Unit 13?(still review crisis intervention from folders)

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Which therapeutic communication technique is often used with clients experiencing delusional thinking? 1. Voicing doubt 2. Exploring 3. Verbalizing the implied 4. Belittling feelings expressed

1 Voicing doubt allows the client to express uncertainty of the reality about the client's perception. This technique is often used with clients experiencing delusion thinking.

The nurse knows which is an important characteristic of the therapeutic relationships? 1. Self-directed 2. Goal-oriented 3. One-sided 4. Collaborative

4 Ideally, the nurse and client 'decide together' what the goal of the therapeutic relationship will be.

The nurse is interviewing a newly admitted psychiatric client. Which of the following nursing statements is an example of offering a general lead? 1. Do you know why you are here? 2. Are you feeling depressed or anxious? 3. Yes, I see. Go on. 4. Can you order the specific events that led to your admission?

ANS: 3 Rationale: The nurses statement, Yes, I see. Go on, is an example of a general lead. Offering general leads encourages the client to continue sharing information.

18. What is the main goal of the working phase of the nurseclient therapeutic relationship? A. Role modeling to improve interaction with others B. Resolution of the clients problems C. Using therapeutic communication to clarify perceptions D. Helping the client access outpatient treatment

ANS: B The goal of the working phase of the nurseclient therapeutic relationship is to resolve client problems by promoting behavioral change. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

7. Which phase of the nurseclient relationship begins when the individuals first meet and is characterized by an agreement to continue to meet and work on setting client-centered goals? A. Preinteraction B. Orientation C. Working D. Termination

ANS: B The orientation phase is when the individuals first meet and is characterized by an agreement to continue to meet and work on setting client-centered goals. There are four phases of relationship development: preinteraction, orientation, working, and termination. KEY: Cognitive Level: Comprehension | Integrated Process: Nursing Process: Implementation | Client Need: Psychosocial Integrity

14. A nurse moving out of state speaks to a client about the need to work with a new nurse. The client states, Im not well enough to switch to a different nurse. What does this client response indicate to the nurse? A. The client is using manipulation to receive secondary gain. B. The client is using the defense mechanism of denial. C. The client is having trouble terminating the relationship. D. The client is using splitting as a way to remain dependent on the nurse.

ANS: C Termination should begin in the orientation phase to minimize feelings of loss when the nurseclient relationship ends. When a client feels sadness and loss, behaviors to delay termination may become evident. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A clients younger daughter is ignoring curfew. The client states, Im afraid she will get pregnant. The nurse responds, Hang in there. Dont you think she has a lot to learn about life? This is an example of which communication block? A. Requesting an explanation B. Belittling the client C. Making stereotyped comments D. Probing

ANS: C This is an example of the nontherapeutic communication block of making stereotyped comments. Clichs and trite expressions are meaningless in a therapeutic nurseclient relationship.

17. As the client and nurse move from the orientation stage to the working stage of the therapeutic relationship, which is the nurses most therapeutic statement? A. I want to assure you that I will maintain your confidentiality. B. A long-term goal for someone your age would be to develop better job skills. C. Which identified problems would you like for us to initially address? D. I think first we need to focus on your relationship issues.

ANS: C When moving on a continuum from the orientation to working phase of the nurseclient relationship, the clients identified goals are addressed through mutual therapeutic work to promote client behavioral change. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A citizen at a community health fair asks the nurse, What is the most prevalent mental disorder in the United States? Select the nurses best response. a. Schizophrenia b. Bipolar disorder c. Dissociative fugue d. Alzheimers disease

ANS: D The 12-month prevalence for Alzheimers disease is 10% for persons older than 65 and 50% for persons older than 85. The prevalence of schizophrenia is 1.1% per year. The prevalence of bipolar disorder is 2.6%. Dissociative fugue is a rare disorder. See related audience response question.

A patients relationships are intense and unstable. The patient initially idealizes the significant other and then devalues him or her, resulting in frequent feelings of emptiness. This patient will benefit from interventions to develop which aspect of mental health? a. Effectiveness in work b. Communication skills c. Productive activities d. Fulfilling relationships

ANS: D The information given centers on relationships with others that are described as intense and unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to describe work effectiveness, communication skills, or activities.

Which understanding about individuals who attempt suicide will help a nurse plan the care for a suicidal patient? Every suicidal person should be considered: a. mentally ill. b. intent on dying. c. cognitively impaired. d. experiencing hopelessness.

ANS: D Hopelessness is the characteristic common among people who attempt suicide. The incorrect options reflect myths about suicide. Not all who attempt suicide are intent on dying. Not all are mentally ill or cognitively impaired.

Suicide

The act of taking one's own life It is not a diagnosis or a disorder, it is a behavior "Irrational" behavior

6. A mother who is notified that her child was killed in a tragic car accident states, "I can't bear to go on with my life." Which nursing statement conveys empathy? 1. "This situation is very sad, but time is a great healer." 2. "You are sad, but you must be strong for your other children." 3. "Once you cry it all out, things will seem so much better." 4. "It must be horrible to lose a child, and I'll stay with you until your husband arrives."

"It must be horrible to lose a child, and I'll stay with you until your husband arrives." Rationale: The nurse's response, "It must be horrible to lose a child, and I'll stay with you until your husband arrives," conveys empathy to the client. Empathy is the ability to see the situation from the client's point of view. Empathy is considered to be one of the most important characteristics of the therapeutic relationship.

19. A newly admitted client, diagnosed with obsessive-compulsive disorder (OCD), washes his hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? 1. "Everyone diagnosed with OCD needs to control their ritualistic behaviors." 2. "It is important for you to discontinue these ritualistic behaviors." 3. "Why are you asking for help, if you won't participate in unit therapy?" 4. "Let's figure out a way for you to attend unit activities and still wash your hands."

"Let's figure out a way for you to attend unit activities and still wash your hands." Rationale: The most appropriate statement by the nurse is, "Let's figure out a way for you to attend unit activities and still wash your hands." This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship.

13. A client diagnosed with post-traumatic stress disorder related to a rape is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique might a nurse use that is an example of "broad openings"? 1. "What occurred prior to the rape, and when did you go to the emergency department?" 2. "What would you like to talk about?" 3. "I notice you seem uncomfortable discussing this." 4. "How can we help you feel safe during your stay here?"

"What would you like to talk about?" Rationale: The nurse's statement, "What would you like to talk about?" is an example of the therapeutic communication technique of a broad opening. Using broad openings allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction.

18. A mother rescues two of her four children from a house fire. In an emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response? 1. "The smoke was too thick. You couldn't have gone back in." 2. "You're experiencing feelings of guilt, because you weren't able to save your children." 3. "Focus on the fact that you could have lost all four of your children." 4. "It's best if you try not to think about what happened. Try to move on."

"You're experiencing feelings of guilt, because you weren't able to save your children." Rationale: The best response by the nurse is, "You're experiencing feelings of guilt, because you weren't able to save your children." This response uses the therapeutic communication technique of restating what the client has said. This lets the client know whether an expressed statement has been understood or if clarification is necessary.

The nurse tells an angry client, "I see you have been walking back and forth frequently." Which therapeutic communication technique should the nurse follow while communicating with the client? 1. Making observations 2. Giving broad openings 3. Offering general leads 4. Placing the event in a timeline

1 Making observations or verbalizing the perceived behavior encourages the client to recognize specific behavior and evaluate the observation with the nurse. This gives the client an opening to discuss issues.

A client with low self-esteem tells the nurse, "I am of no value to anybody." Which statement by the nurse in response to the client indicates a better example of therapeutic communication? 1. "Of course you are something. Everyone is something." 2. "You are feeling like nobody cares about you right now." 3. "What makes you say this?" 4. "You must be feeling very lonely right now."

2 Denial of the problem blocks discussion with the client and avoids helping the client identify the areas of difficulty. This statement made by the nurse is a better way of responding to the client.

In a therapeutic relationship empathy is extremely important. Which does the nurse know describes empathy? 1. Sharing the feelings of another person 2. Accurately perceiving and understanding another person's feelings 3. Identifying with what another is feeling 4. Experiencing a need to alleviate another's distress.

2 Empathy involves understanding what another person is feeling while staying emotionally separate.

The nurse accepts a client unconditionally and regards him or her as a worthy person. Which characteristic is exhibited by the nurse? 1. Trust 2. Respect 3. Empathy 4. Genuineness

2 Respect is to acknowledge the client's dignity, value, and worth. Therefore, if the nurse accepts the client unconditionally and regards him or her as a worthy person, it is a characteristic of respect exhibited by the nurse.

What is the minimum distance that the nurse should maintain while interacting with a client? 1. 18 inches 2. 30 inches 3. 60 inches 4. 156 inches

3 The nurse should communicate with a stranger within social distance by maintaining a distance of 4 to 12 feet.

The nurse tells the client the truth. What is this characteristic of the nurse called? 1. Respect 2. Empathy 3. Sympathy 4. Genuineness

4 Genuineness is the ability of the nurse to interact with the client by being honest and real. Therefore, if the nurse is telling the truth to the client, it represents genuineness.

Which therapeutic communication technique is being used in the following nurse-client interaction? Client: My father spanked me often. Nurse: Your father was a harsh disciplinarian. 1. Restatement 2. Offering general leads 3. Focusing 4. Accepting

ANS: 1 Rationale: The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. It allows the client to know whether the statement has been understood and provides an opportunity to continue.

What is a nurses purpose for providing appropriate feedback? 1. To give the client good advice 2. To advise the client on appropriate behaviors 3. To evaluate the client's behavior 4. To give the client critical information

ANS: 4 Rationale: The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors.

Which assessment finding most clearly indicates that a patient may be experiencing a mental illness? The patient: a. reports occasional sleeplessness and anxiety. b. reports a consistently sad, discouraged, and hopeless mood. c. is able to describe the difference between as if and for real. d. perceives difficulty making a decision about whether to change jobs.

ANS: B The correct response describes a mood alteration, which reflects mental illness. The distracters describe behaviors that are mentally healthy or within the usual scope of human experience.

Which client statement indicates that termination of the therapeutic nurse client relationship has been handled successfully? A. I know I can count on you for continued support. B. I am looking forward to discharge, but I am surprised that we will no longer work together. C. Reviewing the changes that have happened during our time together has helped me put things in perspective. D. I don't know how comfortable I will feel when talking to someone else.

ANS: C

23. A client is newly admitted to an inpatient psychiatric unit. Which of the following is most critical to assess when determining risk for suicide? A. Family history of depression B. The clients orientation to reality C. The clients history of suicide attempts D. Family support systems

ANS: C A history of suicide attempts places a client at a higher risk for current suicide behaviors. Knowing this specific data will alert the nurse to the clients risk.

Which individual is demonstrating the highest level of resilience? One who: a. is able to repress stressors. b. becomes depressed after the death of a spouse. c. lives in a shelter for two years after the home is destroyed by fire. d. takes a temporary job to maintain financial stability after loss of a permanent job.

ANS: D Resilience is closely associated with the process of adapting and helps people facing tragedies, loss, trauma, and severe stress. It is the ability and capacity for people to secure the resources they need to support their well-being. Repression and depression are unhealthy. Living in a shelter for two years shows a failure to move forward after a tragedy. See related audience response question.

17. A nursing instructor is teaching about suicide. Which student statement indicates that learning has occurred? A. Suicidal threats and gestures should be considered manipulative and/or attention-seeking. B. Suicide is the act of a psychotic person. C. All suicidal individuals are mentally ill. D. Fifty to eighty percent of all people who kill themselves have a history of a previous attempt.

ANS: D It is a fact that between 50% and 80% of all people who kill themselves have a history of a previous attempt. All other answer choices are myths about suicide.

Which therapeutic communication technique is being used in this nurse client interaction? Client: When I get angry, I get into a fistfight with my wife or I take it out on the kids. Nurse: I notice that you are smiling as you talk about this physical violence. A. Encouraging comparison B. Exploring C. Formulating a plan of action D. Making observations

Predisposing factors: Fraud

Anger is turned inward on self, hopelessness, history of aggression and violence, and shame/humiliation

11. The nurse is interviewing a newly admitted psychiatric client. Which of the following nursing statements is an example of offering a "general lead"? 1. "Do you know why you are here?" 2. "Are you feeling depressed or anxious?" 3. "Yes, I see. Go on." 4. "Can you order the specific events that led to your admission?"

"Yes, I see. Go on." Rationale: The nurse's statement, "Yes, I see. Go on," is an example of a general lead. Offering general leads encourages the client to continue sharing information.

The nurse knows touch is a powerful method of communication. Which type of physical contact is considered functional-professional? 1. A handshake 2. Nurse examining a client 3. Engaging in a strong embrace 4. Touching in the genital region

2 A nurse examining a client is functional-professional; it is impersonal and businesslike. It is used to accomplish a task.

Which client's facial expression is associated with a feeling of low self-esteem? 1. Frowning eyebrows 2. Sneered lips 3. Downcast eyes 4. Wrinkling nose

3 A client with low self-esteem will have downcast eyes or will lack eye contact while communicating with another person.

Which nonverbal behavior of the nurse indicates an open posture for attentive listening? 1. Establishing eye contact 2. Sitting squarely facing the client 3. Leaning forward toward the client 4. Keeping the arms and legs uncrossed

4 Keeping the arms and legs uncrossed indicates an open posture for attentive listening.

19. Which nursing intervention strategy is most appropriate to implement initially with a suicidal client? A. Ask a direct question such as, Do you ever think about killing yourself? B. Ask client, Please rate your mood on a scale from 1 to 10. C. Establish a trusting nurse client relationship. D. Apply the nursing process to the planning of client care.

ANS: A The risk of suicide is greatly increased if the client has suicidal ideations, if the client has developed a plan, and particularly if the means exist for the client to execute the plan.

What is the main goal of the working phase of the nurse client therapeutic relationship? A. Role modeling to improve interaction with others B. Resolution of the clients problems C. Using therapeutic communication to clarify perceptions D. Helping the client access outpatient treatment

ANS: B The goal of the working phase of the nurseclient therapeutic relationship is to resolve client problems by promoting behavioral change.

22. Which statement indicates that the nurse is acting as an advocate for a client who was hospitalized after a suicide attempt and is now nearing discharge? A. I must observe you continually for 1 hour in order to keep you safe. B. Lets confer with the treatment team about the resources that you may need after discharge. C. You must have been very upset to do what you did today. D. Are you currently thinking about harming yourself?

ANS: B The nurse is functioning in an advocacy role when collaborating with the client and treatment team to discuss client problems and needs.

Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? A. My sister has the same diagnosis as you and she also hears voices. B. I understand that the voices seem real to you, but I do not hear any voices. C. Why not turn up the radio so that the voices are muted. D. I wouldn't worry about these voices. The medication will make them disappear.

21. Which client data indicate that a suicidal client is participating in a plan for safety? A. Compliance with antidepressant therapy B. A mood rating of 9/10 C. Disclosing a plan for suicide to staff D. Expressing feelings of hopelessness to nurse

ANS: C A degree of the responsibility for the suicidal clients safety is given to the client. When a client shares with staff a plan for suicide, the client is participating in a plan for safety by communicating thoughts of self-harm that would initiate interventions to prevent suicide.

A nurse moving out of state speaks to a client about the need to work with a new nurse. The client states, Im not well enough to switch to a different nurse. What does this client response indicate to the nurse? A. The client is using manipulation to receive secondary gain. B. The client is using the defense mechanism of denial. C. The client is having trouble terminating the relationship. D. The client is using splitting as a way to remain dependent on the nurse.

Which of the following interventions are appropriate for a patient on suicide precautions? (Select all.) a. Remove all sharp objects, belts, and other potentially dangerous articles from the patient's environment b. Accompany the patient to off-unit activities c. Reassess intensity of suicidal thoughts and urges on a regular basis d. Put all of the patient's possessions in storage an explain to her that she may have them back when she is off suicide precautions

a, b, and c

Which therapeutic communication technique would the nurse use for a client who is moving rapidly from one thought to another? 1. Focusing 2. Restating 3. Exploring 4. Reflecting

1 Focusing is the therapeutic communication technique that should be used in a client who is rapidly moving from one thought to another. It helps keep the client stable in one thought.

Which precaution should the nurse follow while caring for an Asian American client? 1. Limit touch with this client. 2. Refrain from taking financial gifts from the client. 3. Refrain from collecting background data of the client. 4. Refrain from giving excuses about the client's inappropriate behavior to others.

1 In Asian American culture, touch is not considered acceptable. The nurse should particularly be careful while taking care of an Asian American client.

A client with depression says, "I feel like I am alone out in the ocean." What would the nurse say in response to this statement using a therapeutic communication technique? 1. "You must be feeling very lonely." 2. "Are you feeling that no one understands you?" 3. "You are feeling like nobody cares about you." 4. "Please explain the situation more clearly."

1 In response to the client's statement, the nurse should try to desymbolize the statement and find an underlying clue in it. This statement is attempting to do so.

While caring for a client with deficit knowledge, the nurse says, "I will clarify all your questions about the therapy." What is the rationale behind this statement by the nurse? 1. To protect himself or herself from any verbal attack of the client 2. To present reality to the client 3. To prevent unmanageable anxiety of the client 4. To facilitate understanding between the client and the nurse

1 The statement by the nurse indicates defending. When the nurse speaks in a defending way, it protects from verbal attack.

Which category of touch does the nurse exhibit while greeting a client with a handshake? 1. Social-polite 2. Love-intimacy 3. Friendship-warmth 4. Functional-professional

1 Touch is a powerful communication tool that elicits negative and positive reactions. Social-polite touch is an impersonal touch that conveys an acceptance toward another person. The nurse accepting the client and giving a handshake is an example of social-polite touch.

The client becomes angered when a nurse comes in wearing a hat that reminds the client of the his abusive mother used to wear. Which term describes this emotion? 1. Transference 2. Countertransference 3. Overcoming resistance 4. Reality perception

1 Transference occurs when the client unconsciously displaces (or "transfers") feelings formed toward a person from his or her past onto another.

Which actions of the nurse convey an attitude of respect towards the client? Select all that apply. 1. Being honest while interacting with the client 2. Calling the client by name 3. Spending time with the client 4. Understanding the situation from the client's point of view 5. Promoting an atmosphere of privacy during therapeutic interaction

1, 2, 3, 5 Option 1: Being honest while interacting with the client even when the truth may be difficult to discuss conveys respect. Option 2: Calling the client by name conveys respect towards the client. Option 3: Spending time with the client conveys respect towards the client. Option 4: Understanding the situation from the client's point of view conveys empathy. Option 5: Promoting an atmosphere of privacy during therapeutic interactions with the client conveys respect towards the client.

The nurse is caring for a psychiatric client who is experiencing concrete thinking. Which nursing intervention is most essential to develop a therapeutic relationship with the client? 1. Establishing an acquaintance with the client 2. Keeping promises made to the client 3. Considering the client's ideas when planning care 4. Being open and real while interacting with the client

2 A client who is experiencing concrete thinking focuses on specifics rather than generalities. Therefore, keeping promises made to the client helps the nurse fulfill the specifics and also develop trust.

A client's spouse presents a bouquet of flowers and chocolates to the nurse for taking care of the client. What is the most appropriate response of the nurse? 1. "I do not accept gifts." 2. "Thank you. I will share your gift with my colleagues." 3. "It is against the rules of the hospital to accept gifts." 4. "The flowers and chocolates are wonderful. Thank you for them."

2 Accepting small gifts as a token of appreciation from the client may be considered appropriate. If the nurse responds, "Thank you. I will share it with my colleagues," it would be more appropriate because the nurse is acknowledging the effort of other staff members involved in caring for the client.

What is an example of a negative attitude? 1. Having an idea that alcoholism is a disease 2. The negative stigma associated with mental illness 3. Conveying the truth to all psychotic clients about their medical illness 4. Conjecturing that all people with mental illness are dangerous

2 An attitude is a way of thinking, which can be selective and biased. The negative stigma associated with mental illness is an example of a negative attitude.

The nurse is caring for a client who is depressed due to the death of his or her partner. At dinnertime the nurse asks the client, "Can I sit and eat with you?" What is the rationale behind this nursing intervention? 1. To emphasize the client's importance 2. To increase the feeling of self-worth 3. To encourage a like response from the client 4. To increase the understanding between the nurse and the client

2 Asking the client to join for dinner indicates that the nurse is making him or herself available to the client and, therefore, increases the feeling of self-worth in the client.

The nurse begins a session with the client by saying, "What would you like to discuss today?" This is an example of which communication technique? 1. Offering general leads 2. Giving broad openings 3. Encouraging the description of perceptions 4. Offering self

2 Broad openings allow the client to take the initiative in introducing the topic.

The nurse is developing a therapeutic relationship with the client. Which statement made by the nurse indicates an empathetic response? 1. "I understand your feelings because I have gone through the same thing." 2. "If you felt bad about those harsh comments, it is ok to be sad and cry." 3. "I will surely incorporate your ideas and preferences when planning your care." 4. "Be assured that whatever we discuss will not leave the boundaries of our health-care team."

2 In an empathetic response, the nurse understands and perceives the feelings of the client accurately. The nurse encourages the client to explore his or her feelings. Therefore, this statement indicates an empathetic response.

Which therapeutic technique should the nurse use to encourage a client to recognize specific behaviors and compare perceptions with the nurse? 1. Giving recognition 2. Making observations 3. Giving broad openings 4. Encouraging comparison

2 Making observations is a therapeutic technique that involves what is observed or perceived. This will encourage the client to recognize specific behaviors and compare those perceptions with the nurse.

The nurse is disciplined for having dinner after hours with a client. Which type of boundary was breached? 1. Material boundaries 2. Professional boundaries 3. Personal boundaries 4. Social boundaries

2 Professional boundaries limit and outline expectations for appropriate professional relationships with clients.

When the client begins speaking in a session, the nurse says, "Let's not discuss that today." This is an example of which type of nontherapeutic communication technique? 1. Disapproving 2. Rejecting 3. Defending 4. Probing

2 Refusing to consider or showing contempt for a client's ideas or behavior may cause the client to discontinue interaction with the nurse for fear of further rejection.

The client says, "All men are messy and untidy." What type of belief does the client have? 1. Faith 2. Stereotype 3. Rational belief 4. Irrational belief

2 Stereotypes are socially shared beliefs, which categorize all individuals with a common factor like age, sex, race, into one group. Therefore, the client's statement represents a stereotype.

The registered nurse is teaching a student nurse about skills for active listening. Which statement made by the student nurse needs correction? 1. "Always maintain an open posture while listening to someone." 2. "Maintain constant eye contact while listening to others." 3. "Always sit squarely facing the client while listening to him or her." 4. "Lean forward toward the client while listening to him or her."

2 The eye contact of the nurse should be intermittently directed, which shows the willingness of the nurse to listen. Thus, this statement needs correction.

The nurse is caring for a client with anxiety. The client asks the nurse, "Will I be normal?" Which nurse's statement reassures the client? 1. "Let's not discuss your thoughts." 2. "Don't worry about it. We can work on that as a team." 3. "Let's talk about how your behavior caused anxiety." 4. "What do you think you should do to become normal?"

2 The nurse reassures the client that there is no need to worry, thereby reassuring the client's feelings and discouraging further anxiety.

Which phase of the nurse-client relationship development deals with creating an environment for the establishment of trust and rapport with the client? 1. The working phase 2. The orientation phase 3. The termination phase 4. The preinteraction phase

2 The orientation phase is the introductory phase where the nurse and client get acquainted. Therefore, if the nurse is creating an environment to establish trust and rapport with the client, then it is the orientation phase.

The nurse is caring for a client who is in the isolation room. Which statement made by the nurse indicates that the nurse is trying to increase the client's feeling of self-worth? 1. "I see you put away your clothes." 2. "I'll sit in here with you for a while." 3. "I notice you are pacing a lot." 4. "Yes, I understand what you said."

2 This statement helps increase the client's feeling of self-worth.

A client who separated from his or her spouse tells the nurse, "I don't know why I am living. There is nothing to live for." Which statement made by the nurse serves as the best nontherapeutic communication technique? 1. "Tell me why you separated." 2. "You appear to be upset. Can you tell me how you're feeling?" 3. "Everybody gets down sometimes. I also feel this sometimes." 4. "It must have been very difficult for you when you separated from your spouse."

2 This statement made by the nurse is the best nontherapeutic communication technique because it conveys understanding and empathy to the client.

The nurse remains respectful of a client who is engaging in behaviors opposed to the nurse's religious beliefs. Which describes the nurse's response? 1. Confidentiality 2. Unconditional positive regard 3. Genuineness 4. Concrete thinking

2 To show respect is to believe in the dignity and worth of an individual regardless of his or her unacceptable behavior.

While collecting data from the client, the nurse observes that the client is communicating superficially. Which therapeutic communication technique should the nurse apply to respond to this client? 1. "Let's look at this a little more closely." 2. "Please explain the situation more clearly." 3. "Tell me if my understanding agrees with yours." 4. "I am not sure that I understood what you just told me. Would you please explain it again?"

2 When the client is communicating superficially, the nurse should respond by asking the client to explain the situation more clearly. This will make the client improve his or her communication.

When should an individual maintain a distance of 4 to 12 feet while communicating with others? Select all that apply. 1. While communicating with friends 2. While communicating with strangers 3. While communicating with colleagues 4. While communicating at a cocktail party 5. While communicating with others in a public building

2, 4 While interacting with strangers, an individual should maintain a social distance of 4 to 12 feet. While communicating with others at a cocktail party, an individual should maintain a social distance of 4 to 12 feet. (5)?(p.118)An individual while communicating with others in a public building should maintain a pubic distance of more than 12 feet.

The nurse is caring for a psychiatric client who has been rejected by his partner. Which nursing intervention will increase feelings of self-worth in the client? 1. Expressing empathy towards the client 2. Getting acquainted with the client 3. Recognizing and respecting the client 4. Providing a safe environment to the client

3 A psychiatric client will have low self-esteem after being rejected by others. Recognizing and respecting the client will increase feelings of self-worth.

A client is crying to the nurse because someone made a joke about her being overweight. Which of the nurse's responses is an example of empathy? 1. "I can identify with what you are feeling. I am overweight too." 2. "I get so angry when people are insensitive like that." 3. "You feel angry and embarrassed. It is alright to cry." 4. "It's typical of skinny people to be so rude."

3 Because the nurse identifies the client's feelings and makes it safe for the client to express those feelings, this is an example of empathy.

While escorting a client to the examination room, the nurse observes a smile on the client's face when the primary health-care provider approaches. What emotion is the client expressing? 1. Frustration 2. Disagreement 3. Happiness 4. Low self-esteem

3 Happiness is satisfaction or contentment. A smile on the client's face indicates that he or she is happy when looking at the primary health-care provider, whom he or she has met before.

Which phase of development of the therapeutic relationship involves the evaluation of goals attained by the client after the therapy? 1. The working phase 2. The orientation phase 3. The termination phase 4. The preinteraction phase

3 In the termination phase, a conclusion is brought to the relationship. Therefore, if the nurse is evaluating the goals attained by the client after the therapy, it is the termination phase.

Which action of the nurse indicates the working phase of relationship development with a client? 1. Formulating nursing diagnoses 2. Examining the client's feelings, fears, and anxieties 3. Continuously evaluating the client's progress towards goal attainment 4. Developing a plan of action that is realistic for meeting the goals

3 In the working phase, the nurse continuously evaluates the progress of the client towards goal attainment.

The nurse is caring for a client during an anger-management program. Which action represents the working phase of therapeutic relationship management? 1. The nurse preparing a plan for continuing care. 2. The nurse assessing the client's previous medical records. 3. The nurse helping the client practice various adaptive procedures to control anger. 4. The client and nurse setting goals to develop some adaptive ways to handle anger.

3 In the working phase, the therapeutic work of the relationship between the nurse and client is carried out. Therefore, the nurse helping the client practice various adaptive procedures to control anger represents the working phase.

A client in group therapy is uncomfortable speaking in front of other members but communicates openly in a one-to-one session with the nurse. Which element is contributing to the client's anxiety? 1. Religion 2. Values 3. Environment 4. Culture

3 Some individuals who feel uncomfortable and refuse to speak during a group therapy session may be open and willing to discuss problems privately on a one-to-one basis with the nurse because the environment feels safer.

While caring for a client with persistent depressive disorder, the nurse says, "I can understand what you are feeling now. I too have been in this same situation before." Which feeling of the nurse is indicated by these statements? 1. Rapport 2. Empathy 3. Sympathy 4. Genuineness

3 Sympathy is the ability to share the feelings of the client. In this case, the nurse is trying to share his or her feelings with the client about a similar situation that was experienced earlier.

The nurse is in the first phase of relationship development with a client who is an alcoholic. What should be the goal of the nurse during this phase? 1. Establishing trust 2. Promoting client change 3. Exploring self-perceptions 4. Ensuring therapeutic closure

3 The first phase is the preinteraction phase, where the nurse prepares for the first encounter with the client. Everyone brings attitudes and feelings from their own experiences to the clinical setting. Therefore, it is necessary to be aware of self-perceptions so as to not let them affect providing care to clients.

The nurse is counseling a group of clients on a one-to-one basis to obtain information regarding their current health situation. Which type of distance should the nurse maintain while communicating with the clients? 1. Public 2. Social 3. Personal 4. Intimate

3 The nurse can have a close conversation with the client in a personal distance while maintaining a distance of 18 to 40 inches.

The nurse is caring for a client with situational low self-esteem. Which statement made by the nurse helps the client recognize his or her life experiences? 1. "Explain what happened when you felt that way." 2. "I understand that you are telling me this happened." 3. "How did you respond when this happened in the past?" 4. "What might you do to handle this more appropriately?"

3 The nurse encourages the client to compare the similarities and differences of experiences and ideas, which helps the client recognize that life experiences may recur.

The nurse is caring for a client who unconsciously transfers his or her feelings for a person in the client's past towards the nurse because the nurse's appearance reminds the client of that person. Which outcome in the client would indicate the effectiveness of the nursing care? 1. The client will formulate a plan with the nurse. 2. The client will develop problem-solving skills. 3. The client will assume responsibility for his or her own behavior. 4. The client will discuss and compare the exhibited behaviors with the nurse.

3 When the client assumes responsibility for his or her own behavior, it indicates that the client no longer shows the transference behavior and that the nursing care is effective.

Which represents love-intimacy in an individual? 1. Accepting the hand of a person during a handshake 2. Expressing physical attraction towards others 3. Having a strong desire towards a person 4. Being emotionally attached to a person

4 Emotional attachment or attraction to a person represents love-intimacy in an individual.

While caring for an angry client, the nurse makes empty conversation. What could be the rationale behind this nursing intervention? 1. To explore the client's areas of difficulty 2. To tell the client about the meaning of the experience 3. To take over the direction of the discussion from the client 4. To encourage a like response from the client

4 Empty conversation from the nurse encourages a like response from the client. It is practiced as a nontherapeutic communication technique in which stereotyped comments are made to encourage a like response from the client.

Which is a task completed in the preinteraction phase of the client relationship? Gathering assessment information to build a strong client database 2. Promoting the client's insight and perception of reality 3. Using the problem-solving model 4. Examining one's own feelings, fears, and anxieties about working with a particular client

4 Examining one's own feelings, fears, and anxieties about working with a particular client happens in the preinteraction phase.

While caring for a client with anger, the nurse formulates a plan of action with the client. What would be the rationale behind this nursing intervention? 1. To nurture the client in the dependent role 2. To find clues to the underlying true feelings of the client 3. To encourage a like response from the client 4. To prevent anxiety or anger from escalating to an unmanageable level

4 Formulating a plan of action with the client helps prevent anxiety or anger from escalating to an unmanageable level.

A client with depression says, "Everyone has deserted me. I feel that my life has no value." Which nontherapeutic technique would the nurse use to take over this discussion? 1. Interpreting the situation 2. Using denial technique 3. Expressing belittling feelings 4. Introducing an unrelated topic

4 Introducing an unrelated topic allows the nurse to take over the discussion.

Which gesture exemplifies the "O" in the acronym SOLER for nonverbal behaviors involved in active listening? 1. Sitting in front of the client 2. Lean in toward the client 3. Establish eye contact 4. Client sitting in a chair with arms and legs uncrossed

4 Posture is considered "open" when arms and legs remain uncrossed; observing this is the "O" in SOLER.

The nurse is standing in front of a room of clients. Which term describes the distance between the nurse and the clients? 1. Intimate 2. Social 3. Personal 4. Public

4 Public distance is one that exceeds 12 feet. Examples include speaking in public or yelling to someone from a distance.

The nurse tells a client with a history of violence, "Let's discuss your behavior and see if we can clarify the situation." What could be the rationale behind this statement? 1. To help recognize life experiences that tend to recur 2. To define the perception of the situation for the client 3. To delve further into the subject with the client, beyond a superficial level of communication 4. To facilitate and increase the rapport for both client and nurse

4 Seeking clarification and validation facilitates and increases the mutual understanding between the nurse and the client. Therefore, this statement facilitates and increases the rapport for both client and nurse.

The nurse is conducting a process recording of a client with a history of anger. The nurse asks the client, "What were your feelings before taking all those pills the other night?" The client replies, "I was just so angry thinking that my husband wants a divorce." What may likely be the nurse's thoughts after the client's reply? 1. Feeling sorry 2. Feeling uncomfortable 3. Trying hard to remain objective 4. Feeling more comfortable

4 The nurse likely begins to feel comfortable after the client's reply because the client is willing to talk to the nurse and trusts him or her. This change in behavior helps the nurse to explore and understand the client.

A client who lost his or her spouse in an accident tells the nurse, "Leave me alone. I can't talk to you." How should the nurse respond to this client using therapeutic communication techniques? 1. "Everything will be fine." 2. "Tell me what you are thinking?" 3. "I think you should come in here and discuss your feelings." 4. "Are you feeling that no one understands your feelings?"

4 The nurse should put into words what the client has implied or said indirectly. This statement made by the nurse is the best response to the client.

A client tells the nurse, "I can't concentrate on anything. My mind keeps wandering." How should the nurse respond to convey to the client that he or she has understood the client's statement? 1. Referring questions back to the client 2. Taking notice of a single idea of the client 3. Researching further into the client's feelings 4. Repeating the main idea of what the client has said

4 The nurse should repeat the main idea of what the client has said to make the client know that the statement is understood. Repeating the main idea will help both the client and the nurse to validate the statement.

The nurse is caring for a client with chronic low self-esteem. Which statement made by the nurse indicates an accepting attitude? 1. "I want to listen to what you have to say." 2. "Explain to me what you are feeling now." 3. "We can sit in the dayroom and eat dinner together." 4. "I understand what you're saying."

4 This statement indicates an accepting attitude of reception to and regard for the client.

What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client? 1. Clarify personal attitudes, values, and beliefs. 2. Obtain thorough assessment data. 3. Determine the clients length of stay. 4. Establish personal goals for the interaction.

ANS: 1 Rationale: The most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client is to clarify personal attitudes, values, and beliefs. Understanding one's own attitudes, values, and beliefs is called self-awareness.

Which client action should a nurse expect during the working phase of the nurse-client relationship? 1. The client gains insight and incorporates alternative behaviors. 2. The client establishes rapport with the nurse and mutually develops treatment goals. 3. The client explores feelings related to reentering the community. 4. The client explores personal strengths and weaknesses that impact behavioral choices.

ANS: 1 Rationale: The nurse should expect that that the client will gain insight and incorporate alternative behaviors during the working phase of the nurse-client relationship. The client may also overcome resistance, problem-solve, and continually evaluate progress toward goals.

A mother rescues two of her four children from a house fire. In an emergency department, she cries, I should have gone back in to get them. I should have died, not them. What is the nurse's best response? 1. The smoke was too thick. You couldn't have gone back in. 2. You're experiencing feelings of guilt, because you weren't able to save your children. 3. Focus on the fact that you could have lost all four of your children. 4. It's best if you try not to think about what happened. Try to move on.

ANS: 2 Rationale: The best response by the nurse is, You're experiencing feelings of guilt, because you weren't able to save your children. This response uses the therapeutic communication technique of restating what the client has said. This lets the client know whether an expressed statement has been understood or if clarification is necessary.

A nurse maintains an uncrossed arm and leg posture when communicating with a client. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? 1. S 2. O 3. L 4. E 5. R

ANS: 2 Rationale: The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the O in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), observing and open posture (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

A client diagnosed with post-traumatic stress disorder related to a rape is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique might a nurse use that is an example of broad openings? 1. What occurred prior to the rape, and when did you go to the emergency department? 2. What would you like to talk about? 3. I notice you seem uncomfortable discussing this. 4. How can we help you feel safe during your stay here?

ANS: 2 Rationale: The nurses statement, What would you like to talk about? is an example of the therapeutic communication technique of a broad opening. Using broad openings allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction.

What should be the priority nursing action during the orientation (introductory) phase of the nurse-client relationship? 1. Acknowledge the clients actions and generate alternative behaviors. 2. Establish rapport and develop treatment goals. 3. Attempt to find alternative placement. 4. Explore how thoughts and feelings about this client may adversely impact nursing care.

ANS: 2 Rationale: The priority nursing action during the orientation phase of the nurse-client relationship should be to establish rapport and develop treatment goals. Rapport implies feelings on the part of both the nurse and the client, based on respect, acceptance, a sense of trust, and a nonjudgmental attitude. It is the essential foundation of the nurse-client relationship.

When an individual is two-faced, which characteristic essential to the development of a therapeutic relationship should a nurse identify as missing? 1. Respect 2. Genuineness 3. Sympathy 4. Rapport

ANS: 2 Rationale: When an individual is two-faced, which means double-dealing or deceitful, the nurse should identify that genuineness is missing in the relationship. Genuineness refers to the nurses ability to be open and honest and maintain congruence between what is felt and what is communicated. When a nurse fails to bring genuineness to the relationship, trust cannot be established.

An instructor is correcting a nursing students clinical worksheet. Which instructor statement is the best example of effective feedback? 1. Why did you use the clients name on your clinical worksheet? 2. You were very careless to refer to your client by name on your clinical worksheet. 3. Surely you didn't do this deliberately, but you breached confidentiality by using names. 4. It is disappointing that after being told you're still using client names on your worksheet.

ANS: 3 Rationale: The instructors statement, Surely you didn't do this deliberately, but you breached confidentiality by using names, is an example of effective feedback. Feedback is method of communication for helping others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice.

A client exhibiting dependent behaviors says, Do you think I should move from my parents house and get a job? Which nursing response is most appropriate? 1. It would be best to do that in order to increase independence. 2. Why would you want to leave a secure home? 3. Let's discuss and explore all of your options. 4. I'm afraid you would feel very guilty leaving your parents.

ANS: 3 Rationale: The most appropriate response by the nurse is, Let's discuss and explore all of your options. In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action.

Which therapeutic communication technique is being used in the following nurse-client interaction? Client: When I am anxious, the only thing that calms me down is alcohol. Nurse: Other than drinking, what alternatives have you explored to decrease anxiety? 1. Reflecting 2. Making observations 3. Formulating a plan of action 4. Giving recognition

ANS: 3 Rationale: The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking. The use of this technique may serve to prevent anger or anxiety from escalating.

Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse-client relationship? 1. I can't bear the thought of leaving here and failing. 2. I might have a hard time working with you, because you remind me of my mother. 3. I really don't want to talk any more about my childhood abuse. 4. I'm not sure that I can count on you to protect my confidentiality.

ANS: 3 Rationale: The nurse should identify that the client statement, I really don't want to talk any more about my childhood abuse, reflects that the client is in the working phase of the nurse-client relationship. The working phase includes overcoming resistance behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues.

A newly admitted client, diagnosed with obsessive-compulsive disorder (OCD), washes his hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? 1. Everyone diagnosed with OCD needs to control their ritualistic behaviors. 2. It is important for you to discontinue these ritualistic behaviors. 3. Why are you asking for help, if you won't participate in unit therapy? 4. Let's figure out a way for you to attend unit activities and still wash your hands.

ANS: 4 Rationale: The most appropriate statement by the nurse is, Let's figure out a way for you to attend unit activities and still wash your hands. This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship.

On which task should a nurse place priority during the working phase of relationship development? 1. Establishing a contract for intervention 2. Examining feelings about working with a particular client 3. Establishing a plan for continuing aftercare 4. Promoting the clients insight and perception of reality

ANS: 4 Rationale: The nurse should place priority on promoting the clients insight and perception of reality during the working phase of relationship development. Establishing a contract for intervention would occur in the orientation phase. Examining feelings about working with a client should occur in the pre-interaction phase. Establishing a plan for aftercare would occur in the termination phase.

If a client demonstrates transference toward a nurse, how should the nurse respond? 1. Promote safety and immediately terminate the relationship with the client. 2. Encourage the client to ignore these thoughts and feelings. 3. Immediately reassign the client to another staff member. 4. Help the client to clarify the meaning of the relationship, based on the present situation.

ANS: 4 Rationale: The nurse should respond to a client's transference by clarifying the meaning of the nurse-client relationship based on the present situation. Transference occurs when the client unconsciously displaces feelings about a person from the past toward the nurse. The nurse should assist the client in separating the past from the present.

A mother who is notified that her child was killed in a tragic car accident states, I can't bear to go on with my life. Which nursing statement conveys empathy? 1. This situation is very sad, but time is a great healer. 2. You are sad, but you must be strong for your other children. 3. Once you cry it all out, things will seem so much better. 4. It must be horrible to lose a child, and I'll stay with you until your husband arrives.

ANS: 4 Rationale: The nurses response, It must be horrible to lose a child, and I'll stay with you until your husband arrives, conveys empathy to the client. Empathy is the ability to see the situation from the client's point of view. Empathy is considered to be one of the most important characteristics of the therapeutic relationship.

A nurse says to a client, Things will look better tomorrow after a good night's sleep. This is an example of which communication technique? 1. The therapeutic technique of giving advice 2. The therapeutic technique of defending 3. The non therapeutic technique of presenting reality 4. The non therapeutic technique of giving reassurance

ANS: 4 Rationale: The nurses statement, Things will look better tomorrow after a good night's sleep, is an example of the nontherapeutic communication technique of giving reassurance. Giving reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the clients feelings.

Which finding best indicates that the goal Demonstrate mentally healthy behavior was achieved? A patient: a. sees self as capable of achieving ideals and meeting demands. b. behaves without considering the consequences of personal actions. c. aggressively meets own needs without considering the rights of others. d. seeks help from others when assuming responsibility for major areas of own life.

ANS: A The correct response describes an adaptive, healthy behavior. The distracters describe maladaptive behaviors.

In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill? One who: a. describes hearing Gods voice speaking. b. is usually pessimistic but strives to meet personal goals. c. is wealthy and gives away $20 bills to needy individuals. d. always has an optimistic viewpoint about life and having own needs met.

ANS: A The question asks about risk. Hearing voices is generally associated with mental illness, but in charismatic religious groups, hearing the voice of God or a prophet is a desirable event. Cultural norms vary, which makes it more difficult to make an accurate diagnosis. The individuals described in the other options are less likely to be labeled mentally ill.

16. According to Peplau, which nursing intervention is most appropriate when the nurse is functioning in the role of a surrogate? A. The nurse functions as a nurturing parent in order to build a trusting relationship. B. The nurse plays cards with a small group of clients. C. The nurse discusses childhood events that may affect personality development. D. The nurse provides a safe social environment.

ANS: A According to Peplau, when a client is acutely ill, he or she may incur the role of infant or child, while the nurse is perceived as the mother surrogate. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

According to Peplau, which nursing intervention is most appropriate when the nurse is functioning in the role of a surrogate? A. The nurse functions as a nurturing parent in order to build a trusting relationship. B. The nurse plays cards with a small group of clients. C. The nurse discusses childhood events that may affect personality development. D. The nurse provides a safe social environment.

ANS: A According to Peplau, when a client is acutely ill, he or she may incur the role of infant or child, while the nurse is perceived as the mother surrogate.

Which statement provides the best rationale for why a nurse should closely monitor a severely depressed patient during antidepressant medication therapy? A. As depression lifts, physical energy becomes available to carry out suicide. B. Suicide may be precipitated by a variety of internal and external events C. Suicidal patients have difficulty using social supports D. Suicide is an impulsive act.

ANS: A Antidepressant medication has the objective of relieving depression. The risk for suicide is greater as the depression lifts, primarily because the patient has more physical energy at a time when he or she may still have suicidal ideation. The other options have little to do with nursing interventions relating to antidepressant medication therapy.

12. A nurse is caring for a client who has threatened to commit suicide by hanging. The client states, Im going to use a knotted shower curtain when no one is around. Which information would determine the nurses plan of care for this client? A. The more specific the plan is, the more likely the client will attempt suicide. B. Clients who talk about suicide never actually commit it. C. Clients who threaten suicide should be observed every 15 minutes. D. After a brief assessment, the nurse should avoid the topic of suicide.

ANS: A Clients who have specific plans are at greater risk for suicide.

After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, Im so proud of you for being assertive. You are so good! Which communication technique has the leader employed? A. The nontherapeutic technique of giving approval B. The nontherapeutic technique of interpreting C. The therapeutic technique of presenting reality D. The therapeutic technique of making observations

Chapter 07. Relationship Development Multiple Choice 1. What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client? A. To clarify personal attitudes, values, and beliefs B. To obtain thorough assessment data C. To determine the clients length of stay D. To establish personal goals for the interaction

ANS: A The most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client is to clarify personal attitudes, values, and beliefs. Understanding ones own attitudes, values, and beliefs is called self-awareness. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

7. A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations? A. You appear to be talking to someone I do not see. B. Please describe what you are seeing. C. Why do you continually look in the corner of this room? D. If you hum a tune, the voices may not be so distracting.

ANS: A The nurse is making an observation when stating, You appear to be talking to someone I do not see. Making observations involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurses perceptions. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations? A. You appear to be talking to someone I do not see. B. Please describe what you are seeing. C. Why do you continually look in the corner of this room? D. If you hum a tune, the voices may not be so distracting.

2. Which therapeutic communication technique is being used in this nurseclient interaction? Client: My father spanked me often. Nurse: Your father was a harsh disciplinarian. A. Restatement B. Offering general leads C. Focusing D. Accepting

ANS: A The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the clients statement has been heard and understood. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

5. Which client response should a nurse expect during the working phase of the nurseclient relationship? A. The client gains insight and incorporates alternative behaviors. B. The client and nurse establish rapport and mutually develop treatment goals. C. The client explores feelings related to reentering the community. D. The client explores personal strengths and weaknesses that impact behaviors.

ANS: A The nurse should expect that the client would gain insight and incorporate alternative behaviors during the working phase of the nurseclient relationship. The client may also overcome resistance, problem-solve, and continually evaluate progress toward goals. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client has made the decision to leave her alcoholic husband. She is feeling very depressed. Which nontherapeutic statement by the nurse conveys sympathy? A. You are feeling very depressed. I felt the same way when I decided to leave my husband. B. I can understand you are feeling depressed. It was a difficult decision. Ill sit with you. C. You seem depressed. It was a difficult decision to make. Would you like to talk about it? D. I know this is a difficult time for you. Would you like a prn medication for anxiety?

An adult attempts suicide after declaring bankruptcy. The patient is hospitalized and takes an antidepressant medication for five days. The patient is now more talkative and shows increased energy. Select the highest priority nursing intervention. a. Supervise the patient 24 hours a day. b. Begin discharge planning for the patient. c. Refer the patient to art and music therapists. d. Consider the discontinuation of suicide precautions.

ANS: A The patient now has more energy and may have decided on suicide, especially considering the history of the prior suicide attempt. The patient is still a suicide risk; therefore, continuous supervision is indicated.

Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A. We've discussed past coping skills. Lets see if these coping skills can be effective now. B. Please tell me in your own words what brought you to the hospital. C. This new approach worked for you. Keep it up. D. I notice that you seem to be responding to voices that I do not hear.

21. A client is trying to explore and solve a problem. Which nursing statement would be an example of verbalizing the implied? A. You seem to be motivated to change your behavior. B. How will these changes affect your family relationships? C. Why dont you make a list of the behaviors you need to change. D. The team recommends that you make only one behavioral change at a time.

ANS: A This is an example of the therapeutic communication technique of verbalizing the implied. Verbalizing the implied puts into words what the client has only implied or said indirectly. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

27. During a nurseclient interaction, which nursing statement may belittle the clients feelings and concerns? A. Dont worry. Everything will be alright. B. You appear uptight. C. I notice you have bitten your nails to the quick. D. You are jumping to conclusions.

ANS: A This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occurs when the nurse misjudges the degree of the clients discomfort, suggesting a lack of empathy and understanding. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

During a nurse client interaction, which nursing statement may belittle the client's feelings and concerns? A. Don't worry. Everything will be alright. B. You appear uptight. C. I notice you have bitten your nails to the quick. D. You are jumping to conclusions.

29. Which nursing response is an example of the nontherapeutic communication block of requesting an explanation? A. Can you tell me why you said that? B. Keep your chin up. Ill explain the procedure to you. C. There is always an explanation for both good and bad behaviors. D. Are you not understanding the explanation I provided?

ANS: A This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking why a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which nursing response is an example of the nontherapeutic communication block of requesting an explanation? A. Can you tell me why you said that? B. Keep your chin up. I'll explain the procedure to you. C. There is always an explanation for both good and bad behaviors. D. Are you not understanding the explanation I provided?

24. A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication? A. Touch carries a different meaning for different individuals. B. Touch is often used when deescalating volatile client situations. C. Touch is used to convey interest and warmth. D. Touch is best combined with empathy when dealing with anxious clients.

ANS: A Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication? A. Touch carries a different meaning for different individuals. B. Touch is often used when deescalating volatile client situations. C. Touch is used to convey interest and warmth. D. Touch is best combined with empathy when dealing with anxious clients.

ANS: A Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction.

19. Which client statement may indicate a transference reaction? A. I need a real nurse. You are young enough to be my daughter and I dont want to tell you about my personal life. B. I deserve more than I am getting here. Do you know who I am and what I do? Let me talk to your supervisor. C. I dont seem to be able to relate to people. I would rather stay in my room and be by myself. D. My mother is the source of my problems. She has always told me what to do and what to say.

ANS: A Transference occurs when a client unconsciously displaces or transfers to the nurse feelings formed toward a person from the past. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

Which client statement may indicate a transference reaction? A. I need a real nurse. You are young enough to be my daughter and I don't want to tell you about my personal life. B. I deserve more than I am getting here. Do you know who I am and what I do? Let me talk to your supervisor. C. I don't seem to be able to relate to people. I would rather stay in my room and be by myself. D. My mother is the source of my problems. She has always told me what to do and what to say.

ANS: A Transference occurs when a client unconsciously displaces or transfers to the nurse feelings formed toward a person from the past.

An experienced nurse says to a new graduate, When youve practiced as long as I have, you instantly know how to take care of psychotic patients. What information should the new graduate consider when analyzing this comment? Select all that apply. a. The experienced nurse may have lost sight of patients individuality, which may compromise the integrity of practice. b. New research findings should be integrated continuously into a nurses practice to provide the most effective care. c. Experience provides mental health nurses with the essential tools and skills needed for effective professional practice. d. Experienced psychiatric nurses have learned the best ways to care for mentally ill patients through trial and error. e. An intuitive sense of patients needs guides effective psychiatric nurses.

ANS: A, B Evidence-based practice involves using research findings and standards of care to provide the most effective nursing care. Evidence is continuously emerging, so nurses cannot rely solely on experience. The effective nurse also maintains respect for each patient as an individual. Overgeneralization compromises that perspective. Intuition and trial and error are unsystematic approaches to care.

25. After a teenager reveals that he is gay, the father responds by beating him. The next morning, the teenager is found hanging in his closet. Which paternal grief responses should a nurse anticipate? Select all that apply. A. I cant believe this is happening. B. If only I had been more understanding. C. How dare he do this to me! D. I'm just going to have to accept that he was gay. E. Well, that was a selfish thing to do.

ANS: A, B, C Suicide of a family member can induce a whole gamut of feelings in the survivors. Shock, disbelief, guilt, remorse, anger, and resentment are all feelings that may be experienced by this father. The last two possible responses suggest acceptance and understanding. It is far more common for survivors of suicide to have a sense of feeling wounded and as if they will never get over it.

34. Which of the following individuals are communicating a message? Select all that apply. A. A mother spanking her son for playing with matches B. A teenage boy isolating himself and playing loud music C. A biker sporting an eagle tattoo on his biceps D. A teenage girl writing, No one understands me E. A father checking for new e-mail on a regular basis

ANS: A, B, C, D The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

26. A nursing student is developing a study guide related to historical facts about suicide. Which of the following facts should the student include? Select all that apply. A. In the Middle Ages, suicide was viewed as a selfish and criminal act. B. During the Roman Empire, suicide was followed by incineration of the body. C. Suicide was an offense in ancient Greece, and a common-site burial was denied. D. During the Renaissance, suicide was discussed and viewed more philosophically. E. Old Norse traditionally set a person who committed suicide adrift in the North Sea.

ANS: A, C, D These are true historical facts about suicide and should be included in the students study guide.

Which findings are signs of a person who is mentally healthy? Select all that apply. a. Says, I have some weaknesses, but I feel Im important to my family and friends. b. Adheres strictly to religious beliefs of parents and family of origin. c. Spends all holidays alone watching old movies on television. d. Considers past experiences when deciding about the future. e. Experiences feelings of conflict related to changing jobs.

ANS: A, D, E Mental health is a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively, and make a contribution to the community. Mental health provides people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem.

Complete this analogy. NANDA: clinical judgment: NIC: _________________ a. patient outcomes c. diagnosis b. nursing actions d. symptoms

ANS: B Analogies show parallel relationships. NANDA, the North American Nursing Diagnosis Association, identifies diagnostic statements regarding human responses to actual or potential health problems. These statements represent clinical judgments. NIC (Nursing Interventions Classification) identifies actions provided by nurses that enhance patient outcomes. Nursing care activities may be direct or indirect.

A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional intervention? a. Conduct mental health assessments. b. Prescribe psychotropic medication. c. Establish therapeutic relationships. d. Individualize nursing care plans.

ANS: B In most states, prescriptive privileges are granted to masters-prepared nurse practitioners who have taken special courses on prescribing medication. The nurse prepared at the basic level is permitted to perform mental health assessments, establish relationships, and provide individualized care planning

A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information? a. Nursing Outcomes Classification (NOC) b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) c. The ANAs Psychiatric-Mental Health Nursing Scope and Standards of Practice d. International Statistical Classification of Diseases and Related Health Problems (ICD-10)

ANS: B The DSM-5 details the diagnostic criteria for psychiatric clinical conditions. The other references are good resources but do not define the diagnostic criteria.

A nurse encounters an unfamiliar psychiatric disorder on a new patients admission form. Which resource should the nurse consult to determine criteria used to establish this diagnosis? a. International Statistical Classification of Diseases and Related Health Problems (ICD-10) b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) c. A behavioral health reference manual d. Wikipedia

ANS: B The DSM-5 gives the criteria used to diagnose each mental disorder. The distracters may not contain diagnostic criteria for a psychiatric illness.

Which component of treatment of mental illness is specifically recognized by Quality and Safety Education for Nurses (QSEN)? a. All genomes are unique. b. Care is centered on the patient. c. Healthy development is vital to mental health. d. Recovery occurs on a continuum from illness to health.

ANS: B The key areas of care promoted by QSEN are patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.

When a nursing student expresses concerns about how mental health nurses lose all their nursing skills, the best response by the mental health nurse is: a. Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of the patients problems. b. Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations. c. Thats a misconception. Psychiatric nurses frequently use high technology monitoring equipment and manage complex intravenous therapies. d. Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That appeals to me.

ANS: B The practice of psychiatric nursing requires a different set of skills than medical-surgical nursing, though there is substantial overlap. Psychiatric nurses must be able to help patients with medical as well as mental health problems, reflecting the holistic perspective these nurses must have. Nurse-patient ratios and workloads in psychiatric settings have increased, just like other specialties. Psychiatric nursing involves clinical practice, not just documentation. Psychosocial pain and suffering are as real as physical pain and suffering.

A staff nurse tells another nurse, I evaluated a new patient using the SAD PERSONS scale and got a score of 10. Im wondering if I should send the patient home. Select the best reply by the second nurse. a. That action would seem appropriate. b. A score over 8 requires immediate hospitalization. c. I think you should strongly consider hospitalization for this patient. d. Give the patient a follow-up appointment. Hospitalization may be needed soon.

ANS: B A SAD PERSONS scale score of 0 to 5 suggests home care with follow-up. A score of 6 to 8 requires psychiatric consultation. A score over 8 calls for hospitalization.

16. Which is a correctly written, appropriate outcome for a client with a history of suicide attempts who is currently exhibiting symptoms of low self-esteem by isolating self? A. The client will not physically harm self. B. The client will express three positive self-attributes by day 4. C. The client will reveal a suicide plan. D. The client will establish a trusting relationship.

ANS: B Although the client has a history of suicide attempts, the current problem is isolative behaviors based on low self-esteem. Outcomes should be client centered, specific, realistic, and measureable and contain a time frame.

9. A stockbroker commits suicide after being convicted of insider trading. In speaking with the family, which statement by the nurse demonstrates accurate and appropriate sharing of information? A. Your grieving will subside within 1 year; until then I recommend antidepressants. B. Support groups are available specifically for survivors of suicide, and I would be glad to help you locate one in this area. C. The only way to deal effectively with this kind of grief is to write a letter to the brokerage firm to express your anger with them. D. Since stigmatization often occurs in these situations, it would be best if you avoid discussing the suicide with anyone.

ANS: B Bereavement following suicide is complicated by the complex psychological impact of the act on those close to the victim. Support groups for survivors can provide a meaningful resource for grief work.

23. A student nurse tells the instructor, Im concerned that when a client asks me for advice I wont have a good solution. Which should be the nursing instructors best response? A. Its scary to feel put on the spot by a client. Nurses dont always have the answer. B. Remember, clients, not nurses, are responsible for their own choices and decisions. C. Just keep the clients best interests in mind and do the best that you can. D. Set a goal to continue to work on this aspect of your practice.

ANS: B Giving advice tells the client what to do or how to behave. It implies that the nurse knows what is best and that the client is incapable of any self-direction. It discourages independent thinking. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A student nurse tells the instructor, Im concerned that when a client asks me for advice I wont have a good solution. Which should be the nursing instructors best response? A. Its scary to feel put on the spot by a client. Nurses dont always have the answer. B. Remember, clients, not nurses, are responsible for their own choices and decisions. C. Just keep the clients best interests in mind and do the best that you can. D. Set a goal to continue to work on this aspect of your practice.

Which statement by a patient during an assessment interview should alert the nurse to the patients need for immediate, active intervention? A. I am mixed up but I know I need help B. I have no one for help or support C. It is worse when you are a person of color D. I tried to get attention before i shot myself.

ANS: B Lack of social support and social isolation increase the suicide risk. The willingness to seek help lowers the risk. Being a person of color does not suggest a higher risk; more whites commit suicide than do individuals of other racial groups. Attention seeking is not correlated with a higher risk of suicide.

Which intervention should the nurse recommend for the distressed family and friends of someone who has committed suicide? A. Participating in reminiscence therapy B. Attending a self-help group for survivors C. Contracting for two sessions of group therapy D. Completing a psychological postmortem assessment

ANS: B Survivors need outlets for their feelings about the loss and the deceased person. Self-help groups provide peer support while survivors work through feelings of loss, anger, and guilt. Psychological postmortem assessment would not provide the support necessary to work through feelings of loss associated with the suicide of a family member. Reminiscence therapy is not geared to loss resolution. Contracting for two sessions of group therapy would probably not provide sufficient time to work through the issues associated with a death by suicide.

15. A mother rescues two of her four children from a house fire. In an emergency department, she cries, I should have gone back in to get them. I should have died, not them. Which of the following responses by the nurse is an example of reflection? A. The smoke was too thick. You couldnt have gone back in. B. Youre feeling guilty because you werent able to save your children. C. Focus on the fact that you could have lost all four of your children. D. Its best if you try not to think about what happened. Try to move on.

ANS: B The best response by the nurse is, Youre experiencing feelings of guilt because you werent able to save your children. This response utilizes the therapeutic communication technique of reflection, which identifies a clients emotional response and reflects these feelings back to the client so that they may be recognized and accepted. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

5. A nurse recently admitted a client to an inpatient unit after a suicide attempt. A health-care provider orders amitriptyline (Elavil) for the client. Which intervention related to this medication should be initiated to maintain this clients safety upon discharge? A. Provide a 6-month supply of Elavil to ensure long-term compliance. B. Provide a 1-week supply of Elavil with refills contingent on follow-up appointments. C. Provide a pill dispenser as a memory aid. D. Provide education regarding the avoidance of foods containing tyramine.

ANS: B The health-care provider should provide a 1-week supply of Elavil with refills contingent on follow-up appointments as an appropriate intervention to maintain the clients safety. Tricyclic antidepressants have a narrow therapeutic range and can be used in overdose to commit suicide. Distributing limited amounts of the medication decreases this potential.

2. A hungry, homeless client, diagnosed with schizophrenia, refuses to participate in an admission interview. When the nurse postpones the admission interview, verbally assures safety, and provides a warm meal, he or she is promoting which of the following? A. Sympathy B. Trust C. Veracity D. Manipulation

ANS: B The nurse is promoting trust by postponing the admission interview, assuring safety, and providing a warm meal. Trust implies a feeling of confidence that a person is reliable and sincere and has integrity and veracity. Trustworthiness is demonstrated through nursing interventions that convey a sense of warmth and caring to the client. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A hungry, homeless client, diagnosed with schizophrenia, refuses to participate in an admission interview. When the nurse postpones the admission interview, verbally assures safety, and provides a warm meal, he or she is promoting which of the following? A. Sympathy B. Trust C. Veracity D. Manipulation

11. If an individual is two-faced, which characteristic essential to the development of a therapeutic relationship should a nurse identify as missing? A. Respect B. Genuineness C. Sympathy D. Rapport

ANS: B The nurse should identify that genuineness is missing in the relationship. Genuineness refers to an individuals ability to be open and honest and maintain congruence between what is felt and what is communicated. Genuineness is essential to establishing trust in a relationship. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

8. A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? A. S B. O C. L D. E E. R

ANS: B The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the O in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), open posture when interacting with the client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R). KEY: Cognitive Level: Application | Integrated Processes: Communication and Documentation | Client Need: Psychosocial Integrity

13. A client diagnosed with paranoid schizophrenia becomes agitated when asked to play a game. The client responds, Do you want to be my girlfriend? Which nursing response is most appropriate? A. You are upset now. It would be best if you go to your room until you feel better. B. Remember, we have a professional relationship. Are you feeling uncomfortable? C. We have discussed this before. I am not allowed to date clients. D. I think you should discuss your fantasies with your therapist.

ANS: B The nurse should promote the clients insight and perception of reality by confirming appropriate roles in the nurseclient relationship and identifying what is troubling the client in this situation. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client diagnosed with paranoid schizophrenia becomes agitated when asked to play a game. The client responds, Do you want to be my girlfriend? Which nursing response is most appropriate? A. You are upset now. It would be best if you go to your room until you feel better. B. Remember, we have a professional relationship. Are you feeling uncomfortable? C. We have discussed this before. I am not allowed to date clients. D. I think you should discuss your fantasies with your therapist.

20. Which nursing action demonstrates the role of the teacher in a therapeutic milieu? A. The nurse implements a self-affirmation exercise during a one-to-one client interaction. B. The nurse holds a group meeting to present common side effects of psychiatric medications. C. The nurse introduces the concept of fair play while playing cards with a group of clients. D. The nurse models adaptive and effective coping mechanisms with clients on the psychiatric unit.

ANS: B The nurse, in the role of teacher, identifies learning needs and provides information required by the client or family to improve the clients health. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which nursing action demonstrates the role of the teacher in a therapeutic milieu? A. The nurse implements a self-affirmation exercise during a one-to-one client interaction. B. The nurse holds a group meeting to present common side effects of psychiatric medications. C. The nurse introduces the concept of fair play while playing cards with a group of clients. D. The nurse models adaptive and effective coping mechanisms with clients on the psychiatric unit.

ANS: B The nurse, in the role of teacher, identifies learning needs and provides information required by the client or family to improve the clients health.

6. A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening? A. What occurred prior to the rape, and when did you go to the emergency department? B. What would you like to talk about? C. I notice you seem uncomfortable discussing this. D. How can we help you feel safe during your stay here?

ANS: B The nurses statement, What would you like to talk about? is an example of the therapeutic communication technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the clients role in the interaction. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which phase of the nurseclient relationship begins when the individuals first meet and is characterized by an agreement to continue to meet and work on setting client-centered goals? A. Preinteraction B. Orientation C. Working D. Termination

4. What is the priority nursing action during the orientation (introductory) phase of the nurseclient relationship? A. Acknowledge the clients actions and generate alternative behaviors. B. Establish rapport and develop treatment goals. C. Attempt to find alternative placement. D. Explore how thoughts and feelings about this client may adversely impact care.

ANS: B The priority nursing action during the orientation phase of the nurseclient relationship should be to establish rapport and develop treatment goals. Rapport implies feelings on the part of both the nurse and the client based on respect, acceptance, a sense of trust, and a nonjudgmental attitude. It is the essential foundation of the nurseclient relationship. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

10. After years of dialysis, an 84-year-old states, Im exhausted, depressed, and done with these attempts to keep me alive. Which question should the nurse ask the spouse when preparing a discharge plan of care? A. Have there been any changes in appetite or sleep? B. How often is your spouse left alone? C. Has your spouse been following a diet and exercise program consistently? D. How would you characterize your relationship with your spouse?

ANS: B This client has many risk factors for suicide. The client should have increased supervision to decrease likelihood of self-harm.

26. After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, You are incompetent! Which is the nurses best response? A. Do you believe that I was the cause of your blood test being canceled? B. I see that you are upset, but I feel uncomfortable when you swear at me. C. Have you ever thought about ways to express anger appropriately? D. Ill give you some space. Let me know if you need anything.

ANS: B This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, You are incompetent! Which is the nurses best response? A. Do you believe that I was the cause of your blood test being canceled? B. I see that you are upset, but I feel uncomfortable when you swear at me. C. Have you ever thought about ways to express anger appropriately? D. I'll give you some space. Let me know if you need anything.

ANS: B This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify.

32. Which nursing statement is a good example of the therapeutic communication technique of offering self? A. I think it would be great if you talked about that problem during our next group session. B. Would you like me to accompany you to your electroconvulsive therapy treatment? C. I notice that you are offering help to other peers in the milieu. D. After discharge, would you like to meet me for lunch to review your outpatient progress?

ANS: B This is an example of the therapeutic communication technique of offering self. Offering self makes the nurse available on an unconditional basis, increasing clients feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which nursing statement is a good example of the therapeutic communication technique of offering self? A. I think it would be great if you talked about that problem during our next group session. B. Would you like me to accompany you to your electroconvulsive therapy treatment? C. I notice that you are offering help to other peers in the milieu. D. After discharge, would you like to meet me for lunch to review your outpatient progress?

31. Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? A. My sister has the same diagnosis as you and she also hears voices. B. I understand that the voices seem real to you, but I do not hear any voices. C. Why not turn up the radio so that the voices are muted. D. I wouldnt worry about these voices. The medication will make them disappear.

ANS: B This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

33. A client slammed a door on the unit several times. The nurse responds, You seem angry. The client states, Im not angry. What therapeutic communication technique has the nurse employed, and what defense mechanism is the client unconsciously demonstrating? A. Making observations and the defense mechanism of suppression B. Verbalizing the implied and the defense mechanism of denial C. Reflection and the defense mechanism of projection D. Encouraging descriptions of perceptions and the defense mechanism of displacement

ANS: B This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity Multiple Response

A client slammed a door on the unit several times. The nurse responds, You seem angry. The client states, Im not angry. What therapeutic communication technique has the nurse employed, and what defense mechanism is the client unconsciously demonstrating? A. Making observations and the defense mechanism of suppression B. Verbalizing the implied and the defense mechanism of denial C. Reflection and the defense mechanism of projection D. Encouraging descriptions of perceptions and the defense mechanism of displacement

23. The nurseclient therapeutic relationship includes which of the following characteristics? Select all that apply. A. Meeting the psychological needs of the nurse and the client B. Ensuring therapeutic termination C. Promoting client insight into problematic behavior D. Collaborating to set appropriate goals E. Meeting both the physical and psychological needs of the client

ANS: B, C, D, E The nurseclient therapeutic relationship should include promoting client insight into problematic behavior, collaboration to set appropriate goals, meeting the physical and psychological needs of the client, and ensuring therapeutic termination. The nurses psychological needs should not be addressed within the nurseclient relationship. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A patient in the emergency department says, Voices say someone is stalking me. They want to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a threat. Which aspects of the patients mental health have the greatest and most immediate concern to the nurse? Select all that apply. a. Happiness b. Appraisal of reality c. Control over behavior d. Effectiveness in work e. Healthy self-concept

ANS: B, C, E The aspects of mental health of greatest concern are the patients appraisal of and control over behavior. The appraisal of reality is inaccurate. There are auditory hallucinations, delusions of persecution, and delusions of grandeur. In addition, the patients control over behavior is tenuous, as evidenced by the plan to stab anyone who seems threatening. A healthy self-concept is lacking, as evidenced by the delusion of grandeur. Data are not present to suggest that the other aspects of mental health (happiness and effectiveness in work) are of immediate concern.

When a new bill introduced in Congress reduces funding for care of persons with mental illness, a group of nurses writes letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Recovery b. Attending c. Advocacy d. Evidence-based practice

ANS: C An advocate defends or asserts anothers cause, particularly when the other person lacks the ability to do that for self. Examples of individual advocacy include helping patients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the human condition. Since funding is necessary to deliver quality programming for persons with mental illness, the letter- writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs

Which comment best indicates that a patient perceived the nurse was caring? My nurse: a. always asks me which type of juice I want to help me swallow my medication. b. explained my treatment plan to me and asked for my ideas about how to make it better. c. spends time listening to me talk about my problems. That helps me feel like I am not alone. d. told me that if I take all the medicines the doctor prescribes, then I will get discharged sooner.

ANS: C Caring evidences empathetic understanding as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The distracters give examples of statements that demonstrate advocacy or giving advice.

Which disorder is a culture-bound syndrome? a. Epilepsy c. Running amok b. Schizophrenia d. Major depression

ANS: C Culture-bound syndromes occur in specific sociocultural contexts and are easily recognized by people in those cultures. A syndrome recognized in parts of Southeast Asia is running amok, in which a person (usually a male) runs around engaging in furious, almost indiscriminate violent behavior.

A category 5 tornado occurred in a community of 400 people resulting in destruction of many homes and businesses. In the 2 years after this disaster, 140 individuals were diagnosed with posttraumatic stress disorder (PTSD). Which term best applies to these newly diagnosed cases? a. Prevalence b. Co-morbidity c. Incidence d. Parity

ANS: C Incidence refers to the number of new cases of mental disorders in a healthy population within a given period of time. Prevalence describes the total number of cases, new and existing, in a given population during a specific period of time, regardless of when they became ill. Parity refers to equivalence, and legislation required insurers that provide mental health coverage to offer annual and lifetime benefits at the same level provided for medical/surgical coverage. Co-morbidity refers to having more than one mental disorder at a time.

The spouse of a patient diagnosed with schizophrenia says, I dont understand how events from childhood have anything to do with this disabling illness. Which response by the nurse will best help the spouse understand the cause of this disorder? a. Psychological stress is the basis of most mental disorders. b. This illness results from developmental factors rather than stress. c. Research shows that this condition more likely has a biological basis. d. It must be frustrating for you that your spouse is sick so much of the time.

ANS: C Many of the most prevalent and disabling mental disorders have strong biological influences. Genetics are only one part of biological factors. Empathy does not address increasing the spouses level of knowledge about the cause of the disorder. The other distracters are not established facts.

18. A nurse is caring for four clients diagnosed with major depressive disorder. When considering each clients belief system, the nurse should conclude which client would potentially be at highest risk for suicide? A. Roman Catholic B. Protestant C. Atheist D. Muslim

ANS: C Depressed men and women who consider themselves affiliated with a religion are less likely to attempt suicide than their nonreligious counterparts.

A tearful, anxious patient at the outpatient clinic reports, "I should be dead." The initial task of the nurse conducting the assessment interview is to: a. assess lethality of suicide plan. b. encourage expression of anger. c. establish rapport with the patient. d. determine risk factors for suicide.

ANS: C Establishing rapport will allow the nurse to obtain relevant assessment data such as the presence of a suicide plan, the lethality of a suicide plan, and the presence of risk factors for suicide.

14. A new nursing graduate asks the psychiatric nurse manager how to best classify suicide. Which is the nurse managers best reply? A. Suicide is a DSM-5 diagnosis. B. Suicide is a mental disorder. C. Suicide is a behavior. D. Suicide is an antisocial affliction.

ANS: C Suicide is not a diagnosis, disorder, or affliction. It is a behavior.

21. Which client statement indicates that termination of the therapeutic nurseclient relationship has been handled successfully? A. I know I can count on you for continued support. B. I am looking forward to discharge, but I am surprised that we will no longer work together. C. Reviewing the changes that have happened during our time together has helped me put things in perspective. D. I dont know how comfortable I will feel when talking to someone else.

ANS: C Termination should begin in the orientation phase to minimize feelings of loss when the nurseclient relationship ends. Bringing a therapeutic conclusion to the relationship occurs when progress has been made toward attainment of mutually set goals. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

9. An instructor is correcting a nursing students clinical worksheet. Which instructor statement is the best example of effective feedback? A. Why did you use the clients name on your clinical worksheet? B. You were very careless to refer to your client by name on your clinical worksheet. C. I noticed that you used the clients name in your written process recording. That is a breach of confidentiality. D. It is disappointing that after being told, youre still using client names on your worksheet.

ANS: C The instructors statement, I noticed that you used the clients name in your written process recording, is an example of effective feedback. Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice or criticism. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

13. A client diagnosed with dependent personality disorder states, Do you think I should move from my parents house and get a job? Which nursing response is most appropriate? A. It would be best to do that in order to increase independence. B. Why would you want to leave a secure home? C. Lets discuss and explore all of your options. D. Im afraid you would feel very guilty leaving your parents.

ANS: C The most appropriate response by the nurse is, Lets discuss and explore all of your options. In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

3. Which therapeutic communication technique is being used in this nurseclient interaction? Client: When I am anxious, the only thing that calms me down is alcohol. Nurse: Other than drinking, what alternatives have you explored to decrease anxiety? A. Reflecting B. Making observations C. Formulating a plan of action D. Giving recognition

ANS: C The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the clients poor coping choice, may serve to prevent anger or anxiety from escalating. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

4. A client with a history of three suicide attempts has been taking fluoxetine (Prozac) for 1 month. The client suddenly presents with a bright affect, rates mood at 9/10, and is much more communicative. Which action should be the nurses priority at this time? A. Give the client off-unit privileges as positive reinforcement. B. Encourage the client to share mood improvement in group. C. Increase frequency of client observation. D. Request that the psychiatrist reevaluate the current medication protocol.

ANS: C The nurse should be aware that a sudden increase in mood rating and change in affect could indicate that the client is at risk for suicide and client observation should be more frequent. Suicide risk may occur early during treatment with antidepressants. The return of energy may bring about an increased ability to act out self- destructive behaviors prior to attaining the full therapeutic effect of the antidepressant medication.

Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse client relationship? A. I can't bear the thought of leaving here and failing. B. I might have a hard time working with you. You remind me of my mother. C. I cant tell my husband how I feel; he wouldn't listen anyway. D. Im not sure that I can count on you to protect my confidentiality.

ANS: C The nurse should identify that the client statement I cant tell my husband how I feel; he wouldn't listen anyway reflects resistance to change, which is a common behavior in the working phase of the nurse client relationship. The working phase includes overcoming resistant behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues.

8. Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurseclient relationship? A. I cant bear the thought of leaving here and failing. B. I might have a hard time working with you. You remind me of my mother. C. I cant tell my husband how I feel; he wouldnt listen anyway. D. Im not sure that I can count on you to protect my confidentiality.

ANS: C The nurse should identify that the client statement I cant tell my husband how I feel; he wouldnt listen anyway reflects resistance to change, which is a common behavior in the working phase of the nurseclient relationship. The working phase includes overcoming resistant behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

20. A client is newly committed to an inpatient psychiatric unit. Which nursing intervention best lowers this clients risk for suicide? A. Encouraging participation in the milieu to promote hope B. Developing a strong personal relationship with the client C. Observing the client at intervals determined by assessed data D. Encouraging and redirecting the client to concentrate on happier times

ANS: C The nurse should observe the actively suicidal client continuously for the first hour after admission. After a full assessment the treatment team will determine the observation status of the client. Observation of the client allows the nurse to interrupt any observed suicidal behaviors.

6. What should be the nurses primary goal during the preinteraction phase of the nurseclient relationship? A. To evaluate goal attainment and ensure therapeutic closure B. To establish trust and formulate a contract for intervention C. To explore self-perceptions D. To promote client change

ANS: C The nurses primary goal of the preinteraction phase should be to explore self-perceptions. The nurse should be aware of how any preconceptions may affect his or her ability to care for individual clients. Another goal of the preinteraction phase is to obtain available client information. KEY: Cognitive Level: Comprehension | Integrated Processes: Nursing Process: Planning | Client Need: Psychosocial Integrity

What should be the nurses primary goal during the pre interaction phase of the nurse client relationship? A. To evaluate goal attainment and ensure therapeutic closure B. To establish trust and formulate a contract for intervention C. To explore self-perceptions D. To promote client change

3. A client diagnosed with major depressive disorder with psychotic features hears voices commanding self- harm. The client refuses to commit to developing a plan for safety. What should be the nurses priority intervention at this time? A. Obtaining an order for locked seclusion until client is no longer suicidal B. Conducting 15-minute checks to ensure safety C. Placing the client on one-to-one observation while monitoring suicidal ideations D. Encouraging client to express feelings related to suicide

ANS: C The nurses priority intervention when a client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideation.

4. The nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a general lead? A. Do you know why you are here? B. Are you feeling depressed or anxious? C. Yes, I see. Go on. D. Can you chronologically order the events that led to your admission?

ANS: C The nurses statement, Yes, I see. Go on, is an example of the therapeutic communication technique of a general lead. Offering a general lead encourages the client to continue sharing information. KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation | Client Need: Psychosocial Integrity

1. A nurse discovers a clients suicide note that details the time, place, and means to commit suicide. What should be the priority nursing intervention and the rationale for this action? A. Administering lorazepam (Ativan) prn, because the client is angry about the discovery of the note B. Establishing room restrictions, because the clients threat is an attempt to manipulate the staff C. Placing this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide D. Calling an emergency treatment team meeting, because the clients threat must be addressed

ANS: C The priority nursing action should be to place this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide. The appropriate nursing diagnosis for this client would be risk for suicide.

19. A clients younger daughter is ignoring curfew. The client states, Im afraid she will get pregnant. The nurse responds, Hang in there. Dont you think she has a lot to learn about life? This is an example of which communication block? A. Requesting an explanation B. Belittling the client C. Making stereotyped comments D. Probing

ANS: C This is an example of the nontherapeutic communication block of making stereotyped comments. Clichs and trite expressions are meaningless in a therapeutic nurseclient relationship. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

22. The nurse says to a newly admitted client, Tell me more about what led up to your hospitalization. What is the purpose of this therapeutic communication technique? A. To reframe the clients thoughts about mental health treatment B. To put the client at ease C. To explore a subject, idea, experience, or relationship D. To communicate that the nurse is listening to the conversation

ANS: C This is an example of the therapeutic communication technique of exploring. The purpose of exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

The nurse says to a newly admitted client, Tell me more about what led up to your hospitalization. What is the purpose of this therapeutic communication technique? A. To reframe the clients thoughts about mental health treatment B. To put the client at ease C. To explore a subject, idea, experience, or relationship D. To communicate that the nurse is listening to the conversation

20. Which nursing statement is a good example of the therapeutic communication technique of giving recognition? A. You did not attend group today. Can we talk about that? B. Ill sit with you until it is time for your family session. C. I notice you are wearing a new dress and you have washed your hair. D. Im happy that you are now taking your medications. They will really help.

ANS: C This is an example of the therapeutic communication technique of giving recognition. Giving recognition acknowledges and indicates awareness. This technique is more appropriate than complimenting the client, which reflects the nurses judgment. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which nursing statement is a good example of the therapeutic communication technique of giving recognition? A. You did not attend group today. Can we talk about that? B. Ill sit with you until it is time for your family session. C. I notice you are wearing a new dress and you have washed your hair. D. I'm happy that you are now taking your medications. They will really help.

28. A client on an inpatient psychiatric unit tells the nurse, I should have died, because I am totally worthless. In order to encourage the client to continue talking about feelings, which should be the nursing initial response? A. How would your family feel if you died? B. You feel worthless now, but that can change with time. C. Youve been feeling sad and alone for some time now? D. It is great that you have come in for help.

ANS: C This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client on an inpatient psychiatric unit tells the nurse, I should have died, because I am totally worthless. In order to encourage the client to continue talking about feelings, which should be the nursing initial response? A. How would your family feel if you died? B. You feel worthless now, but that can change with time. C. Youve been feeling sad and alone for some time now? D. It is great that you have come in for help.

A nurse assesses a patient who reports a 3-week history of depression and crying spells. The patient says, my business is bankrupt, and I was served with divorce papers. Which subsequent statement by the patient alerts the nurse to a concealed suicidal message? A. I wish I were dead B. Life is not worth living C. I have a plan that will fix everything D. My family will be better off without me

ANS: C Verbal clues to suicide may be overt or covert. The incorrect options are overt references to suicide. The correct option is more veiled. It alludes to the patient's suicide as being a way to "fix everything" but does not say it outright.

14. When interviewing a client, which nonverbal behavior should a nurse employ? A. Maintaining indirect eye contact with the client B. Providing space by leaning back away from the client C. Sitting squarely, facing the client D. Maintaining open posture with arms and legs crossed

ANS: C When interviewing a client, the nurse should employ the nonverbal behavior of sitting squarely, facing the client. Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R). KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

When interviewing a client, which nonverbal behavior should a nurse employ? A. Maintaining indirect eye contact with the client B. Providing space by leaning back away from the client C. Sitting squarely, facing the client D. Maintaining open posture with arms and legs crossed

Which belief will best support a nurses efforts to provide patient advocacy during a multidisciplinary patient care planning session? a. All mental illnesses are culturally determined. b. Schizophrenia and bipolar disorder are cross-cultural disorders. c. Symptoms of mental disorders are unchanged from culture to culture. d. Assessment findings in mental disorders reflect a persons cultural patterns.

ANS: D A nurse who understands that a patients symptoms are influenced by culture will be able to advocate for the patient to a greater degree than a nurse who believes that culture is of little relevance. The distracters are untrue statements.

A nurse is part of a multidisciplinary team working with groups of depressed patients. Half the patients receive supportive interventions and antidepressant medication. The other half receives only medication. The team measures outcomes for each group. Which type of study is evident? a. Incidence b. Prevalence c. Co-morbidity d. Clinical epidemiology

ANS: D Clinical epidemiology is a broad field that addresses studies of the natural history (or what happens if there is no treatment and the problem is left to run its course) of an illness, studies of diagnostic screening tests, and observational and experimental studies of interventions used to treat people with the illness or symptoms. Prevalence refers to numbers of new cases. Co-morbidity refers to having more than one mental disorder at a time.Incidence refers to the number of new cases of mental disorders in a healthy population within a given period. See related audience response question.

Select the best response for the nurse who receives a question from another health professional seeking to understand the difference between a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis and a nursing diagnosis. a. There is no functional difference between the two. Both identify human disorders. b. The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis takes culture into account. c. The DSM-5 diagnosis describes causes of disorders whereas a nursing diagnosis does not explore etiology. d. The DSM-5 diagnosis guides medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for issues a patient is experiencing.

ANS: D The medical diagnosis is concerned with the patients disease state, causes, and cures, whereas the nursing diagnosis focuses on the patients response to stress and possible caring interventions. Both tools consider culture. The DSM-5 is multiaxial. Nursing diagnoses also consider potential problems.

15. According to Peplau, which nursing action demonstrates the nurses role as a resource person? A. The nurse balances a safe therapeutic environment to increase the clients sense of belonging. B. The nurse holds a group meeting with the clients on the unit to discuss common feelings about mental illness. C. The nurse monitors the administration of medications and watches for signs of cheeking. D. The nurse explains, in language the client can understand, information related to the clients health care.

ANS: D According to Peplau, a resource person provides specific answers to questions usually formulated with relation to a larger problem. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

8. The family of a suicidal client is very supportive and requests more facts related to caring for their family member after discharge. Which information should the nurse provide? A. Address only serious suicide threats to avoid the possibility of secondary gain. B. Promote trust by verbalizing a promise to keep suicide attempt information within the family. C. Offer a private environment to provide needed time alone at least once a day. D. Be available to actively listen, support, and accept feelings.

ANS: D Being available to actively listen, support, and accept feelings increases the potential that a client would confide suicidal ideations to family members.

7. The treatment team is making a discharge decision regarding a previously suicidal client. Which client assessment information should a nurse recognize as contributing to the teams decision? A. No previous admissions for major depressive disorder B. Vital signs stable; no psychosis noted C. Able to comply with medication regimen; able to problem-solve life issues D. Able to participate in a plan for safety; family agrees to constant observation

ANS: D Participation in a plan of safety and constant family observation will decrease the risk for self-harm. All other answer choices are not directly focused on suicide prevention and safety.

6. During a one-to-one session with a client, the client states, Nothing will ever get better, and Nobody can help me. Which nursing diagnosis is most appropriate for a nurse to assign to this client at this time? A. Powerlessness R/T altered mood AEB client statements B. Risk for injury R/T altered mood AEB client statements C. Risk for suicide R/T altered mood AEB client statements D. Hopelessness R/T altered mood AEB client statements

ANS: D The clients statements indicate the problem of hopelessness. Prior to assigning either risk for injury or risk for suicide, a further evaluation of the clients suicidal ideations and intent would be necessary.

16. A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? A. Everyone diagnosed with OCD needs to control their ritualistic behaviors. B. It is important for you to discontinue these ritualistic behaviors. C. Why are you asking for help if you wont participate in unit therapy? D. Lets figure out a way for you to attend unit activities and still wash your hands.

ANS: D The most appropriate statement by the nurse is, Lets figure out a way for you to attend unit activities and still wash your hands. This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing the clients anxiety. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Chapter 08. Therapeutic Communication Multiple Choice 1. Which therapeutic communication technique is being used in this nurseclient interaction? Client: When I get angry, I get into a fistfight with my wife or I take it out on the kids. Nurse: I notice that you are smiling as you talk about this physical violence. A. Encouraging comparison B. Exploring C. Formulating a plan of action D. Making observations

ANS: D The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

12. On which task should a nurse place priority during the working phase of relationship development? A. Establishing a contract for intervention B. Examining feelings about working with a particular client C. Establishing a plan for continuing aftercare D. Promoting the clients insight and perception of reality

ANS: D The nurse should place priority on promoting the clients insight and perception of reality during the working phase of relationship development. Establishing a contract for intervention would occur in the orientation phase. Examining feelings about working with a client should occur in the preinteraction phase. Establishing a plan for aftercare would occur in the termination phase. KEY: Cognitive Level: Analysis | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

3. Which is the best nursing action when a client demonstrates transference toward a nurse? A. Promoting safety and immediately terminating the relationship with the client B. Encouraging the client to ignore these thoughts and feelings C. Immediately reassigning the client to another staff member D. Helping the client to clarify the meaning of the current nurseclient relationship

ANS: D The nurse should respond to a clients transference by clarifying the meaning of the nurseclient relationship, based on the current situation. Transference occurs when the client unconsciously displaces feelings toward the nurse about a person from the past. The nurse should assist the client in separating the past from the present. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

2. During the planning of care for a suicidal client, which correctly written outcome should be a nurses first priority? A. The client will not physically harm self. B. The client will express hope for the future by day 3. C. The client will establish a trusting relationship with the nurse. D. The client will remain safe during the hospital stay.

ANS: D The nurses priority should be that the client will remain safe during the hospital stay. Client safety should always be the nurses priority. The A answer choice is incorrectly written. Correctly written outcomes must be client focused, measurable, and realistic and contain a time frame. Without a time frame, an outcome cannot be correctly evaluated.

10. A mother who has learned that her child was killed in a tragic car accident states, I cant bear to go on with my life. Which nursing statement conveys empathy? A. This situation is very sad, but time is a great healer. B. You are sad, but you must be strong for your other children. C. Once you cry it all out, things will seem so much better. D. It must be horrible to lose a child; Ill stay with you until your husband arrives.

ANS: D The nurses response, It must be horrible to lose a child; Ill stay with you until your husband arrives, conveys empathy to the client. Empathy is the ability to see the situation from the clients point of view. Empathy is considered to be one of the most important characteristics of the therapeutic relationship. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

5. A nurse states to a client, Things will look better tomorrow after a good nights sleep. This is an example of which communication technique? A. The therapeutic technique of giving advice B. The therapeutic technique of defending C. The nontherapeutic technique of presenting reality D. The nontherapeutic technique of giving false reassurance

ANS: D The nurses statement, Things will look better tomorrow after a good nights sleep, is an example of the nontherapeutic technique of giving false reassurance. Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the clients feelings. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

11. What is the purpose of a nurse providing appropriate feedback? A. To give the client good advice B. To advise the client on appropriate behaviors C. To evaluate the clients behavior D. To give the client critical information

ANS: D The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

30. A client states, You wont believe what my husband said to me during visiting hours. He has no right treating me that way. Which nursing response would best assess the situation that occurred? A. Does your husband treat you like this very often? B. What do you think is your role in this relationship? C. Why do you think he behaved like that? D. Describe what happened during your time with your husband.

ANS: D This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client states, You wont believe what my husband said to me during visiting hours. He has no right treating me that way. Which nursing response would best assess the situation that occurred? A. Does your husband treat you like this very often? B. What do you think is your role in this relationship? C. Why do you think he behaved like that? D. Describe what happened during your time with your husband.

25. Which nursing statement is a good example of the therapeutic communication technique of focusing? A. Describe one of the best things that happened to you this week. B. Im having a difficult time understanding what you mean. C. Your counseling session is in 30 minutes. Ill stay with you until then. D. You mentioned your relationship with your father. Lets discuss that further.

ANS: D This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

Which nursing statement is a good example of the therapeutic communication technique of focusing? A. Describe one of the best things that happened to you this week. B. Im having a difficult time understanding what you mean. C. Your counseling session is in 30 minutes. Ill stay with you until then. D. You mentioned your relationship with your father. Lets discuss that further.

18. A client tells the nurse, I feel bad because my mother does not want me to return home after I leave the hospital. Which nursing response is therapeutic? A. Its quite common for clients to feel that way after a lengthy hospitalization. B. Why dont you talk to your mother? You may find out she doesnt feel that way. C. Your mother seems like an understanding person. Ill help you approach her. D. You feel that your mother does not want you to come back home?

ANS: D This is an example of the therapeutic communication technique of restatement. Restatement is the repeating of the main idea that the client has verbalized. This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue, or clarify if necessary. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client tells the nurse, I feel bad because my mother does not want me to return home after I leave the hospital. Which nursing response is therapeutic? A. It's quite common for clients to feel that way after a lengthy hospitalization. B. Why don't you talk to your mother? You may find out she doesn't feel that way. C. Your mother seems like an understanding person. I'll help you approach her. D. You feel that your mother does not want you to come back home?

Select the most helpful response for a nurse to make when a patient being treated as an outpatient states, I am considering suicide. a. Im glad you shared this. Please do not worry. We will handle it together. b. I think you should admit yourself to the hospital to get help. c. We need to talk about the good things you have to live for. d. Bringing this up is a very positive action on your part.

ANS: D This response gives the patient reinforcement and validation for making a positive response rather than acting out the suicidal impulse. It gives neither advice nor false reassurance, and it does not imply stereotypes such as, "You have a lot to live for." It uses the patient's ambivalence and sets the stage for more realistic problem-solving strategies.

13. A suicidal client says to a nurse, There's nothing to live for anymore. Which is the most appropriate nursing reply? A. Why dont you consider doing volunteer work in a homeless shelter? B. Lets discuss the negative aspects of your life. C. Things will look better in the morning. D. It sounds like you are feeling pretty hopeless.

ANS: D This statement verbalizes the clients implied feelings and allows him or her to validate and explore them.

22. The term ________________________ implies special feelings on the part of both the client and the nurse, based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude.

ANS: rapport Rationale: Rapport implies special feelings on the part of both the client and the nurse, based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude. Establishing rapport may be accomplished by discussing non-health-related topics.

A client with a history of suicide attempt has been discharged & is being followed in an outpatient clinic. At this time, which is the most appropriate nursing intervention for this client? A. Provide the client with a safe & structure environment B. Isolate the client from all stressful situations that may precipitate a suicide attempt C. Observe the client continuously to prevent self-harm D. Assist the client to develop more effective coping mechanisms

ANSWER D

Which is a misconception about suicide? A. 8 out of 10 individuals who commit suicide give warnings about their intentions B. Most suicidal individuals are very ambivalent about their feelings about suicide C. Most individuals commit suicide by taking an overdose of drugs D. Initial mood improvement can precipitate suicide

ANSWER: C Gunshot wounds are the leading cause of death among suicide victims

The feeling experienced by a patient that should be assessed by the nurse as most predict of elevated suicide risk is: A. Hopelessness B. Sadness C. Elation D. Anger

Ans: A Of the feelings listed, hopelessness is most closely associated with increased suicide risk. Depression, aggression, impulsivity and shame are other feelings noted as risk factors for suicide.

A nurse and patient construct a no-suicide contract. Select the preferable wording for the contract. A. I will not try to harm myself during the next 24 hours B. I will not make a suicide attempt while I am hospitalized C. For the next 24 hours I will not kill or harm myself in anyway. D. I will not Jill myself until I call my primary nurse or a member of the staff.

Ans: C The correct answer leaves no loopholes. The wording about not harming oneself and not making an attempt leaves loopholes or can be ignored by the patient who thinks, I am not going to harm myself, I am going to kill myself, or I am not going to attempt suicide I am going to commit suicide. A patient may call a therapist and leave the telephone to carry out the suicidal plan.

Which individual in the emergency department should be considered at the highest risk for complying suicide? A. An adolescent Asian-American girl with superior athletic and academic skills who has asthma B. A 38-year old single African American female church member with fibrocystic breast disease C. A 60 year old married Hispanic man with 12 grandchildren who has type 2 diabetes D. A 79 year old single white man with cancer of the prostate gland

Ans: D High risk factors include being an older adult, single and male and having a co-occurring medical illness. Cancer is one of the somatic conditions associated with increased suicidal risk. Protective factors for African American women and Hispanic individuals include strong religious and family ties. Asian Americans have a suicide rate that increases with age.

A nurse answers a suicide crisis line. A caller says I live alone in a home several miles from my nearest neighbors. I have been considering suicide for 2 months. I have had several drinks and now my gum is loaded. I'm going to shoot myself in the heart. How would the nurse assess the lethality of this plan? A. No risk B. Low level C. Moderate level D. High level

Ans: D The patient has a highly detailed plan a highly lethal method the means to carry it out, lowered impulse control because of alcohol ingestion and low potential for rescue.

A nurse counsels a patient with recent suicidal ideation. Which is the nurses most therapeutic comment? A. Let's make a list of all your problems and think of solutions for each one. B. I'm happy you're taking control of your problems and trying to find solutions C. When you have bad feelings try to focus on positive experiences from your life D. Let's consider which problems are most important and which are less important.

Ans:D The nurse helps the patient develop effective coping skills. He or she assists the patient to reduce the overwhelming approaches to problem solving.

Which changes is brain biochemical function is most associated with suicidal behavior? A. Dopamine excess B. Serotonin deficiency C. Acetylcholine excess D. Gamma-aminobutyric acid deficiency

Answer B: research shows that low levels of serotonin may play a role in the decision to attempt suicide. The other neurotransmitter alterations have not been implicated in suicidal crises.

A college student failed 2 tests. Afterward, the student cried for hours a s then tried to telephone a parent but got no answer. The student then gave several expensive sweaters to a roommate. Which behavior provides the strongest clue of an impending suicide attempt? A. Calling parents B. Excessive crying C. Giving away sweaters D. Staying alone in dorm room

Answer C: giving away prized possessions may signal that the individual thinks he or she will have no further need for the items, such as when a suicide plan has been formulated. Calling parents and crying do not provide clues to suicide, in and of themselves. Remaining in the dormitory would be an expected behavior because the student has nowhere else to go.

A nurse uses the SAD PERSONS scale to interview a patient. This tool provides data relevant to: a. current stress level. b. mood disturbance. c. suicide potential. d. level of anxiety.

Answer C: the SAD PERSONS tool evaluates 10 major risk factors in suicide potential: sex, age, depression, previous attempt, ethanol use, rational thinking loss, social supports lacking, organized plan, no spouse, and sickness. The tool does not have appropriate categories to provide information on the other options listed.

A person intentionally overdoses on antidepressant drugs. Which nursing diagnosis has the highest priority? A. Powerlessness B. Social isolation C. Risk for suicide D. Ineffective management of the therapeutic regimen

Answer C: this diagnosis is the only one with life-or-death ramifications and is therefore higher in priority than the other options.

The nurse is caring for an actively suicidal client on the psychiatric unit. What is the nurse's priority intervention? A. Discuss strategies for the management of anxiety, anger & frustration B. Provide opportunities for increasing the client's self-worth, morale and control C. Place client on suicide precautions with one-to-one observation D. Explore experiences that affirm self-worth and self-efficacy

Answer: C

20. Which of the following characteristics should be included in a therapeutic nurse-client relationship? (Select all that apply.) 1. Meeting the psychological needs of the nurse and the client 2. Ensuring therapeutic termination 3. Promoting client insight into problematic behavior 4. Collaborating to set appropriate goals 5. Meeting both the physical and psychological needs of the client

Ensuring therapeutic termination Promoting client insight into problematic behavior Collaborating to set appropriate goals Meeting both the physical and psychological needs of the client Rationale: The nurse-client therapeutic relationship should include promoting client insight into problematic behavior, collaboration to set appropriate goals, meeting the physical and psychological needs of the client, and ensuring therapeutic termination. Meeting the nurse's psychological needs should never be addressed within the nurse-client relationship.

3. What should be the priority nursing action during the orientation (introductory) phase of the nurse-client relationship? 1. Acknowledge the client's actions and generate alternative behaviors. 2. Establish rapport and develop treatment goals. 3. Attempt to find alternative placement. 4. Explore how thoughts and feelings about this client may adversely impact nursing care.

Establish rapport and develop treatment goals. Rationale: The priority nursing action during the orientation phase of the nurse-client relationship should be to establish rapport and develop treatment goals. Rapport implies feelings on the part of both the nurse and the client, based on respect, acceptance, a sense of trust, and a nonjudgmental attitude. It is the essential foundation of the nurse-client relationship.

8. On which task should a nurse place priority during the working phase of relationship development? 1. Establishing a contract for intervention 2. Examining feelings about working with a particular client 3. Establishing a plan for continuing aftercare 4. Promoting the client's insight and perception of reality

Promoting the client's insight and perception of reality Rationale: The nurse should place priority on promoting the client's insight and perception of reality during the working phase of relationship development. Establishing a contract for intervention would occur in the orientation phase. Examining feelings about working with a client should occur in the pre-interaction phase. Establishing a plan for aftercare would occur in the termination phase.

12. A nurse says to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique? 1. The therapeutic technique of giving advice 2. The therapeutic technique of defending 3. The nontherapeutic technique of presenting reality 4. The nontherapeutic technique of giving reassurance

The nontherapeutic technique of giving reassurance Rationale: The nurse's statement, "Things will look better tomorrow after a good night's sleep," is an example of the nontherapeutic communication technique of giving reassurance. Giving reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client's feelings.

According to the dsm-v, which statement made by an adult client supports the criteria for generalized anxiety disorder? (SATA) a. i've been really anxious for at least 2 years now b. my anxiety had to be genetic; my mom was a terrible worrier too c. my marriage is in trouble b/c i'm always so irritable d. i've had a good physical and my hcp says i'm in good health e. it's hard falling asleep and even harder staying asleep - i'm restless all night

a - i've been really anxious for at least 2 years now c - my marriage is in trouble b/c i'm always so irritable d - i've had a good physical and my hcp says i'm in good health e - it's hard falling asleep and even harder staying asleep; i'm restless at night

which statement best describes the diagnostic and statistical manual fifth edition (DSM-5)? a. it is a medical psychiatric assessment system b. it is a compendium of treatment modalities c. it offers a complete list of nursing diagnoses d. it suggests common interventions for mental disorders

a - it is amedical psychiatric assessment system

The nurse in the emergency department encounters a patient, Niko, who is expressing suicide ideation. The nurse recognizes that which of the following considerations are important to good suicide risk assessment? (Select all.) a. Collaborating with the patient b. Asking specific questions about leisure activities c. Establishing trust and open communication with the patient d. Asking the patient specific questions about the strength of intention to die e. Identifying whether the patient has thought about a plan for trying to kill himself

a, c, d, and e

A depressed patient says, "Nothing matters anymore." What is the most appropriate response by the nurse? a. "Are you having thoughts of suicide?" b. "I am not sure I understand what you are trying to say." c. "Try to stay hopeful. Things have a way of working out." d. "Tell me more about what interested you before you became depressed."

a. "Are you having thoughts of suicide?" The nurse must make overt what is covert; that is, the possibility of suicide must be openly addressed. The patient often feels relieved to be able to talk about suicidal ideation.

a 29-year old patient has been admitted following a suicide attempt. which nursing statement illustrates the concept of patient advocacy? a. "dr. raye, i noticed you ordered fluoxetine for this pt. during the admission interview, the client stated they will refuse the medication b/c of adverse effects they experienced previously." b. "dr. raye, during the admissions interview, the pt stated that there is a family hx of 3 other suicide attempts in the past." c. "i'd like you to tell me more about your depression and your suicide attempt." d. "i will take you on a tour of the unit and orient you to the rules so you can get adjusted to here."

a. "dr. raye, i noticed you ordered fluoxetine for this pt. during the admission interview, the client stated they will refuse the medication b/c of adverse effects they experienced previously."

Which of the following individuals demonstrates the highest number of risk factors for suicide? a. John, who reports that he is in deep emotional plan, feels hopeless, and says "No one is there for me" b. Kelly, who has been seeing a doctor for chronic, intractable pain, verbalizes a deep commitment to her religious faith and is taking pain medications c. Jim, an American Indian, who graduated from high school with honors but does not yet have a job d. Mike, a physician, who reports feeling "burnt out" and is considering retirement

a. John, who reports that he is in deep emotional plan, feels hopeless, and says "No one is there for me"

how can a nurse best differentiate whether an asian client is demonstrating a mental illness after having attempted suicide? a. ask the client whether he views himself as being depressed b. identify the client's culture's views regarding suicide c. explain that suicide is often regarded as a desperate act d. assess the client for other examples of depressive behaviors

b - identify the client's culture's view regarding suicide

a client tells the mental health nurse, "i am terribly frightened! i hear whispering in my head that someone is going to kill me." which criteria of mental health can the nurse assess as lacking?" a. self-control b. rational thinking c. learning and productivity d. positive self-concept

b - rational thinking

which severe mental illness is recognized across cultures? (SATA) a. antisocial disorder b. schizophrenia c. anorexia nervosa d. social phobia e. bipolar disorder f. borderline personality disorder

b - schizophrenia e - bipolar disorder

Theresa, who has been hospitalized following a suicide attempt, is placed on suicide precautions on the psychiatric unit. She admits that she is still feeling suicidal. Which of the following interventions is the most appropriate in this instance? a. Obtain an order from the physician to place Theresa in restraints to prevent any attempts to harm herself b. Check on Theresa every 15 minutes or assign a staff person to stay with her on a one-to-one basis c. Obtain an order from the physician to give Theresa a sedative to calm her and reduce suicide ideas d. Do not allow Theresa to participate in any unit activities while she is on suicide precautions e. Ask Theresa specific questions about her thoughts, plans, and intentions related to suicide

b and e

a nurse, active in local consumer mental health groups and in local and state mental health associations, keeps aware of state and national legislation affecting mental illness tx. how can this nurse positively affect the climate for effective mental health tx? a. "by becoming active in politics leading to a potential political career." b. "by educating the public on the effects that stigmatizing has on mental health clients." c. "advocating for laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons." d "advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions."

b. "by educating the public on the effects that stigmatizing has on mental health clients."

In determining degree of suicide risk with a suicidal patient, the nurse assess the following behavioral manifestations: severely depressed, withdrawn, statements of worthlessness, difficulty accomplishing activities of daily living, no close support systems. The nurse identifies the patient's risk for suicide as which of the following? a. Low risk b. High risk c. Imminent risk d. Unable to determine

b. High risk

A nurse's identification badge includes the term, "Psychiatric Mental Health Nurse." A client with a history of paranoia asks, "What does that title mean?" Keeping in mind the diagnosis of the patient, how should the nurse respond to this question? a. "don't be afraid, it means i am here to help, not hurt you." b. "psychiatric mental health nurses care for people w/ mental illnesses" c. "we have the specialized skills needed to care for those w/ mental illnesses" d. "the nurses who work in mental health facilities have that title"

c "we have the specialized skills needed to care for those w/ mental illnesses"

what client assessment data demonstrates parity related to mental health care? a. the client is admitted for a 72 hour mental hygiene evaluation b. advance practice nurse can be certified as psych nurse specialist c. a client's mental health coverage is equal to his/her med-surg coverage d. a client who has attempted suicide is hospitalized for a mental health evaluation

c - a client's mental health coverage is equal to his/her med-surg coverage

which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated w/ ECT (electroconvulsive therapy)? a. experimental b. descriptive c. clinical d. analytic

c - clinical epidemiology represents a borad field that addresses what happens to people w/ illnesses who are seen by providers of clinical care.

a nursing dx for a client w/ a psychiatric disorder serves what purpose with considering the plan of care? a. justifying the use of certain psychtropic medication b. providing data essential for insurance reimbursement c. establishing a framework for selecting appropriate interventions d. completing the medical diagnostic statement

c - establishing a framework for selecting appropriate interventions

the mental health status of a particular client can be best assessed by considering which factor? a. the degree of conformity of the individual to society's norms b. the degree to which an individual is logical and rational c. status placement on a continuum from health to illness d. rate of demonstrated intellectual and emotional growth

c - status placement on a continuum from health to illness

a new nurse has accepted a position as staff nurse on a psych unit. which statement made by the new nurse requires additional instructions regarding the therapies provided on the unit? a. you will participate in unit activities and groups daily b. you will be given a schedule daily of the groups we would like you to attend c. you will attend a psychotherapy group that i lead that will help you care for yourself d. you will see your provider daily in a one-to-one session

c - you will attend a psychotherapy group that i lead that will help you care for yourself (Basic level RNs cannot perform psychotherapy. The other options are all appropriate expectations of a patient's schedule on a psychiatric unit.)

Theresa, age 27, was admitted to the psychiatric unit from the medical intensive care unit where she was treated for taking a deliberate overdose of her antidepressant medication, trazodone (Desyrel). She says to the nurse, "My boyfriend broke up with me. We had been together for 6 years. I love him so much. I know I'll never get over him." Which is the best response by the nurse? a. "You'll get over him in time, Theresa" b. "Forget him. There are other fish in the sea" c. "You must be feeling very sad about your loss" d. "Why do you think he broke up with you, Theresa?"

c. "You must be feeling very sad about your loss"

What is a misconception about suicide? a. Eight out of ten individuals who commit suicide give warnings about their intentions b. Most suicidal individuals are ambivalent about their feelings regarding suicide c. Most individuals commit suicide by taking an overdose of drugs d. Initial mood improvement can precipitate suicide

c. Most individuals commit suicide by taking an overdose of drugs

The nurse is caring for an actively suicidal client on the psychiatric unit. What is the nurse's priority interventions? a. Discuss strategies for the management of anxiety, anger, and frustration b. Provide opportunities for increasing the client's self-worth, morale, and control c. Place client on suicide precautions with one-to-one observation d. Explore experiences that affirm self-worth and self-efficacy

c. Place client on suicide precautions with one-to-one observation

Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Theresa says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll choose a no-fail method." Which is the best response by the nurse? a. You are safe here. We will make sure nothing happens to you b. You're just lucky your roommate came home when she did c. What exactly do you plan to do? d. I don't understand. You have so much to live for

c. What exactly do you plan to do?

5. Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse-client relationship? 1. "I can't bear the thought of leaving here and failing." 2. "I might have a hard time working with you, because you remind me of my mother." 3. "I really don't want to talk any more about my childhood abuse." 4. "I'm not sure that I can count on you to protect my confidentiality."

"I really don't want to talk any more about my childhood abuse." Rationale: The nurse should identify that the client statement, "I really don't want to talk any more about my childhood abuse," reflects that the client is in the working phase of the nurse-client relationship. The working phase includes overcoming resistance behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues.

17. A client exhibiting dependent behaviors says, "Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate? 1. "It would be best to do that in order to increase independence." 2. "Why would you want to leave a secure home?" 3. "Let's discuss and explore all of your options." 4. "I'm afraid you would feel very guilty leaving your parents."

"Let's discuss and explore all of your options." Rationale: The most appropriate response by the nurse is, "Let's discuss and explore all of your options." In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action.

15. An instructor is correcting a nursing student's clinical worksheet. Which instructor statement is the best example of effective feedback? 1. "Why did you use the client's name on your clinical worksheet?" 2. "You were very careless to refer to your client by name on your clinical worksheet." 3. "Surely you didn't do this deliberately, but you breeched confidentiality by using names." 4. "It is disappointing that after being told you're still using client names on your worksheet."

"Surely you didn't do this deliberately, but you breeched confidentiality by using names." Rationale: The instructor's statement, "Surely you didn't do this deliberately, but you breeched confidentiality by using names," is an example of effective feedback. Feedback is method of communication for helping others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice.

While obtaining data from a client, the nurse observes that the client's eyebrows are in the frowning position. Which type of associated feelings could the nurse interpret in the client? Select all that apply. 1. Anger 2. Surprise 3. Enthusiasm 4. Unhappiness 5. Concentration

1, 4, 5 When a client shows a facial expression with frowning eyebrows, it indicates that the client is angry. Frowning eyebrows indicate that the client is unhappy. When a client is concentrating on something, then an expression of frowning eyebrows is maintained.

21. Which of the following individuals are communicating a message? (Select all that apply.) 1. A mother spanking her son for playing with matches 2. A teenage boy isolating himself and playing loud music 3. A biker sporting an eagle tattoo on his biceps 4. A teenage girl writing, "No one understands me" 5. A father checking for new e-mail on a regular basis

1. A mother spanking her son for playing with matches 2. A teenage boy isolating himself and playing loud music 3. A biker sporting an eagle tattoo on his biceps 4. A teenage girl writing, "No one understands me" Rationale: The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to80% of communication is nonverbal.

While collecting the history of a client with anger, the nurse observes that the client is blinking his or her eyes continuously. Which associated feeling does the nurse expect from the client's facial expression? 1. Surprise 2. Dislike 3. Low self-esteem 4. Frustration

2 A client who dislikes something often blinks his or her eyes or looks away from the nurse.

Which facial expressions of a client may indicate disgust? Select all that apply. 1. Raised brows 2. Sticking out the tongue 3. Wrinkling up the nose 4. Eyelids squeezed shut 5. Canine-type snarl

3, 5 The facial expression of wrinkling up the nose indicates disgust. Canine-type snarl indicates disgust.

The nurse is conducting a process recording of a client with anger who has attempted suicide. Which statement or question made by the nurse may make the nurse uncomfortable? 1. "How are you feeling about the situation now?" 2. "Seems like a pretty drastic way to make your point." 3. "You wanted to hurt yourself because you were cheated." 4. "Do you still have thoughts of harming yourself?"

4 The nurse may feel uncomfortable asking the client about thoughts of harming himself or herself. This question is asked to know whether the client has suicidal tendencies.

A college student who attempted suicide by overdose is hospitalized. When the parents are contacted, they respond: "there must be a mistake. This could not have happened. We have given our child everything." The parents reaction reflects: A. Denial B. Anger C. Anxiety D. Rescue feelings

A. Denial: The parents statements indicate denial. Denial or minimization of suicidal ideation or attempts is a defense against uncomfortable feelings. Family members are often unable to acknowledge suicidal ideation in someone close to them. The feelings suggested in the distractors are not clearly described in the scenario.

24. A client has been brought to the emergency department for signs and symptoms of Chronic Obstructive Pulmonary Disease (COPD). The client has a history of a suicide attempt 1 year ago. Which nursing intervention would take priority in this situation? A. Assessing the clients pulse oximetry and vital signs B. Developing a plan for safety for the client C. Assessing the client for suicidal ideations D. Establishing a trusting nurse client relationship

ANS: A It is important to prioritize client interventions that assess the symptoms of COPD prior to any other nursing intervention. Physical needs must be prioritized according to Maslow's hierarchy of needs. This clients problems with oxygenation will take priority over assessing for current suicidal ideations.

10. After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, Im so proud of you for being assertive. You are so good! Which communication technique has the leader employed? A. The nontherapeutic technique of giving approval B. The nontherapeutic technique of interpreting C. The therapeutic technique of presenting reality D. The therapeutic technique of making observations

ANS: A The group leader has employed the nontherapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the clients ideas or behaviors are good or bad. This creates a conditional acceptance of the client. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

9. A client has made the decision to leave her alcoholic husband. She is feeling very depressed. Which nontherapeutic statement by the nurse conveys sympathy? A. You are feeling very depressed. I felt the same way when I decided to leave my husband. B. I can understand you are feeling depressed. It was a difficult decision. Ill sit with you. C. You seem depressed. It was a difficult decision to make. Would you like to talk about it? D. I know this is a difficult time for you. Would you like a prn medication for anxiety?

ANS: A The nurses statement, You are feeling very depressed. I felt the same when I decided to leave my husband, is a nontherapeutic statement that conveys sympathy. Sympathy implies that the nurse shares what the client is feeling and by this personal expression alleviates the clients distress. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

17. Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A. Weve discussed past coping skills. Lets see if these coping skills can be effective now. B. Please tell me in your own words what brought you to the hospital. C. This new approach worked for you. Keep it up. D. I notice that you seem to be responding to voices that I do not hear.

ANS: A This is an example of the therapeutic communication technique of formulating a plan of action. By the use of this technique the nurse can help the client plan in advance to deal with a stressful situation, which may prevent anger and/or anxiety from escalating to an unmanageable level. KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client is trying to explore and solve a problem. Which nursing statement would be an example of verbalizing the implied? A. You seem to be motivated to change your behavior. B. How will these changes affect your family relationships? C. Why dont you make a list of the behaviors you need to change. D. The team recommends that you make only one behavioral change at a time.

ANS: A This is an example of the therapeutic communication technique of verbalizing the implied. Verbalizing the implied puts into words what the client has only implied or said indirectly.

11. A nursing instructor is teaching about suicide in the elderly population. Which information should the instructor include? A. Elderly people use less lethal means to commit suicide. B. Although the elderly make up less than 13% of the population, they account for 16% of all suicides. C. Suicide is the second leading cause of death among the elderly. D. It is normal for elderly individuals to express a desire to die, because they have come to terms with their mortality.

ANS: B This factual information should be included in the nursing instructors teaching plan. An expressed desire to die is not normal in any age group.

As the client and nurse move from the orientation stage to the working stage of the therapeutic relationship, which is the nurses most therapeutic statement? A. I want to assure you that I will maintain your confidentiality. B. A long-term goal for someone your age would be to develop better job skills. C. Which identified problems would you like for us to initially address? D. I think first we need to focus on your relationship issues.

23. ___________________ refers to a nurse's behavioral and emotional response to a client. These responses may be related to unresolved feelings toward significant others from the nurse's past.

ANS: Countertransference Rationale: Countertransference refers to a nurse's behavioral and emotional response to a client. These responses may be related to unresolved feelings toward significant others from the nurse's past or they may be generated in response to transference feelings on the part of the client.

Which nursing intervention below is part of the scope of an advanced practice psychiatric/mental health nurse only? a. Coordination of care b. Health teaching c. Milieu therapy d. Psychotherapy

ANS: D Psychotherapy is part of the scope of practice of an advanced practice nurse. The distracters are within a staff nurses scope of practice.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies: a. deviant behaviors. c. people with mental disorders. b. present disability or distress. d. mental disorders people have.

ANS: D The DSM-5 classifies disorders people have rather than people themselves. The terminology of the tool reflects this distinction by referring to individuals with a disorder rather than as a schizophrenic or alcoholic, for example. Deviant behavior is not generally considered a mental disorder. Present disability or distress is only one aspect of the diagnosis.

According to Peplau, which nursing action demonstrates the nurses role as a resource person? A. The nurse balances a safe therapeutic environment to increase the clients sense of belonging. B. The nurse holds a group meeting with the clients on the unit to discuss common feelings about mental illness. C. The nurse monitors the administration of medications and watches for signs of cheeking. D. The nurse explains, in language the client can understand, information related to the clients health care.

ANS: D According to Peplau, a resource person provides specific answers to questions usually formulated with relation to a larger problem.

15. A nursing student is developing a plan of care for a suicidal client. Which documented intervention should the student implement first? A. Communicate therapeutically. B. Observe the client. C. Provide a hazard-free environment. D. Assess suicide risk.

ANS: D Assessment is the first step of the nursing process to gain needed information to determine further appropriate interventions.

22. When is self-disclosure by the nurse appropriate in a therapeutic nurseclient relationship? A. When it is judged that the information may benefit the nurse and client B. When the nurse has a duty to warn C. When the nurse feels emotionally indebted toward the client D. When it is judged that the information may benefit the client

ANS: D Self-disclosure on the part of the nurse may be appropriate when it is judged that the information may therapeutically benefit the client. It should never be undertaken for the purpose of meeting the nurses needs. KEY: Cognitive Level: Knowledge | Integrated Processes: Communication and Documentation | Client Need: Psychosocial Integrity Multiple Response

When is self-disclosure by the nurse appropriate in a therapeutic nurseclient relationship? A. When it is judged that the information may benefit the nurse and client B. When the nurse has a duty to warn C. When the nurse feels emotionally indebted toward the client D. When it is judged that the information may benefit the client

12. A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst? A. Why do you continue to alienate your peers by your angry outbursts? B. You accomplish nothing when you lose your temper like that. C. Showing your anger in that manner is very childish and insensitive. D. During group, you raised your voice, yelled at a peer, and slammed the door.

ANS: D The nurse is providing appropriate feedback when stating, During group, you raised your voice, yelled at a peer, and slammed the door. Giving appropriate feedback involves helping the client consider a modification of behavior. Feedback should give information to the client about how he or she is perceived by others. Feedback should not be evaluative or be used to give advice. KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst? A. Why do you continue to alienate your peers by your angry outbursts? B. You accomplish nothing when you lose your temper like that. C. Showing your anger in that manner is very childish and insensitive. D. During group, you raised your voice, yelled at a peer, and slammed the door.

A college student said, Most of the time Im happy and feel good about myself. I have learned that what I get out of something is proportional to the effort I put into it. Which number on this mental health continuum should the nurse select? Mental Illness 1, 2 Mental Health 3, 4, 5 a. 1 b. 2 c. 3 d. 4 e. 5

ANS: E The student is happy and has an adequate self-concept. The student is reality-oriented, works effectively, and has control over own behavior. Mental health does not mean that a person is always happy.

A patient recently hospitalized for two weeks committed suicide during the night. Which initial measure will be most helpful for staff members and other patients regarding this event? A. Request the public information officer to make an announcement to the local media. B. Hold a staff meeting to express feeling and plan of care for other patients C. Ask the patients roommate not to discuss the event with other patients D. Quickly discharge as many patients as possible to prevent panic

Ans: B Interventions should be aimed at helping the staff and patients come to terms with the loss and to grow because of the incident. Then, a community meeting should be scheduled to allow other patients to express their feelings and request help. Staff members should be prepared to provide additional support and reassurance to patients and should seek opportunities for peer support. The incorrect options will not control information or may result in unsafe care.

When assessing a patients plan for suicide, what aspect has priority? A. Patients financial and educational status B. Patients insight into suicidal motivation. C. Availability of means and lethality of method D. Quality and availability of patients social supports

Ans: C If the person has definite plans that include choosing a method of suicide readily available and if the method is one that is lethal (ie will cause the person to die with little probability for intervention) the suicide risk is considered high. These areas provide a better indication of risk than the areas mention in the other options.

An adolescent tells the school nurse, my friend threatened to take an overdose of pills. The nurse talks to the friend who verbalized the suicidal threat. The most critical question for the nurse to ask would be: A. Why do you want to kill yourself? B. Do you have access to medications? C. Have you been taking drugs and alcohol? D. Did something happen with your parents?

B: do you have access to medications? The nurse must assess the patients access to the means to carry out the plan and if there is access, alert the parents to remove them from the home. The other questions may be important to ask but are not the most critical.

1. What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client? 1. Clarify personal attitudes, values, and beliefs. 2. Obtain thorough assessment data. 3. Determine the client's length of stay. 4. Establish personal goals for the interaction.

Clarify personal attitudes, values, and beliefs. Rationale: The most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client is to clarify personal attitudes, values, and beliefs. Understanding one's own attitudes, values, and beliefs is called self-awareness.

Four individuals have given information about their suicide plans. Which plan evidences the highest suicide risk? a. Turning on the oven and letting gas escape into the apartment during the night b. Cutting the wrists in the bathroom while the spouse reads in the next room c. Overdosing on aspirin with codeine while the spouse is out with friends d. Jumping from a railroad bridge located in a deserted area late at night

D This is a highly lethal method with little opportunity for rescue. The other options are lower lethality methods with higher rescue potential.

10. Which therapeutic communication technique is being used in the following nurse-client interaction? Client: "When I am anxious, the only thing that calms me down is alcohol." Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" 1. Reflecting 2. Making observations 3. Formulating a plan of action 4. Giving recognition

Formulating a plan of action Rationale: The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking. The use of this technique may serve to prevent anger or anxiety from escalating.

7. When an individual is "two-faced," which characteristic essential to the development of a therapeutic relationship should a nurse identify as missing? 1. Respect 2. Genuineness 3. Sympathy 4. Rapport

Genuineness Rationale: When an individual is "two-faced," which means double-dealing or deceitful, the nurse should identify that genuineness is missing in the relationship. Genuineness refers to the nurse's ability to be open and honest and maintain congruence between what is felt and what is communicated. When a nurse fails to bring genuineness to the relationship, trust cannot be established.

2. If a client demonstrates transference toward a nurse, how should the nurse respond? 1. Promote safety and immediately terminate the relationship with the client. 2. Encourage the client to ignore these thoughts and feelings. 3. Immediately reassign the client to another staff member. 4. Help the client to clarify the meaning of the relationship, based on the present situation.

Help the client to clarify the meaning of the relationship, based on the present situation. Rationale: The nurse should respond to a client's transference by clarifying the meaning of the nurse-client relationship based on the present situation. Transference occurs when the client unconsciously displaces feelings about a person from the past toward the nurse. The nurse should assist the client in separating the past from the present.

Serotonin and suicide

Low serotonin levels are associated with suicide

Suicide risk factors

Marital status (suicide rate is twice than for single people compared to married people) Gender (women attempt more, men succeed more) Age (risk increases with age, particularly in men) Religion (affliction with a religious group decreases the risk of suicide) Socioeconomic status (every low or high social classes) Ethnicity (whites are at the highest risk) Psychiatric illness Severe insomnia Alcohol/barbituates Psychosis with command hallucinations Affliction with chronic, painful, or disabling illness Family history LGBT community Having attempted suicide previously Loss of loved one through death or separation Bullying

14. A nurse maintains an uncrossed arm and leg posture when communicating with a client. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? 1. S 2. O 3. L 4. E 5. R

O Rationale: The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the O in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), observing and open posture (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

9. Which therapeutic communication technique is being used in the following nurse-client interaction? Client: "My father spanked me often." Nurse: "Your father was a harsh disciplinarian." 1. Restatement 2. Offering general leads 3. Focusing 4. Accepting

Restatement Rationale: The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. It allows the client to know whether the statement has been understood and provides an opportunity to continue.

Nursing process assessment for suicidal ideas or acts

Seriousness of intent, plan, means of the plan, verbal and behavioral cues

4. Which client action should a nurse expect during the working phase of the nurse-client relationship? 1. The client gains insight and incorporates alternative behaviors. 2. The client establishes rapport with the nurse and mutually develops treatment goals. 3. The client explores feelings related to reentering the community. 4. The client explores personal strengths and weaknesses that impact behavioral choices.

The client gains insight and incorporates alternative behaviors. Rationale: The nurse should expect that that the client will gain insight and incorporate alternative behaviors during the working phase of the nurse-client relationship. The client may also overcome resistance, problem-solve, and continually evaluate progress toward goals.

Predisposing factors: Durkheim

Three social categories: egoistic, altruistic, and anomic

16. What is a nurse's purpose for providing appropriate feedback? 1. To give the client good advice 2. To advise the client on appropriate behaviors 3. To evaluate the client's behavior 4. To give the client critical information

To give the client critical information Rationale: The purpose of providing appropriate feedback is to give the client critical information. Feedback should not be used to give advice or evaluate behaviors.

The nurse identifies the primary nursing diagnosis for Theresa as "Risk for suicide related to feelings of hopelessness from loss of relationship." Which is the outcome that would be most appropriate for this diagnosis? a. The patient has experienced no physical harm to herself b. The patient sets realistic goals for herself c. The patient expresses some optimism and hope for the future d. The patient has reached a stage of acceptance in the loss of the relationship with her boyfriend

a. The patient has experienced no physical harm to herself

according to current information, what factor is associated w/ the most disabling mental disorders? a. biological influences b. psychological trauma c. learned ways of behaving d. faulty patterns of early nurturance

a. biological influences - (and genetic factors) influence mental health.

the nurse planning care for a mentally ill client bases interventions on which concept? a. every client has a certain degree of resilience b. it is a client right to be treated respectfully c. every client comes w/ experiences that contribute to their problem d. there are universal fears that are shared by all mentally healthy individuals

a. every client has a certain degree of resilience (nurses are expected to evaluate clients w/ mental health issues for their strengths and their areas of high functioning

resilience is characteristic of mental health that allows people to adapt to tragedies, trauma, and loss. which client behavior demonstrates this characteristic? a. my mother made decisions about my husband's funeral when i just couldn't do that" b. losing my job was hard, but my skills will help me get another one." c. in spite of all the tx, i know i'll never be really healthy." d. "my kids, happiness is worth any sacrifice i have to make."

b - losing my job was hard, but my skills will help me get another one"

Success of long-term psychotherapy with Theresa (who attempted suicide following a break up with her boyfriend) could be measured by which of the following behaviors? a. Theresa has a new boyfriend b. Theresa has an increased sense of self-worth c. Theresa does not take antidepressants anymore d. Theresa told her old boyfriend how angry she was with him for breaking up with her

b. Theresa has an increased sense of self-worth

What term is used to identify the quantitative study of the distribution of mental disorders in human populations? a. mortality b. prevalence c. epidemiology d. clinical epidemiology

c - epidemiology: the quantitative study of the distrubtion of mental disorders in human populations

an individual is found to consistenly wear only a bathrobe and neglect the cleanliness of his apt. when neighbors ask him to stop his frequent outburts of operatic arias, he acts outrated and tells them he must sing daily and will not promise to be quieter. this behavior suppirts what conclusion about this client? a. the client is demonstrating symptoms of bipolar disorder b. the client is demonstrating socially deviant behavior c. the client is engaging in egocentric behaviors d. the client is not conforming w/ social norms

d - the client is not conforming w/ social norms

A client with a history of a suicide attempt has been discharged and is being followed in an outpatient clinic. At this time, which is the most appropriate nursing intervention for this client? a. Provide the client with a safe and structured environment b. Isolate the client from all stressful situations that may precipitate a suicide attempt c. Observe the client continuously to prevent self-harm d. Assist the client to develop more effective coping mechanisms

d. Assist the client to develop more effective coping mechanisms

Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Klonsky and May's "Three-Step Theory" suggests that the nurse should assess which three issues to evaluated Theresa's active risk for a suicide attempt? a. Level of education, ethnic background, and current employment b. Relationships with previous boyfriends, coping mechanisms, and intent to have future boyfriends c. Self-esteem, grade point average, and physical attractiveness d. Degree of psychological pain, connectedness with others and suicide ideation in combination with capacity to make an attempt

d. Degree of psychological pain, connectedness with others and suicide ideation in combination with capacity to make an attempt

A person attempts suicide by overdose, is treated in the emergency department, and then hospitalized. What is the best initial outcome? The patient will: a. verbalize a will to live by the end of the second hospital day. b. describe two new coping mechanisms by the end of the third hospital day. c. accurately delineate personal strengths by the end of first week of hospitalization. d. exercise suicide self-restraint by refraining from gestures or attempts to kill self for 24 hours.

d. exercise suicide self-restraint by refraining from gestures or attempts to kill self for 24 hours.

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