyzing us, but what about you two? Do you have trouble being assertive with your bosses or the doctors like we do?" Which statement by one of the nurses would be most therapeutic? A. "You're interested in talking with us about our assertiveness, but this group is for all of you here to help you to deal with problems more effectively." B. "Your deflection from your own problems here in this group is inappropriate. Let us remind you that you signed up for this group and agreed to participate in it." C. "Why do I feel attacked by someone whom I'm trying to help? Could it be that you don't want to work in this group anymore?" D. "Maybe some others in this group want to talk about the assignment that we all agreed would be completed today."

A

A client who is an attorney says to the clinic nurse, "I'm worried about my wife. She's been so distant and disorganized since our son died of leukemia 4 months ago. She never suggests that we go out or take our other children anywhere. Is this normal, or do I need to get her to a doctor?" Which statement by the nurse would be therapeutic? A. "It's normal, but by the end of a year you can expect that your wife is improving and able to redirect her energy. Have you expressed your concerns to her?" B. "Absolutely. It sounds as if she may be experiencing a severe depression." C. "To be safe, it would not hurt to have her see your family doctor, or maybe you have a member of the clergy she can talk to." D. "The reluctance to resume activities and overprotect your other children is a normal part of bereavement and will subside in 2 months."

A

A client who was employed as a corporate manager before being laid off says to the nurse, "My wife thinks that I should work in a menial job to maintain our lifestyles until I find another job as a corporate manager, but I don't feel I should have to humiliate myself like that." Which nursing response would be therapeutic? A. "Have you shared your feelings with your wife?" B. "You seem to feel that a less prestigious job would be humiliating for you." C. "How soon will you be able to find work? If this is permanent, you may need to swallow your pride." D. "Oh, I agree with you. Let her get another job if she needs that much money."

A

A client who witnessed her husband being shot and killed in an incident of road rage says to the nurse, "It's been 3 months now, and I still can't drive my car without acting crazy. My sister says I grip the wheel like I'm glued to it. I can't merge with traffic until it's almost completely clear, and I'm parking a mile from in the mall when there's plenty of parking close to the building." Which statement by the nurse would be therapeutic? A. "You're seeking help appropriately, and there are many things you can do to get comfortable behind the wheel again. You've returned to driving, but remember, you're still grieving. It's normal to still feel this way." B. "I still grip the wheel when I merge with traffic, and I just wonder whether your sister needs to see me do it." C. "Smart of you to take no chances. You should see the dents and dings on my car from mall parking. Does your sister depend on you for many things? It seems like she's pushing you too hard." D. "If I were you, I'd have trouble driving the car again. Driving a car and being the victim of road rage are two very different things, and you need therapy and time to heal."

A

A client with depression says to a nurse, "Why is my family meeting with you? Are you telling them about me?" Which response by the nurse would be therapeutic? A. "Your family is learning about depression and how best to help you so that they can be supportive of you. We do not talk about you or anything confidential about you." B. "You sound concerned that I would tell your family something about you even though you know that what we talk about is confidential." C. "I am committed to keeping everything you say to me confidential, so it is troubling when you accuse me of talking to your family." D. "Have you talked with your family? What have they said to you about the meetings?"

A

A dying client with agoraphobia says to the nurse, "I've been unable to leave this house without tremendous effort for so long, and now it doesn't matter." Which statement by the nurse would be therapeutic? A. "It doesn't matter? Can you share your feelings with me?" B. "Did you go through systematic desensitization with your doctor? I understand that it works well." C. "Your gardens are beautiful now. Would you like to stroll in them after our work?" D. "I know what you mean. I spent more than $2,000 on a dental implant and still wound up with false teeth."

A

A health care provider (HCP) tells a client that she has cancer, that her illness is terminal, and that she has a 6-month prognosis. After the health care provider leaves the client's room, which therapeutic statement should the nurse make to the client? A. "What did your HCP tell you about your condition? Can you tell me what you're thinking about?" B. "I am so sorry about this. You are my favorite client, and I will take good care of you." C. "Do you have any questions about what is happening with you? I can assure you that I will do everything I can to help minimize your pain." D. "Do you want me to get the phone so you can talk to your loved ones, or do you have questions for me about what's happening with you?"

A

A nursing student is assigned to work in the emergency department to assist victims after a tornado. The student says to the nurse in charge, "I don't know how to help these parents. Their son was just decapitated by a flying piece of glass, and they won't leave him. They did mention that they are Catholic." Which intervention does the nurse suggest for inclusion in a plan of immediate care for the family? A. Joining the family and, after they have been able to be with their son for some time, helping them relinquish their son's body to the nurses B. Asking the emergency department health care provider to join the student in requesting that the family let the nursing staff care for their son C. Telling the student not to disturb the family until the end of shift D. Calling their family priest immediately to come help them to let their son go

A

A victim of sexual assault is being seen in the crisis center. The client states that she still feels "as though the assault just happened," even though it has been a few months since she was attacked. Which supportive statement should the nurse make to the client? A. "Tell me more about why you feel like the assault just occurred." B. "Things like this take time to get over." C. "Be realistic. Remember, the assault didn't just happen." D. "Why keep thinking about this? It'll only make matters worse."

A

A young woman who has been divorced twice says to the nurse, "I've decided not to date men ever again! It never works out for me. Now I'm left with two children to bring up." Which nursing response would be therapeutic? A. "Divorce is hard to go through. Tell me what difficulties you feel you will face raising your children."." B. "Oh, me too. I always pick the worst kind of men, so I know just how you feel." C. "Divorce is more difficult for children. Maybe you should focus on them for now." D. "You've been unfortunate, but you seem to be focusing on yourself and what you have to do."

A

Several family members are sitting at the hospital with a client who is dying of cancer of the bladder. The dying client's roommate is found waiting outside the room after visiting hours have ended. He tells the nurse that he wants to give his roommate's family privacy. Which action should the nurse take? A. Transferring the roommate to another room B. Reminding the dying client's family that visiting hours have ended C. Informing the dying client's family that the client may have just two visitors at a time D. Telling the roommate that he may return to his room and that the curtain will be drawn around the dying client's bed to provide privacy

A

Suicide precautions are enacted for Joseph, and the nurse assigned to care for Joseph sits down to talk with him. During the conversation Joseph states, "I don't want to live if I can't see my son. He's the only thing that matters to me." Which response by the nurse will most likely promote therapeutic communication? A. "Tell me more about how important your son is to you." B. "Do you have other family members whom you enjoy spending time with?" C. "I'm concerned about you, Joseph. You need to look for other activities to occupy your free time." D. "I understand what you mean. I have a daughter, and I always look forward to seeing her when I get home from work."

A

The client is the wife of a former workaholic who now has not worked in years, refusing to get a job or help with chores around the house. The man watches television and snacks all day. The client tells the nurse that her husband now weighs more than 300 lb (136 kg) and expects her to support him. The client states, "I keep saying everything will be fine. It will be if he keeps up these bad health habits, because they'll kill him, and then I would be free and wouldn't have to deal with his obnoxious behavior." Which negative stress response does the nurse recognize in the client's behavior? A. Wishful thinking B. Daydreaming C. Blaming D. Problem- solving

A

The home care nurse arrives at Louis's home for a daily visit. Laura tells the nurse that she is fatigued and needs help taking care of her husband. She tells the nurse that her daughter and son are her only family but notes that they work all day. Which suggestion by the nurse is most appropriate? A. Obtaining a referral for hospice care B. Trying to rest when Louis is resting C. Hiring a nursing assistant to help provide personal care D. Asking her daughter and son to take some time off from work

A

The home care nurse makes a new-baby visit to a young husband and wife. The visit takes two-and-a-half hours because the parents are so detailed in giving information and asking questions of the nurse. Which intervention by the nurse would be therapeutic? A. Blocking out more time for the next visit and scheduling a follow-up visit as soon as possible to assess how they are coping and gauge their level of anxiety B. Ordering a follow-up visit to the family pediatrician and mental health clinical specialist C. Informing all home care nurses to schedule their visits to the couple as their last visit of the day D. Having the home care office secretary call the nurse's cell phone 20 minutes after starting the visit to expedite the nurse's departure

A

The mother of a 3-year-old child tells the nurse that her child hit her doll after the mother scolded her for picking the neighbors' flowers. Which defense mechanism used by the child does the nurse identify in the mother's report? A. Displacement B. Projection C. Identification D. Sublimation

A

The nurse developing a plan of care for a client whose spouse recently died, determines the client has a problem with dysfunctional grieving. Which priority intervention does the nurse incorporate into the plan? A. Assessing the client's risk for violence toward self and others B. Monitoring the client's sleep pattern C. Assisting the client in resolving the grief through emotional, cognitive, and behavioral means D. Obtaining a health care provider's prescription for an antidepressant

A

The nurse is caring for a 15-year-old girl who has been hospitalized. The client tells the nurse that she had her hair styled just like her young math teacher, whom she admires. Which defense mechanism should the nurse recognize that the client is using? A. Identification B. Projection C. Regression D. Intellectualization

A

The nurse is caring for a 39-year-old client who has experienced a cerebral vascular accident(stroke). The client is recently widowed, is very active physically, and has two young sons. The client says to the nurse, "I don't know what my sons will do if anything permanent happens to me. We have no other relatives, even on my late wife's side." Which of the following nursing responses would be therapeutic? A. "You seem to be feeling very troubled." B. "You are working to get better, but you're worrying about things that aren't going to happen." C. "You seem to be feeling very powerless right now, yet you're getting better, so why worry about what won't happen?" D. "I am troubled that you are worried over the worst possible things that could happen rather than worrying about the efforts needed to strengthen your family situation."

A

The nurse is talking to a client in the mental health unit. The client says, "I'm really angry with my boyfriend about the things he says to me. Women always get put down, as if we don't matter or have anything important to offer." Which response is the most appropriate one for the nurse to make? A. "Tell me how you feel as a woman." B. "I know how you feel. I see that happening with some of my friends." C. "Yes, it's sad that women are treated that way. I guess we need to deal with it." D. "Many women's groups are developing ways to deal with this. I'll give you the names and contact numbers of some of these groups before you're discharged from the hospital."

A

The nurse is talking to a client whose spouse died 10 months ago. Which statement by the client indicates successful mourning? A. "I'm planning a trip to England next fall to tour the mansions and their gardens." B. "Last night they had to treat me in the emergency department because I swallowed a few too many pills. Lately I've felt as if I can't go on alone." C. "My son has taken over managing my money because I got into a little mischief with my charge cards. I'm restricted to one debit card now." D. "I must confess that I have taken to drinking more than I should at night, but a drink or two helps me to sleep alone in that big house."

A

The parents of an adopted child schedule an appointment at a psychiatric clinic, and when they arrive the nurse conducts an initial assessment. One of the parents says to the nurse, "We need to speak to a psychiatrist about our adopted daughter. Could you please get one for us?" Which intervention by the nurse would be therapeutic? A. "The doctors here feel that clients are best served when I conduct the initial assessment, after which the psychiatrist will see you with complete information." B. "That is not the procedure here. If you can't work with the system, you're free to go elsewhere." C. "Do you feel that I am incompetent to talk with you? Everyone who comes here sees me first." D. "I'd like to accommodate you both, but he is busy right now and you will have to talk to me."

A

The slightly overweight mother of a morbidly obese 11-year-old girl says, "My family health care provider is wild over my daughter's weight gain. He says she's not eating correctly and is too sedentary, and now she's at risk for diabetes. He says the sugar in her blood was up this month. It's all my fault because I eat the wrong things, too, and I never get off the couch." Which statement by the nurse would be therapeutic in easing the client's self-blame? A. "Your daughter has a serious problem, but there are many successful programs that you can join with her to lose weight and improve your overall lifestyle." B. "Well, it seems very bleak to you, but your daughter is responsible for her eating and exercising, too." C. "What about her father? Isn't it partly his fault, too? I want to meet with you, him, and your daughter tomorrow." D. "It's all this fast food and TV-watching these days. If our kids aren't watching television, they're playing with their computers."

A

The wife of a victim of a gas explosion says, "It's not bad enough that I've been left alone to care for two children — now the company is denying our claim for compensation and we have to join a class action suit to get my husband's pension." Which statement by the nurse would be therapeutic? A. "You're saying that being left a widow with children is difficult enough, but now you've got to fight for your benefits." B. "Get a lawyer! That's what you all need to do." C. "Do you believe that a class action suit is the correct thing and that you are in the right?" D. "Walk away. It's too much to even think about at your age, and how can you get caught up in all this with children and work, too?"

A

With her parents beside her, Isabel carefully explains her situation to her children and outlines the plans for surgery and chemotherapy over the next few months. The children listen, in tears, and ask questions about what Isabel is facing. Later in the day, Regina starts to talk about looking forward to next summer's trip to Florida, a trip they have taken every year. Isabel says nothing about it but worries that her daughter may not fully understand her situation. Which stage of grief is Regina exhibiting at this time? A. Denial B. Bargaining C. Depression D. Acceptance

A

A client is experiencing anxiety and requests help with using constructive coping mechanisms. When recommending coping mechanisms, the nurse should discuss which responses as most likely to be successful? Select all that apply. A. A response that is protective B. It is an effort to relieve anxiety. C. It may involve behaviors such as using relaxation techniques. A response that encourages relaxation techniques D. A response that involves repression of a painful experience into the unconscious. E. A response used by the individual to consciously confront a threat.

A, B, C, E

Louise tells the nurse that she will try the deep-breathing exercises but asks whether there is anything else that she can try to help her feel calmer. The nurse reviews several stress-reducing strategies with Louise. Which of these statements by Louise indicate a good understanding of stress-reduction techniques? Select all that apply. A. "I'll start going to bed 30 minutes earlier." B. "I'll limit my coffee to one cup in the morning." C. "I'll go to the gym at least three times a week after work." D. "I'll exercise just before bedtime to help improve my sleep." E. "A cup of hot tea will help me relax in the evening." F. "During my break at work, I can find a quiet place and focus on feeling calmer."

A, B, C, F

A nurse is caring for a patient whose spouse has died. How does the nurse determine that a client who has lost a spouse has successfully completed the tasks of mourning? Select all that apply. A. Heard explaining to family that illness "took" her husband B. Reporting that sleeping alone is so hard now C. Relating that "its better he went first" D. Purchasing a smaller car she is comfortable driving E. Placing a picture of her husband on the bedside stand

A, B, D, E

Which therapeutic nursing actions should the nurse use when dealing with the husband of a client who is dying? Select all that apply. A. Encouraging the husband to express his feelings and concerns B. Making decisions for the husband to lessen his burden of grief C. Determining how much the husband wishes to know about the care being provided to his wife D. Refraining from demonstrating emotion over the client's terminal situation in the presence of the husband E. Telling the husband that it will be easier to accept the loss if he avoids reminiscing and talking about his life with his wife

A, C

After Louis has died, his family members gather around his bedside to pray and mourn. A little later, Laura asks the hospice nurse to call the funeral home and requests help in preparing her husband's body before the funeral home arrives. Which actions are appropriate components of postmortem care? Select all that apply. A. Placing a small pillow under the head B. Elevating the head of the bed to 45 degrees or higher C. Gently pulling the eyelids over the eyes to close them D. Removing Louis' dentures and placing them in a denture cup E. Washing soiled body parts and placing an absorbent pad under the buttocks

A, C, E

Louise reads an article about herbal therapies for stress relief and decides that she wants to try drinking tea made with kava. She calls the company nurse to ask about using kava. Which instructions should the nurse provide? Select all that apply. A. "You shouldn't use kava if you think you might be pregnant." B. "Herbal products are safe to use, because they aren't really medications." C. "This herb helps some people feel more relaxed and may help you sleep." D. "It's safe to drink a small glass of wine at night with this tea right before bedtime." E. "If you drink this tea long enough, you may notice a yellow discoloration of your skin."

A, C, E

A few weeks later, while under the care of a hospice program, Isabel dies peacefully at home. Her parents and her children, who have been at her side, are understandably upset. Which statements by the hospice nurse are appropriate at this time? Select all that apply. A. "It's OK to cry." B. "Everything will be fine." C. "I'll be here if you want to talk." D. "Don't cry. She wouldn't want that." E. "You need to be strong for your little brother." F. "Let me know if I can make any phone calls for you."

A, C, F

The home care nurse making a visit to a client who is receiving hospice care understands that hospice care is intended to achieve certain outcomes. What are these outcomes? Select all that apply. A. Relief of symptoms B. Postponement of death C. Hastening of disease remission D. Facilitation of a peaceful death E. Provision of the best possible quality of life

A, D, E

Just before a session with the nurse, Katie receives a call from her boss. After the call, Katie is extremely upset and unable to sit down. She paces the room, crying and repeating, "I don't know what to do. He hates me!" Which nursing interventions will be most likely to be effective at this time? Select all that apply. A. Speaking to Katie in slow, firm, short statements B. Leaving Katie alone until she has settled down C. Assessing the need for medication at this time D. Exploring problem-solving strategies with Katie E. Moving Katie to a quiet setting and staying with her F. Using nonverbal cues, without speaking, to convey concern

A, E

A 16-year-old client says, "My dad thinks I'm evil, but we get into fights because I let things build up. He never has any time for me because he's always glued to the TV. He doesn't even look at me when he talks." Which statement by the nurse encourages the client to use assertive behavior with his father? A. "What makes you feel that you have the right to fly off the handle just because you feel ignored?" B. "Have you tried saying that directly to your dad? For example, you could say, 'I notice that you watch television when I'm telling you things that are important to me.'" C. "So you're saying that you let your feelings build up and then you just explode?" D. "Have you tried standing in front of the television when your dad is watching it?"

B

A 74-year-old widower of 3 months says to the nurse, "When my wife died, I lost my love and my best friend. Everyone I cared about is dead. We both were only children, and we had no kids. I'm more than ready to go when the time comes." Which nursing response should the nurse make? A. "When my dad died, my mother said some of the things you're saying now, and she had three kids." B. "Are you thinking of ending your life because your time has come?" C. "Did you know that many people live happier lives without children?" D. "It must seem very lonely to you. I can't believe that you never had any children."

B

A client is going to receive instruction in biofeedback technique to lower his stress level. The client asks the nurse to describe this technique. What should the nurse tell the client? A. It involves learning to contract and relax muscles in a systematic way and may be combined with breathing exercises B. It is a therapeutic modality that enables an individual to monitor skin temperature, muscle activity, heart rate, blood pressure, and other bodily functions, then learn to control these physiologic responses to stressful or challenging events C. It is a technique that trains the mind to elicit a relaxation response D. It is the purposeful use of one's imagination to achieve relaxation and control

B

A client is seen in the emergency department for complaints of chest pain and difficulty breathing. The results of laboratory and diagnostic tests are normal, indicating that there is no physiological basis for the complaints. On further assessment, the client tells the nurse that chest pain and difficulty breathing are the symptoms that his wife had before she died. Which type of defense mechanism does the nurse recognize in this behavior? A. Projection B. Introjection C. Rationalization D. Reaction formation

B

A client says to the nurse at the mental health clinic, "My husband and sister-in-law both have terminal illnesses, and my family thinks that because I'm a nurse I should be able to handle everything." Which nursing response would be therapeutic? A. "Are you saying you are overly involved and will need to emotionally distance yourself to be therapeutic for your family?" B. "You've seen your loved ones dealing with some troubling events recently. Sounds as if you feel that your family expects more from you than from others in the family because you're a nurse." C. "Shame on them for expecting so much from you. Perhaps we need to schedule a family meeting so I can help you set them straight." D. "I'm sorry to hear that your loved ones are so ill. As a nurse, you should be able to assist them by using your professional expertise. Perhaps that's what your family expects from you."

B

A client says to the nurse, "My doctor says he thinks I'm ready to taper off my pain medication, but the new painkiller he prescribed doesn't relieve my pain the way the other pill did. I get pain when I try to do things." Which nursing response would be most supportive to the client? A. "Your health care provider feels that your body is physically ready to make the change in medication." B. "Perhaps if I medicate you about a half-hour before you plan to start your daily activities, the medicine will be more effective." C. "I think you need to listen to your health care provider when it comes to taking such strong medication." D. "Well, your health care provider is concerned that you will become physically dependent on the first painkiller."

B

A client says to the nurse, "What does my psychiatrist mean when she says that my illness is biologically based?" Which nursing statement would be the most informative? A. "Mental illness is a result of environmental factors." B. "There are many possible physical causes of mental illness, and they include problems in the brain." C. "Mental illness always has its roots in the family." D. "Today we know that all mental illness is genetically inherited."

B

A client tells the nurse that he is experiencing a great deal of work-related stress and is taking an anxiolytic medication. He tells the nurse that he read on the Internet that St. John's wort, an herbal product, is helpful in reducing stress and says that he would like to try taking it. Which is the best response for the nurse to give the client? A. "It's an herbal product made from a plant, so it's harmless." B. "You'll need to discuss the use of St. John's wort with your health care provider before taking it." C. "I read the same thing, and I know that you can buy St. John's wort at any health food store." D. "You should give it a try. I would suggest taking it every morning that you're scheduled to work."

B

A client who was formerly a workaholic has lost his job and is being supported financially by his wife. The client says to the nurse, "I know that my wife is disappointed in me, but I can't seem to get a job doing what I've done for 25 years. Why should I take a low-level job when she's able to support us financially?" Which response by the nurse would be therapeutic? A. "Sounds as if you're lucky to have your wife's job to fall back on." B. "Can you tell me a little more about this?" C. "I'm surprised that such a hardworking man is not able to find a job." D. "I would dig ditches if it contributed to my family's well-being."

B

A client who was recently admitted to the mental health unit has a history of paranoia. When the meal tray is delivered, the client refuses to eat and tells the nurse that someone is poisoning the food. Which statement by the nurse is appropriate? A. "Your food is not poisoned." B. "It must be frightening to you. Has something made you feel that your food is poisoned?" C. "Why do you think the food is poisoned?" D. "There is no poison in the food. Here, I'll taste the food for you."

B

A client whose adolescent son committed suicide by hanging himself in the family's garage says to the nurse, "The coroner just informed us that our son had AIDS." Which response to the client by the nurse is appropriate? A. "Your poor son. How troubled he must have been. It's a shame he couldn't talk to you and get some help." B. "Your son was keeping a very troubling diagnosis to himself. I am so sorry. No matter how close and loving children are to their parents, some children just aren't able to confide in their parents." C. "Your son had an autopsy because he committed suicide, but the coroner didn't have to tell you that he was ill." D. "You didn't know that he had AIDS? How did he see the family health care provider without your knowing?"

B

A client with an anxiety disorder who has been prescribed an antibiotic for otitis media asks the nurse, "Why'd the doctor tell me not to discontinue the antibiotic until the pills are gone?" Which response by the nurse is appropriate? A. "Medication is always prescribed for 1 month. Do you have a month's supply?" B. "Completing the prescription ensures that the infection will be resolved." C. "Doctors always tell clients to take all of their medicine." D. "It's because insurance companies pay for the medications and want to make sure that the client is healed."

B

A client's son and daughter were killed during a fellow student's murderous rampage at their high school 9 months ago. The client says to the nurse, "My wife and I just feel empty and exhausted. I can't believe that I had a vasectomy after our son and daughter were born because we wanted to give them both whatever they needed. We have college funds for both of them that they'll never use now." The nurse should make which appropriate statement to the client? A. "Your loss is incalculable. Perhaps you could consider some ways in which to commemorate their lives for you and in your community." B. "Your loss touches me so. How truly devastated you both must be. Can you share what things you have been doing to grieve?" C. "My parents would be devastated if they lost me and my sister, too. How can I be of service to you?" D. "Your feelings are appropriate for the extent of your loss and how your children's deaths happened."

B

A female victim of incest says to the nurse, "I've had tons of therapy but still can't let my fiancé get too close. He knows I've been sexually abused by my dad and older brother, but I'm wondering whether I'll ever be able to lead a normal sexual life." Which statement by the nurse would be therapeutic? A. "It almost seems that you're saying that you will never be able to love your fiancé." B. "Can you share with me some of the strategies you've been using?" C. "Do you want a normal sexual life? If you do, you will have one, I'm sure." D. "You seem to be saying that you and your fiancé haven't been close, yet you found each another."

B

A university professor meeting with the mental health nurse for his weekly therapy session says, "I have a very intelligent student who keeps disrupting my classroom by bragging, and all I want to do is say, 'OK, you're great and you know it all! Now shut up!' But I just don't want to be rude." Which statement by the nurse is therapeutic? A. "Just smile and say nothing. Go on with your lecture and then talk with the student after class." B. "Sounds like you feel pretty helpless, yet you are the professor here." C. "You're having a pretty strong reaction to this student, aren't you? Why not ask the student to leave the room and use the time to write down his or her thoughts so you can give the others your complete attention?" D. "Just say, 'Gee where did you earn your doctorate?' and move on with your lecture."

B

After 2 weeks, Isabel undergoes surgery to remove her ovaries and surrounding tissues. One week later, she visits her surgeon and gets the news that the cancer has spread to three lymph nodes in the area. "Not the best prognosis," she is told, "but we can still give it a good try." The nurse, helping Isabel get ready to leave, sees that she is sitting very still with her eyes closed. She tells the nurse, "I don't know how I'm going to get through this. I don't want to leave my children alone!" Which response to Isabel's statement is therapeutic? A. "If I were you, I'd get a second opinion before doing anything." B. "This must be a terrible time for you. Would you like to talk about it?" C. "It's too early to be upset. You haven't even had any chemotherapy yet!" D. "Don't worry. Everything will be all right. Dr. Smythe is the best oncologist in the area."

B

After a thorough mental health assessment, Joseph is transferred to the mental health unit in a voluntary admission. The nurse in the mental health unit reviews the emergency department notes in preparation for the interview with Joseph. Which would the nurse determine because Joseph has consented to voluntary admission? A. Joseph cannot request and be granted hospital discharge. B. Admission to the mental health unit was sought by Joseph. C. Admission to the hospital was made without Joseph's consent. D. Joseph will not be making decisions about his treatment or care.

B

In planning the care of a client dying of cancer, the nurse seeks to have the client verbalize acceptance of his impending death. Which statement indicates to the nurse that this goal has been met? A. "I want to go to my family reunion; then I'll be ready to die." B. "I'd like to have my family here when I die." C. "I'll be ready to die once my daughter gets married." D. "I just want to live to see my grandchildren graduate from college."

B

The mental health home care nurse says to the client, "Do you feel ready to try attending a group session at the clinic?" The client shakes his head. Which nursing statement would be therapeutic? A. "Perhaps a group session would be too overwhelming for you right now. How about just seeing me?" B. "You seem to be saying no. Would you tell me more about your reluctance?" C. "OK, but I hope you will let me know when you feel ready to attend a group session at the clinic." D. "No? Why not?"

B

The nurse coordinates the use of hospice care to visit a dying client who will be going home with his family. Which is a function of hospice services that the nurse should tell the family? A. Working with the client to sustain hope by talking of recent research breakthroughs regarding his illness B. Providing bereavement support to the family after the client's death C. Helping the client focus completely on his physical health D. Helping the family stop the client's efforts to go out at night with his friends

B

The nurse employed in hospice care is reading the records of assigned clients. Which client does the nurse identify as being at risk for disenfranchised grief? A. The mother of a child who was killed in an automobile accident B. A same-sex partner of a client with acquired immunodeficiency syndrome C. A client with terminal cancer who is receiving a great deal of support from his wife D. A client with end-stage renal disease who relies heavily on religious beliefs for hope

B

The nurse is caring for a Muslim client who is dying of gastric cancer. Which specific request from the client's family might the nurse anticipate? A. "One of us must be present when he passes." B. "Can we please turn him to face the southwest?" C. "We are expecting the priest to come to administer sacraments." D. "We will need to cremate the body within 24 hours of his passing."

B

The nurse is evaluating the coping skills of a client with a diagnosis of depression. Which statement indicates to the nurse the need to help the client learn and appropriately use these skills? A. "I know that I can't do everything." B. "I won't ever be depressed again." C. "I need to take my medications." D. "I have learned ways to deal with stress."

B

The nurse is providing physical care to a client who has recently been told that he has inoperable lung cancer with a poor prognosis. The client says to the nurse, "I am so scared of dying. You hear so many stories about death. If only someone could tell me what it is really like." Which response should the nurse give the client? A. "What stories have you heard?" B. "You're scared of dying. Let's talk about what makes you scared." C. "I've heard a lot of stories, too. I wish I could give you an answer to this one." D. "People who have died and been resuscitated say it's a beautiful experience."

B

The nurse is reading the medical record of a client who has a diagnosis of moderate anxiety and notes that the health care provider has documented that the client exhibits eustress. Based on this information, which finding would the nurse expect to encounter while assessing the client? A. The client complains of feeling anxious. B. The client engages in purposeful movement. C. The client complains of feeling drained. D. The client complains of fatigue.

B

The nurse notes that a client being admitted to the inpatient mental health unit uses avoidance and denial to cope with stress. Which positive stress response will the nurse plan to focus on when working with the client? A. Reframing B. Problem-solving C. Locus of control D. Use of social supports

B

The nurse reviews the nursing care plan of a client being seen in the mental health clinic and notes that the client is experiencing dysfunctional grieving after losing his spouse. Which is the appropriate outcome for the treatment plan for this client? A. The client verbalizes an absolute need to spend time with friends. B. The client plans to attend a community grief group. C. The client reports that he is trying to use coping strategies. D. The client verbalizes the relationship between significant loss and depression.

B

The nurse teaches Louise deep-breathing exercises to help her relax and reduce stress. She tells Louise that she may perform these exercises while sitting at her desk and that she should perform them whenever she begins to feel stressed. Which observation by the nurse indicates that Louise is performing the breathing exercises correctly? A. Louise breathes in through her nose, holds her breath for 10 seconds, and then breaths out through her nose. B. Louise breathes in through her mouth, holds her breath for 3 seconds, and then breathes out slowly through her nose. C. Louise breathes in through her nose, holds her breath for 15 seconds, and then breathes out quickly through her mouth. D. Louise quickly breathes in through her mouth, holds her breath for 10 seconds, and then quickly breathes out quickly through her nose.

B

The widow of a man who was killed a week ago in a hit-and-run accident while walking the family dog says, "I should have just let the dog run in the backyard or gone with my husband. Our own parish priest hit my husband and finally surrendered to the police. He brought a lawyer with him because he's worried about himself, not my husband. I hate him so much, my stomach hurts." Which nursing statement would be therapeutic? A. "Of course you're angry. Who wouldn't be? Yet nothing is ever clear cut, is it?" B. "You not only lost your husband but also learned it was at the hands of someone you looked up to." C. "I wouldn't blame you if you never entered a church again. This is a terrible thing for the head of a church to do." D. "You're having stomach pain? You should get checked for an ulcer or other gastric problem."

B

The young nurse has just completed postmortem care of a 16-year-old client who died of cancer. The nurse says to the nurse manager, "I never get sick, and this client kept telling me that he couldn't remember not being ill. I feel terrible and so bad for him and about what he went through." Which statement by the nurse manager would be therapeutic? A. "Your feelings are normal and will go away after a good night's sleep." B. "Let's go for coffee and talk about this some more, shall we? We're both due for our coffee breaks." C. "I should never have assigned you someone so close to your own age. I'll be more careful in the future." D. "Next time, take someone else in with you for postmortem care, OK?"

B

Which action on the part of the nurse would best help Katie in regaining her self-worth? A. Suggesting that she quit her job and find a new one B. Assisting Katie in exploring solutions to the problem C. Teaching Katie how to stand up to her boss when he reprimands her D. Encouraging Katie to use any defense mechanism necessary to deal with the problem

B

After several months and six rounds of chemotherapy treatments, Isabel begins to experience an aching pain in her back and hips. A bone scan reveals that the cancer has spread to her bones, and her oncologist tells her that her prognosis at this time is poor. He also tells her that she may have only weeks to live. Isabel again calls her family together and shares the news with them. She has been quietly working with an attorney to get her affairs in order, and her parents have agreed to serve as legal guardians of her children after her death. She has a living will and has included Regina in these discussions about the arrangements. Isabel has noticed that Regina has been quieter and has not talked to Isabel as much as usual. Isabel talks to the social worker at the oncology office about this, and the social worker suggests that Regina may be experiencing anticipatory grieving. Which examples are characteristics of anticipatory grieving? Select all that apply. A. The person experiences grief weeks after the actual loss. B. A family member begins to withdraw emotionally from the terminally ill person. C. A family member may choose to be with friends instead of staying with a dying family member. D. A person is overwhelmed by grief and cannot carry out day-to-day actions such as going to work. E. A family member is unable to sleep after a loss but does not connect the altered sleeping pattern to the loss.

B, C

During the assessment, Joseph discusses his feelings of self-harm with the nurse and hints that he even had a plan for carrying out his suicide if his life "got worse." Which methods of suicide are considered of lower risk, or "soft"? Select all that apply. A. Hanging B. Swallowing pills C. Inhaling natural gas D. Slashing one's wrists E. Staging a high-speed car crash into a cement wall

B, C, D

The nurse is evaluating the grief process for a woman whose husband died in an automobile accident 2 months ago. Which outcomes would the nurse identify as successful? Select all that apply. A. The client refuses to take on new responsibilities. B. The client demonstrates lengthening periods of stability. C. The client expresses positive expectations about the future. D. The client reports decreased preoccupation with the loss of her husband. E. The client's daughter reports that her mother has not paid any bills since the death of her husband.

B, C, D

The nurse plans care for a client experiencing stress. Which characteristics are associated with the stage of resistance in Selye's description of general adaptation syndrome? Select all that apply. A. All energy for adaptation has been expended. B. The body makes some effort to resist the stressor. C. When resources are adequate, the person may successfully recover from a stressor. D. Successful adaptation depends on the adequacy of the person's internal and external resources. E. The person in this stage may become ill and die if assistance from an outside source is not available.

B, C, D

Joseph is discharged from the hospital, but his new mental health contract states that he will attend twice-weekly cognitive therapy sessions. During the working phase of the nurse-client relationship, what specific tasks does the nurse plan? Select all that apply. A. Establishing a rapport B. Promoting Joseph's problem-solving skills C. Gathering further data about Joseph's problems D. Summarizing the goals achieved in the relationship E. Discussion of problems and goals, and redefining as needed F. Helping Joseph explore how to practice alternative adaptive behaviors

B, C, E, F

The home care nurse makes a phone call to arrange a visit from a hospice nurse. A few hours later, the hospice nurse arrives to talk to the family and set up the hospice program. Laura takes the nurse into Louis' room, and says "He's been so sleepy for the last few hours. It won't bother him if we talk in here." Which of these responses by the hospice nurse would be appropriate? Select all that apply. A. "Sure. How long has he been like this?" B. "Well, first I'd like to introduce myself to your husband." C. "OK. Do you have his advance directive for me to review?" D. "Mrs. Mast, let's step into the next room to talk for a few minutes." E. "Yes, let's pull up some chairs and chat about what's going on."

B, D

A 35-year-old client says to the nurse, "I got divorced less than a year after getting married. I left the Navy SEALs shortly after I joined. Now I teach in the air marshal program to avoid being recalled for war, but I'd really like to quit. I start something, am great at it, then get bored and move on. I date, but I'm still living at home. I never seem to be on my own like other guys my age." Which response by the nurse is most appropriate? A. "You have many years to find a new relationship, but moving out of your parents' home is a first step to growing up." B. "You made the Navy SEALs but can't live on your own like an adult and can't stick with anything." C. "Can you tell me more about your marriage and relationships? If you leave home, what do you fear will happen?" D. "When will your mother let you go? Seems to me that jobs have come easy to you but that you can't grow up and separate from your parents."

C

A 35-year-old recently divorced parent of twins comes to the intake office of the psychiatric clinic for the first time with a possible diagnosis of generalized anxiety disorder. The client says to the nurse, "My mother always called me a worrywart like my nana, so I guess I come by my problems naturally. I keep worrying about things I can't change, like my divorce, and blaming myself when I know I'm not the only one responsible for the divorce." Which nursing statement would be therapeutic? A. "So you're a natural worrywart, divorced with twins. I guess you can be forgiven for a little worrying, but tell me about the blaming you've been doing." B. "I wonder whether you think you're responsible for making everything turn out right." C. "Can you tell me more about the worrying and blaming you are experiencing?" D. "Yet you seem to be dwelling on the thought that the divorce is all your fault."

C

A 45-year-old client says to the nurse, "Since I left my wife and children, I can hardly make ends meet between child support and trying to support myself. I don't know why I bother going to work when my wife and kids take just about everything I make." Which nursing statement would be therapeutic? A. "What would you expect your wife and children to do? They didn't leave you." B. "I wonder why you left your wife and children." C. "Do you feel that child support is designed to help children, not punish spouses who leave?" D. "You seem to be very angry about carrying out your responsibility to your children."

C

A 62-year-old woman says, "Since my husband retired, 4 months ago, he's started playing golf 24/7, so after rearing our children alone while my workaholic husband ran his business I'm suddenly a golf widow." Which response by the nurse is appropriate? A. "Do other people call you a golf widow?" B. "Some women wish they had your problem. My mother keeps complaining that Dad is always messing around in the house, driving her nuts." C. "Have you shared your feelings with your husband?" D. "'When you can't beat 'em, join 'em' — that's what I always say. Why not play golf with him?"

C

A 79-year-old client, recently widowed, says to the nurse, "My wife kept up our condominium single-handedly, and now my kids expect me to cook and clean for myself. I'm not lazy, but I don't know how to cook and I've burnt myself twice just frying up what was supposed to be bacon and eggs. I'm so frustrated and I've already lost 10 lb (4.5 kg) this month." Which initial nursing statement should the nurse make to the client? A. "First things first. What are you doing eating bacon and eggs? That's not a good meal for you." B. "I'm calling the doctor immediately to obtain a homemaker for you!" C. "Seems as if you feel lost without your wife and maybe a bit ignored by your children." D. "Meals-on-Wheels can help you minimize the frustration you are having cooking. Are you a member of the local senior center?"

C

A client comes to the mental health clinic after losing all of his personal belongings in a hurricane. The client tells the nurse that the loss of his possessions is his fault because he didn't prepare for the storm. The nurse determines that the client is coping ineffectively and develops goals with the client. Which goal requires revision because it is not realistic? A. The client will develop and use adaptive coping patterns. B. The client will identify effective coping skills. C. The client will stop blaming himself for the loss of his belongings. D. The client will express and share his feelings about this crisis.

C

A client says to the nurse, "I was cheating on my lover because I need the thrill of seeing someone new, and now my lover has left me to go live with this other woman. I know that this other woman wants more than friendship from my lover, and I can't make my lover see that I love her and that my affairs are meaningless. I don't want to lose her, but I can't stop cheating, because I need the thrill it brings." Which statement by the nurse would be therapeutic? A. "So she's left you for cheating on her. If you can't be monogamous, I guess you'll have to be content with one-night stands." B. "I'm confused. What is it that you've come to me for? It sounds like your lover refuses to share her lover with others, no matter how trivial the dalliances." C. "Perhaps your task is not to make your lover see that your dalliances are meaningless but to look at your own behavior and determine what you would like or not like to be different." D. "It sounds like you want to have your cake and eat it, too. If you can't have both things, which would you prefer — the thrills of one-night stands or the steady support of a loving relationship?"

C

A client says to the nurse, "I've started a journal because my health care provider suggested it, and I'm writing about the things that bother me each day. Sometimes I dictate my feelings and what happened during the day into a recorder and write them up before I go to bed — and, do you know, they seem silly to me then. Is this helping me?" Which response by the nurse would be appropriate? A. "I'm not certain that using a tape recorder will help you with the journal-keeping." B. "Well, it will take some time, but let's see how you're doing over a month. In the meantime, keep writing." C. "It seems that people who write in their journals and can share traumatic events improve their self-awareness." D. "Well, I wonder about the dictation, because the writing is what helps reduce stress."

C

A client who delivered a baby 4 weeks ago says, "I'm feeling as if I'm hanging on by a thread to keep my wits about me." Which statement by the nurse would be therapeutic? A. "You have a beautiful new baby, and caring for her will help you feel better. Your hormones will be back in balance soon." B. "Can your husband help you with the baby and your chores? Is he on paternity leave? C. "Can you share with me more specifically how you feel that you're hanging on by a thread? Are you having thoughts of hurting yourself?" D. "You seem to be experiencing postpartum depression. I suggest that you have someone take your baby for a while until your hormones level off."

C

A client who has been admitted to a surgical unit with a diagnosis of cancer is scheduled for surgery in the morning. When the nurse enters the room and begins the surgical preparation, the client states, "I'm not having surgery — you must have the wrong person! My test results were negative. I'll be going home tomorrow." Which defense mechanism should the nurse recognize that the client is using? A. Displacement B. Delusions C. Denial D. Psychosis

C

A client who is a health care provider says to the nurse, after receiving a diagnosis of terminal lung cancer, "All my life I took care of my clients, and now my family is taking care of me." Which statement is a therapeutic nursing response? A. "Well, you'd expect them to care for you, wouldn't you?" B. "You can look back on so many wonderful people you saved and cared for." C. "Your family is caring for you now." D. "It is an honor for all of us to care for you. We want to help you."

C

A client who recently lost his hand in a workplace accident says to the nurse, "I don't know how I'm going to support my family with a plastic hand. I might as well be dead." Which nursing response would be therapeutic? A. "Perhaps you need to focus on being happy that you survived." B. "Don't worry about all of that at this point. You're going to be fine." C. "You're saying that you feel useless without your hand?" D. "You'll never need to worry about work again, because your employer will cover all of your expenses and make a settlement that will support you for life."

C

A client who was admitted to the mental health unit 1 month ago with agoraphobia is cooperative, shares with peers, and makes appropriate suggestions during group discussions. Which is most consistent with the client's behavior? A. Manipulation B. Attention-seeking C. Improvement D. A desire to be accepted

C

A client whose husband died 2 months ago says to the nurse, "After church, I visit my husband's grave and talk to him. It comforts me, but my daughter thinks I'm morbid and crazy and is upset with me because I don't want to meet her for coffee after church like I used to." Which statement by the nurse would be therapeutic? A. "You need to stop your visits immediately, or your daughter will have you examined for a mental disorder." B. "I think your visits are perfectly normal. After all, you were married for a long time. You'll stop when the winter weather comes." C. "Sounds as if you have had difficulty letting your husband go from your life. What would happen if you visited his grave less frequently?" D. "Perhaps you could reduce your visits to his grave to once a month and meet your daughter for coffee like you used to."

C

A dying client says to the nurse, "How do I tell my parents that I am dying of AIDS ?" Which statement by the nurse would be therapeutic? A. "Well, isn't it better that they learn from you than for them to learn on their own?" B. "I've worked with this illness for many years now, and there just doesn't seem to be an easy way to do this." C. "Sounds as if you're thinking that it's time for you to tell your parents about your disease." D. "Are you saying that your parents don't know about your illness?"

C

A recently widowed client says, "I lived my whole life for my husband and children. Now he's dead and my daughter and son have each married and moved across the country. They hardly ever call or visit. It's just that there's really nothing much for me to do." Which response by the nurse to the client is appropriate? A. "Are you thinking of hurting yourself just because you're alone?" B. "You're feeling pretty useless right now, but I wonder if you've taken enough time to grieve?" C. "You seem to be identifying some issues in your life that are troubling, and you sound very down right now." D. "Your children seem very distant. They hardly ever call?"

C

A single mother whose son was suspended from school for carrying a gun into the school, says to the nurse, "I know he has no dad, but I've brought him up to know better, and anyway, where did he get the stupid gun? What should I do? He just won't listen to me." Which nursing response would be helpful at this time? A. "Boys who are cared for only by their moms are at highest risk for violent behavior." B. "Many young people die of gunshots every day in this country, so your son's behavior is unacceptable." C. "There is quite a bit that you can do. Let's talk about what you're already doing first." D. "Do you know all of your son's friends, or is he left alone after school because you work?"

C

A survivor of a nightclub fire that killed more than 100 people says to the nurse, "It should have been me. How come I got out and they didn't?" Which response by the nurse is appropriate? A. "I don't know what to say. It was a terrible fire. I'm so sorry this happened." B. "It seems to me that you're making this all about you when many people died in that fire." C. "It seems that you're blaming yourself for something that was beyond your control." D. "You should be thankful that you're a survivor. The victims and their families lost, not you."

C

An older adult client who is dying says to the nurse, "My son is 40 years old, but he works in a very poorly paying job and is always borrowing money from me. I don't know how he's going to manage without me." Which response by the nurse would be therapeutic? A. "Goodness. At 22, I supported myself and never asked my mother for anything." B. "I wonder why you're so worried about your adult son when you need to concentrate on you?" C. "Could you share your feelings with your son just as you have with me?" D. "Sounds as if your son will never grow up and learn to take care of himself."

C

During a mental health intake interview, a young adult client who lives with his family rent free says, "I'm tired of not being able to offer my friends a beer just because my folks don't believe in taking a drink socially." Which nursing response would be therapeutic? A. "Well, if you directly discussed your concerns with them, I guess it's a case of 'When in Rome, do as the Romans do.'" B. "Well, I guess you could move out and live on your own if you wanted to." C. "It seems that your parents expect you to follow their rules when you live under their roof." D. "You tell me you live rent free, yet you expect the same privileges as an adult who supports the household?"

C

Hospice care has been initiated for Louis, and he is being provided with several daytime services. His condition is deteriorating. During the night, Laura notices that Louis' breathing pattern has changed, and she calls the hospice nurse. The nurse comes quickly to assess Louis and notes periods of apnea alternating with periods of deep, rapid breathing. What is the appropriate explanation for the nurse to give to Laura? A. Louis probably has some sinus congestion. B. This type of breathing is a sign of pneumonia. C. This type of breathing is a sign of approaching death. D. Louis needs to be turned and repositioned more frequently.

C

Isabel has begun outpatient chemotherapy. After each session, she goes home to rest, and she has been unable to care for her children. Her mother comes over in the afternoons to be there when the children come home from school and to cook dinner for the family. Trevor comes home one day with a note from his teacher. He has been rude at school, using "bad language" and talking back to the teacher. When asked about this, Trevor replies, "I'm fine. The teacher is stupid." Isabel calls the clinic nurse to talk about Trevor's behavior. Which statement by the nurse provides the best interpretation of Trevor's behavior? A. "Yes, he's being rude and insensitive, but he'll grow out of it soon." B. "Trevor needs to accept what's happening to you and stop acting out." C. "This may be his way of running away from the situation. Let's try to get him to talk about it." D. "The teacher just doesn't understand the difficult time that Trevor is going through right now."

C

Joseph has been undergoing therapy, and suicide precautions have been discontinued. Joseph asks the nurse about being discharged from the mental health unit. What information does the nurse keep in mind as he responds to Joseph? A. Administrative approval is required before discharge. B. Because of his admission status, Joseph may not request discharge. C. Voluntarily admitted clients have the right to request and be granted release from the mental health unit. D. Discharge will not be considered unless Joseph is able to move in with a relative or friend who can stay with Joseph full time for at least 1 month.

C

Katie, anxious about her work, is now afraid of her new boss. She dislikes going to work because she is afraid of being reprimanded, hates feeling inadequate and worthless, and fears demotion. Katie decides to seek help for her problem because she doesn't like taking her frustrations out on her children and makes an appointment to speak to the nurse at the mental health clinic. Which conclusion regarding Katie's defense mechanisms does the nurse make? A. They need restructuring. B. They must be used at work to deal with this situation. C. They are used to cope with the stress and to maintain self-esteem and ego integrity. D. They should not be used at all, because Katie must learn to deal with the situation on her own.

C

The 45-year-old husband of a client with breast cancer who just died says to the nurse, "If our doctor had operated sooner, my wife would be alive now." Which statement by the nurse would be therapeutic? A. Say nothing. Simply nod and say "Mm-hmm" noncommittally. B. "Let's focus not on what was not done but instead on what was done for your wife." C. "Sounds as if you're feeling angry and pretty helpless right now." D. "Your doctor did all he could for your wife. You know, health care providers can only apply their best clinical judgment."

C

The client says to a nurse, "Do you know that after 24 years of marriage I still serve my husband breakfast in bed? After all I do for him, he still doesn't treat me well. He should treat me better." Which nursing response is appropriate? A. "You know, you could work and make money serving food to people." B. "I agree. If you can do all that for your husband, he should treat you better." C. "It seems that you feel that your husband could treat you well just as you treat him." D. "Ask your husband to do the things you'd like. If he doesn't, tell him you're leaving him."

C

The family of a client who is being discharged after trying to kill himself with one of his father's guns asks for a family meeting with the nurse to discuss their son's situation. Which statement by the nurse would be the most therapeutic start to the meeting? A. "I must begin by saying that I am uncomfortable meeting without your son here to talk for himself." B. "Why don't we all introduce ourselves and say what our relationship is to your son? I'll begin, because I'm the nurse who'll be seeing him after he comes home." C. "I am going to begin by talking in general terms about your son's return home and some of the things that might happen. I can suggest measures that might be helpful, and then you can ask questions." D. "Let's start by introducing ourselves and talking about what is most troubling to each of you about having your son home."

C

The husband of a terminally ill client says to the nurse, "My company went bankrupt, my son is a drug addict, my daughter is an alcoholic, and now this! My doctor wants me to try some stress reduction because my blood pressure is up. Whose wouldn't be? I've tried music and relaxation, but they don't work." Which statement by the nurse would be therapeutic? A. "Before we talk about stress management, let's discuss your children." B. "Can you afford to pay for therapy sessions? I see that your benefits are pretty much maxed out, and I'd hate to ask you to take on any additional burden." C. "Let's talk more about what has been helpful to you in the past." D. "You have a lot of problems. How long does your wife have to live, and what is her relationship with your children?"

C

The nurse assesses Katie's level of anxiety and records the information (refer "Chart" below). Perceptual Field Focused on details Attention scattered Completely self-absorbed Ability to Learn Perceptions distorted Cannot see connections between events Physical or Other Characteristics Respiratory rate: 24 breaths/minute Pulse: 110 beats/min, regular rhythm Expresses feelings of dread and a sense of impending doom Complains of extreme nausea and frequent headaches What level of anxiety does the nurse conclude that Katie is experiencing? A. Mild B. Moderate C. Severe D. Panic

C

The nurse employed in the mental health unit of a hospital is leading a group psychotherapy session. Which is the nurse's role in the termination of stage of group development? A. Encourage problem-solving B. Encourage accomplishment of the group's work C. Acknowledge the contributions of each group member D. Encourage members to become acquainted with one another

C

The nurse in a mental health clinic is interviewing a client who was referred to the clinic by the client's primary health care provider. Which finding indicates to the nurse that the client needs assistance to restore and maintain mental health? A. The client has a positive self-concept. B. The client identifies strengths and uses these for goal attainment. C. The client has a distorted view of the world and communicates inappropriately. D. The client identifies coping mechanisms used to successfully cope with threats to the self.

C

The nurse is working with several clients who are using maladaptive defense mechanisms. Which situation is an example of the maladaptive defense mechanism known as identification? A. A client criticizes the nurse after his family fails to visit him. B. A married man flirts with his secretary and then brings flowers home to his wife. C. A young boy thinks that a neighborhood gang leader who sells illegal drugs is someone to look up to. D. A nursing student who fears failure on a final exam develops a terrible headache and is unable to take the exam.

C

The parent of a 25-year-old man who has just been found to have a left frontal brain tumor says to the nurse, "At the local hospital, our doctor thought that his headaches were nothing and prescribed an analgesic. If I hadn't insisted on a CT scan, no one would have found the tumor." Which statement by the nurse would be therapeutic? A. "These days only the squeaky wheel gets the grease in medicine. Your squeaking was excellent advocacy." B. "What's being planned for your son now?" C. "You and your son are having a very trying time. What's happened since your son's diagnosis?" D. "Sounds like you have to be your own health care provider these days — good for you! — but I'm sure your health care provider was following medical protocol."

C

The wife of a client who is dying says to the nurse, "I am able to take off the 6 months from work our doctor feels that my husband will live, but what if he lives beyond that time?" Which therapeutic response should the nurse make? A. "Your husband has managed to be active up to now, so he could live longer than predicted, but his actual lifespan remains unclear." B. "Why not write down the pros and cons of taking work leave all at once and any other options and then decide with your husband and family which would be most helpful?" C. "Are there other options for you in taking work leave? Perhaps you could simply reduce your work hours at first so that you can extend your compassionate leave." D. "Only you and your husband can determine how you should best allocate your work leave."

C

The wife of a dying man is ignoring his rapid physiological decline and imminent death. She continues with her usual activities, exhibits inability to remember what others have just told her, and misses important appointments. Which therapeutic statement should the nurse make to the wife? A. "Can you talk about what's happening to you right now? Your behavior is not appropriate at this stage of your husband's illness. You seem to be having sympathy pains for him, like men during their wives' pregnancies." B. "You will need to concentrate on getting to these appointments on time and write down what everyone says so you will remember." C. "It isn't unusual for family to suffer from anticipatory grief when a loved one is dying." D. "I cannot emphasize how much your husband needs you to be there for him right now. He is in the stage of denial."

C

The wife of an alcoholic client says to the nurse, "I can't afford to bail my husband out of this mess. Our business is filing for bankruptcy, and the Internal Revenue Service has posted a notice of auction on our home." Which statement by the nurse would be therapeutic? A. "You're codependent with your husband. Don't you see this? Are you willing to attend some group meetings to learn about ways to deal more effectively with your problem?" B. "It's a shame. So many troubling things have been happening to you both because of the disease of alcoholism." C. "The lack of money has stopped you from saving your husband? It sounds like you need to help yourself right now. What do you think?" D. "You're having a very difficult time, and the problem stems entirely from your husband's drinking."

C

A 12-year-old client who has been reported for drawing sexually explicit scenes in her textbooks during class says to the psychiatric nurse, "I just felt like it." Which response by the nurse would be therapeutic and aid assessment of abuse-related symptoms? A. "You just felt like destroying your textbooks?" B. "Well, a picture paints a thousand words." C. "Your parents and teachers are very concerned about your drawings." D. "I am concerned about you. Are you being or have you ever been abused?"

D

A 25-year-old client says to the nurse, "I got my degree in criminal justice. I graduated first in my class from the police academy and had just started as a patrolman when my partner and I responded to a domestic violence call in the most rural part of our patrol area. Someone started shooting at us, and I'm terrified. Maybe I'm not right for this job." Which statement by the nurse would be therapeutic? A. "You seem to be surprised that you were frightened by the violence. Have you talked with your co-workers about their experiences?" B. "Did you really think that you wouldn't be frightened? You're fortunate if this is the first time you've ever been afraid." C. "My earlier work as a nurse involved trips through our local crack houses. Wait until you've had some experience working narcotics and then tell me how you feel." D. "You're saying that because you felt afraid in a violent situation, you may not be right for the job?"

D

A 52-year-old client is admitted to the hospital for surgery to treat lung cancer. The client says to the nurse, "I was an alcoholic for 15 years, and now that I'm 25 years sober, I'm being punished." Which statement by the nurse would be therapeutic? A. "Sounds like you feel that you're being punished for your drinking, yet you've been sober, so perhaps you're being rewarded by having a cancer that's curable." B. "You feel that you're being punished even though you've been sober for 25 years. Your doctor must have told you that the cancer is unrelated to alcohol." C. "You started drinking at 12 years of age — is that why you feel that the cancer is retribution?" D. "Because you seem to be blaming yourself unnecessarily, perhaps we can talk about your illness and what you can expect after surgery."

D

A 56-year-old client says to the nurse, "I'm a guidance counselor at the middle school, and the kids like to come to see me for help, but I just found out from my wife that my 22-year-old daughter is a lesbian, and now I'm the one who needs advice. How am I supposed to accept that? She was the boy we didn't have, and I made a tomboy of her by taking her to baseball games with me. Is that why she's gay?" Which statement by the nurse would be therapeutic? A. "How did your wife happen to tell you about this? Did your daughter ask her to tell you?" B. "Are you prejudiced against lesbian and gay people?" C. "You're good at talking with middle schoolers, but how about young adults?" D. "It sounds like you and your daughter were very close but she kept her sexual orientation from you."

D

A 68-year-old client whose husband died 2 months ago says to the nurse, "I'm having trouble sleeping lately, even though I don't nap in the daytime. I've been using warm milk without any results." Which statement by the nurse would be therapeutic? A. "Perhaps you should join the grieving spouses group that meets on Monday nights." B. "Since you've lost your husband, have you experienced any other problems besides trouble sleeping?" C. "So you've started having sleeping problems but no other problems?" D. "One of the things that I've found has helped others is a small snack with your warm milk before sleep and a moderate increase in walking during the day. Is that something you could try?"

D

A client in the mental health unit tells the nurse, "My husband makes all the decisions about money, but I'm the one who's making the money now, not him. He needs to back off, but he's always directing every decision we make." Which nursing response would be the most therapeutic? A. "You seem frustrated with your husband's habit of controlling financial decisions." B. "You're making the most money, so the decisions should be left to you." C. "Have you told your husband to back off"? D. "How do you feel the money decisions could best be handled in your household?"

D

A client says to the nurse, "I have to do everything. My family can't plan or organize anything. My wife just wants to go out and socialize. My grown son and his wife live with us. They never do anything around the house but 'their' stuff, because they say they pay rent. We really need their rent money since I lost my job. My wife could work but she says 'it's too late to start over' for her. Well, that's what I'm doing—more work at far less money." Which response by the nurse would be therapeutic? A. "Do the terms 'divorce' and 'leave the nest' mean anything to you or your family?" B. "You tell me that you do everything. You don't say what happens when you stop doing everything. Does your wife understand that you are not able to work as you once did and that you need her help?" C. "Would your family come in to see me so I can hear their version of the problems you cite?" D. "You seem to be going through quite a lot recently. I'd like to hear more from you about your concerns. Would your family come in and talk with us?"

D

A client says to the nurse, "I've been following my diet and taking my medication. What else do you want to talk about today?" Which response would be most helpful during the working phase of the therapeutic alliance? A. "Sounds fine to me. Let's meet again in 6 months." B. "I don't believe that you have been following your diet, because you haven't lost any weight." C. "Well, you've talked about diet in your terms, but perhaps I should test you on specific things." D. "Some people have added exercise to diet and medication therapy and gotten positive results. Do you think that this would work for you?"

D

A client says to the nurse, "My doctor tells me that I need to start progressive muscle relaxation(PMR) to ease my stress, but I just can't get the hang of it." Which response by the nurse would be most helpful? A. "I want you to practice it as often as you can. Play soft, soothing music in the background when you practice your exercises." B. "For it to be effective and produce deep relaxation, the technique requires your complete receptivity to its benefit and your need for it." C. "I could never master the technique myself, so I understand your frustration. Would you like me to explain its difficulty for you to the doctor?" D. "PMR requires training sessions. Let's check into classes that you can attend to learn the technique."

D

A client says to the nurse, "My health care provider wants me to start keeping a journal every day about what's happening in my job." Which response by the nurse is appropriate? A. "You can erase your stresses by identifying things that set off negative physical experiences." B. "Well, it has always helped me to write down daily happenings and relate them to my stress level." C. "Yes, that is an excellent suggestion. You need to keep a meticulous diary of your day with all of the details." D. "Journal-keeping that identifies what seems to cause a strain in a person's life is a good way of improving one's health."

D

A client who has been referred for group therapy asks the nurse about the therapy. The nurse tells the client that this type of therapy is focused on which purpose? A. Social functioning in groups B. Cognitive behavioral therapy C. Social skills training D. The development of interpersonal skills

D

A client who is an alcoholic, and has been sober for 8 months asks the nurse, "Do you think I should add individual therapy to my treatment plan?" Which response by the nurse would be therapeutic? A. "What do you think? What is the individual therapy all about?" B. "Okay, what's going on with you? You had to be coerced into treatment, but now you seem to want the full monty." C. "Are you feeling that you're vulnerable to a slip? If not, why complicate treatment further?" D. "The best time to add individual therapy seems to be after 2 to 5 years of sobriety. Individuals vary, though, and it may be that you are asking because you feel ready to work on your issues."

D

A client who is experiencing suicidal thoughts says to the nurse, "Life is just not worth it anymore." What is the appropriate initial response? A. "You should feel grateful for everything you have." B. "A good night's sleep will help you feel better." C. "You have a lot to live for." D. "Tell me what you mean by that."

D

A client with claustrophobia is seen in the mental health clinic and is told that one treatment for the disorder is systematic desensitization. When the client asks the nurse to describe the treatment, what information does the nurse provide? A. It involves focus on the consequence of a behavior. B. A stimulus attractive to the client is paired with an unpleasant experience. C. The therapist will perform certain behaviors, and the client will imitate the behaviors. D. It involves exposure to the phobic situation, starting with short periods and gradually increasing, until the fear has ceased.

D

A single mother whose only son died 2 months ago says to the nurse, "I've been bothered at work with thoughts of my son. Suddenly I'll think of something awful I said to him years ago or some punishment I gave him because he'd been bad." Which plan should the nurse include in caregiving? A. Scheduling the client for an appointment with the psychiatrist, because this is a pathological manifestation. B. Calling the health care provider to report that the client is a high risk for suicide and increasing the frequency of visits with the client. C. Seeking emergency certification for the psychiatric inpatient unit at the community hospital because of high lethality concerns and visiting the client daily. D. Explaining that bereaved persons often describe intrusive thoughts of negative experiences with the deceased and then increasing the frequency of nurse-client visits.

D

A young adult client says to the nurse, "All my friends are married and have children. I can't seem to meet anyone, and I know I'll never be happy until I meet someone I can care about enough to marry." Which statement by the nurse would assist the client in reframing the situation? A. "Sounds as if you're exaggerating your situation and looking only at the half-full glass." B. "It seems that you measure your life and what you need to do against the behaviors of others." C. "Aren't you a little young to be thinking in such negative terms? You do still have plenty of time before your biological clock winds down." D. "You can't seem to meet someone that you care about? You can still find enjoyment in friendships, work, books, and other things as well."

D

A young adult client who is dying says to the nurse, "I keep asking my wife what I can do for her and our daughter before I die, but she refuses to tell me." Based on the client's statement, what is the appropriate nursing intervention? A. Talking with all family members, including the daughter, about the importance of expressing their concerns and feelings to the dying client B. Teaching the client's wife to write down her thoughts and feelings and to read them to her husband C. Saying to the client, "It sounds to me like your wife is truly comfortable and doesn't want you to worry needlessly" D. Talking with both the client and his wife about the importance of expressing their feelings and how to do it in healthy ways

D

A young widow of 18 months says to the nurse, "I'm going to need a babysitter, because I'm going on a blind date at my brother and sister-in-law's house. They fixed me up, but I think it may be too soon." Which statement by the nurse would be therapeutic? A. "Nonsense. Your children need a new father, as your family knows. Your husband would want you to go on with life." B. "Hello? You go girl! You can see it's only natural, can't you?" C. "If it were me, I would be dating other men by now. After 6 months of mourning, most of society feels that it's okay." D. "By the end of a year, most people are able to renew their interest in other people and activities."

D

As the nurse prepares to interview a client being admitted to the mental health unit, the client says, "I asked my family to bring me in here to talk to someone, but now I don't know where to begin." Which response by the nurse would be most helpful? A. "Why not just start talking and see where it takes you?" B. "If I were you, I'd begin with what you were doing this morning." C. "Don't worry. Everyone who comes in here for the first time feels reluctant to talk." D. "Perhaps you can start by sharing some of your most recent concerns."

D

During a nursing interview, a client says, "My daughter was murdered in her apartment, and her estranged husband called to tell me. I can't stop myself from wondering whether he killed her, but the police have ruled him out as a suspect." Which response by the nurse would be therapeutic? A. "I agree. What do you want to bet he did it?" B. "Have you shared your concerns with the police?" C. "Sounds like it." D. "It feels terrible to lose a daughter."

D

Katie, very upset about her boss' comments, returns home from work to find her children sprawled on the couch, watching television and eating cookies and milk. She immediately yells at them, telling them to get off the couch and get their rooms cleaned and homework done. Which defense mechanism is exemplified by Katie's behavior toward her children? A. Introjection B. Dissociation C. Identification D. Displacement

D

Laura calls her daughter and son to inform them that Louis does not have much time left. The daughter comes quickly to her parents' house, and Louis dies shortly thereafter. The daughter, who is crying, says to the hospice nurse, "It's all my fault. If I hadn't refused to have that test 10 years ago, I could have donated a kidney, and my father would still be alive. It's all my fault!" Which response by the nurse is appropriate? A. "It's not your fault! You have to stop thinking that way." B. "You shouldn't feel so guilty. Your brother also refused to have anything to do with being a donor." C. "Probably so — but, then again, a lot has changed in 10 years. Ten years ago, there was more risk involved in the procedure." D. "You made the best decision at the time. Let's talk about what makes you feel as though your father's death is your fault."

D

Louise calls the firm's nurse's office and schedules an appointment. She tells the nurse that she is feeling tired and stressed and that she is experiencing palpitations every time one of the lawyers places a document on her desk. Louise tells the nurse that she has heard that taking ginseng will relieve the stress and asks whether it is safe to take. How should the nurse respond to Louise? A. "Many reports indicate that ginseng reduces stress." B. "Ginseng is a natural herbal substance and is safe to take." C. "It's a good idea to try ginseng, because it is so important to keep the stress level down to prevent illness." D. "It's best to consult a health care provider regarding the use of ginseng, because it may not be appropriate for you."

D

On the initial visit to the mental health clinic, a client says to the nurse, "When I married my husband, more than 30 years ago, he was a big, handsome, competent professional who never wanted me to work and was so loving. Well, two kids later he's a slob who gambles and loses one job after another. Now I'm the breadwinner and he's content to be a shiftless town joke." Which statement by the nurse would be therapeutic? A. "Can you tell me how long you have felt like this and how much longer you plan to continue this way?" B. "You sound disgusted with your husband. Is this an accurate assessment? Why not divorce him?" C. "You seem to have changed your feelings about your husband completely. This didn't happen overnight, so why are you here now?" D. "Many things have happened to you and your husband. Sounds as if you've both been struggling for some time. Would you like to have him come in with you to talk with me about all of this?"

D

The family of a client at the end-of-life has requested their pastor visit the client in the hospital. Privately, the client tells the nurse, "He's not my pastor. My daughter is always trying to get me to go to her church. I don't want to see him." Which response by the nurse is most appropriate? A. "A crisis of faith is common at the end of life." B. "Have you shared your feelings with your family?" C. "Spiritual needs can be as important as the needs of the body." D. "I will communicate to your family that you do not want to see the pastor."

D

The new nurse employee is developing a plan of care, with the registered nurse, for a client who recently received a diagnosis of acquired immunodeficiency syndrome (AIDS) and is experiencing difficulty adjusting to the illness. The registered nurse should suggest revision of which intervention for this client? A. Helping the client verbalize concerns related to fear B. Monitoring the client for signs of self-harm C. Assisting the client with problem-solving and decision-making D. Discouraging social networking to prevent the spread of infection

D

The nurse caring for Joseph discusses the plan of care with the psychiatrist, who tells the nurse that Joseph would benefit from cognitive therapy. What information does the nurse provide to Joseph about this type of therapy? A. Medication is the main treatment in this form of therapy. B. A reward will be given to Joseph for every hour in which he does not have a suicidal thought. C. The psychiatrist will function as a role model, helping Joseph learn to prevent thoughts of suicide. D. Therapeutic techniques are designed to identify, reality-test, and correct distorted or dysfunctional beliefs.

D

The nurse is caring for a bereaved man with acquired immunodeficiency syndrome (AIDS) who lost his twin brother in a rock-climbing accident a month ago. Which statement by the client should cause the nurse to be concerned? A. "I should have made him stay home. He was always clumsy." B. "I miss him so much. We were close and talked almost daily." C. "You'd have thought that I would be the one to die first." D. "Lately I've been feeling that life isn't that great."

D

The nurse is performing an assessment of a client who abuses alcohol. During the assessment, the client preaches about the evils of drinking. Which adaptive defense mechanism should the nurse recognize in the client's behavior? A. Projection B. Identification C. Rationalization D. Reaction formation

D

The nurse is talking to a client with depression when the client says, "I don't know why my son turned out like he did. I never thought that he would rob a bank! I don't know what I did wrong. I know that he didn't grow up with a father, but I gave him everything. I wish I could start over and do things differently." Which response by the nurse would be therapeutic? A. "Do I hear you saying that you feel that your son's behavior was caused by his upbringing?" B. "Don't blame yourself. Some people just turn out bad no matter what." C. "All we can do is give our children love and do our very best. The rest is up to them." D. "You seem to be feeling regret."

D

The nurse provides information to a client about stress-management techniques. Which statement by the client indicates a need for further information? A. "Listening to music can be really soothing." B. "Getting enough sleep every night will help me deal with the stress." C. "I should get regular exercise as part of my stress-management program." D. "Everyone thinks that caffeine can make the stress worse, but that's a myth."

D

The nurse providing information to the wife of a client who abuses alcohol encourages the woman to attend an Al-Anon support group. The wife tells the nurse that she is embarrassed by her husband's behavior and that it would be difficult for her to face other people. Which response should the nurse give the woman to help alleviate her concerns? A. The support group is always led by a nurse and health care provider. B. She will not know any of the members of the support group. C. She does not need to provide her name or any other identifying information to the group. D. The members of the group have experienced or are experiencing the same problem she is facing.

D

The parents of a 20-year-old who was killed while driving drunk say to the nurse, "We're so devastated, but we are also angry that she would drink and drive when we told her over and over not to." Which statement by the nurse would be therapeutic? A. "Young people don't always obey their parents." B. "Does anyone in the family have a drinking or drug problem?" C. "Everyone feels guilt or anger when they lose a loved one." D. "Your sadness over losing your daughter is mixed with anger at her driving while intoxicated."

D

Two police officers arrive at the emergency department with a client who was been displaying violent behavior in a local park. The police report to the nurse that they tried unsuccessfully to reason with the client and that the client continued to direct violent behaviors at other individuals in the park. After a thorough psychosocial assessment of the client, the health care provider determines that the client requires emergency involuntary admission to the mental health facility. What determination does the nurse make with regard to this type of admission? A. It requires the client's consent. B. It takes away the client's right to informed consent. C. It is normally sought by the client or the client's guardian. D. It is necessary for a client who is a danger to self or others.

D