Module 3: Mental Health Concepts

A young nurse has just completed postmortem care of a 16-year-old client who died of cancer. The nurse says to the nurse manager, "I never get sick, and this client kept telling me that he couldn't remember not being ill. I feel terrible and so bad for him and about what he went through." Which statement by the nurse manager would be therapeutic?

"Let's go for coffee and talk about this some more, shall we? We're both due for our coffee breaks."

A nurse is participating in a care planning conference regarding care for a client whose spouse recently died. The registered nurse formulates a nursing diagnosis of dysfunctional grieving. Which priority intervention does the nurse expect to see incorporated into the plan?

Determining the client's risk for violence toward self and others

A nurse is reading the medical record of a client who has a diagnosis of moderate anxiety and notes that the physician has documented that the client exhibits eustress. On the basis of this information, which finding would the nurse expect to encounter while assessing the client?

The client engages in purposeful movement.

A nurse reviews the nursing care plan of a client being seen in the mental health clinic and notes that the client is experiencing dysfunctional grieving after losing his spouse. Which is the appropriate outcome for the treatment plan for this client?

The client plans to attend a community grief group.

The wife of a client who is dying says to the nurse, "I am able to take off the 6 months from work our health care provider feels that my husband will live, but what if he lives beyond that time?" Which therapeutic response should the nurse make?

"Are there other options for you in taking work leave? What are your thoughts about reducing your work hours at first so that you can extend your compassionate leave?"

The slightly overweight mother of a morbidly obese 11-year-old girl says, "My family physician is wild over my daughter's weight gain. He says she's not eating correctly and is too sedentary, and now she's at risk for diabetes. He says the sugar in her blood was up this month. It's all my fault because I eat the wrong things too, and I never get off the couch." Which statement by the nurse would be therapeutic in easing the client's self-blame?

"Your daughter has a serious problem, but there are many successful programs that you can join with her to lose weight and improve your overall lifestyle."

A psychiatrist notes that a client being admitted to the inpatient mental health unit uses avoidance and denial to cope with stress. Which positive stress response will the nurse plan to focus on when working with the client?

Problem-solving

A nurse is evaluating the coping skills of a client with a diagnosis of depression. Which statement indicates to the nurse the need to help the client learn and appropriately use these skills?

"I won't ever be depressed again."

When assisting with the plan of care of a client dying of cancer, the nurse seeks to have the client verbalize acceptance of his impending death. Which statement indicates to the nurse that this goal has been met?

"I'd like to have my family here when I die."

A dying client with agoraphobia says to the nurse, "I've been unable to leave this house without tremendous effort for so long, and now it doesn't matter." Which statement by the nurse would be therapeutic?

"It doesn't matter? Can you share your feelings with me?"

A client who recently lost his hand in a workplace accident says to the nurse, "I don't know how I'm going to support my family with a plastic hand. I might as well be dead." Which nursing response would be therapeutic?

"You're saying basically that you feel useless without your hand?"

A client with depression says to a nurse, "Why is my family meeting with you? Are you telling them about me?" Which response by the nurse would be therapeutic?

"Your family is learning about depression and how best to help you so that they can be supportive of you. We do not talk about you or anything confidential about you."

A client with an anxiety disorder who has been prescribed an antibiotic for otitis media asks the nurse, "Why'd the health care provider tell me not to discontinue the medication until the pills are gone?" Which response by the nurse is appropriate?

"Completing the medication ensures that the infection will be resolved."

An older adult client who is dying says to the nurse, "My son is 40 years old, but he works in a very poorly paying job and is always borrowing money from me. I don't know how he's going to manage without me." Which response by the nurse would be therapeutic?

"Could you share your feelings with your son just as you have with me?"

A 62-year-old woman says, "Since my husband retired, 4 months ago, he's started playing golf 24/7, so after rearing our children alone while my workaholic husband ran his business, now I'm suddenly a golf widow." Which response by the nurse is appropriate?

"Have you shared your feelings with your husband?"

A client who was employed as a corporate manager before being laid off says to the nurse, "My wife thinks that I should work in a menial job to maintain our lifestyles until I find another job as a corporate manager, but I don't feel I should have to humiliate myself like that." Which nursing response would be therapeutic?

"Have you shared your feelings with your wife?"

A nurse is talking to a client whose spouse died 10 months ago. Which statement by the client indicates successful mourning?

"I'm planning a trip to England next fall to tour the mansions and their gardens."

A 79-year-old client, recently widowed, says to the nurse, "My wife kept up our condominium single-handedly, and now my kids expect me to cook and clean for myself. I'm not lazy, but I don't know how to cook and I've burnt myself twice just frying up what was supposed to be bacon and eggs. I'm so frustrated and I've already lost 10 pounds this month." Which initial nursing statement should the nurse make to the client?

"It seems as if you feel lost without your wife and maybe a bit ignored by your children."

A client says to the nurse, "My health care provider wants me to start keeping a journal every day about what's happening in my job." Which response by the nurse is appropriate?

"Journal-keeping that identifies what seems to cause a strain in a person's life is a good way of improving one's health."

A client says to the nurse, "My health care provider tells me that I need to start progressive muscle relaxation (PMR) to ease my stress, but I just can't get the hang of it." Which response by the nurse would be most helpful?

"PMR requires training sessions. Let's check into classes that you can attend to learn the technique."

A client says to the nurse, "My health care provider says he thinks I'm ready to taper off my pain medication, but the new painkiller he prescribed doesn't relieve my pain the way the other pill did. I get pain when I try to do things." Which nursing response would be most supportive to the client?

"Perhaps if I medicate you about a half-hour before you plan to start your daily activities, the medicine will be more effective."

As the nurse prepares to interview a client being admitted to the mental health unit, the client says, "I asked my family to bring me in here to talk to someone, but now I don't know where to begin." Which response by the nurse would be most helpful?

"Perhaps you can start by sharing some of your most recent concerns."

The parents of an adopted child schedule an appointment at a psychiatric clinic, and when they arrive, the nurse conducts an initial interview. One of the parents says to the nurse, "We need to speak to a psychiatrist about our adopted daughter. Could you please get one for us?" Which intervention by the nurse would be therapeutic?

"The health care providers here feel that clients are best served when I conduct the initial interview after which the psychiatrist will see you with complete information."

A client says to the nurse, "What does my psychiatrist mean when she says that my illness is biologically based?" Which nursing statement would be the most informative?

"There are many possible physical causes of mental illness, and they include problems in the brain."

A physician tells a client that she has cancer, that her illness is terminal, and that she has a 6-month prognosis. After the physician leaves the client's room, which therapeutic statement should the nurse make to the client?

"What did your health care provider tell you about your condition? Can you tell me what you're thinking about?"

A recently widowed client says, "I lived my whole life for my husband and children. Now he's dead and my daughter and son have each married and moved across the country. They hardly ever call or visit. It's just that there's really nothing much for me to do." Which response by the nurse to the client is appropriate?

"You seem to be identifying some issues in your life that are troubling, and you sound very down right now."

A nurse is teaching assertiveness training to a client with anger-management issues. Which instruction would the nurse give for helping the client assertively confront someone?

Ask for private time to talk and point out the facts without being accusatory, then determine areas of mutual misunderstanding and request the changes you need.

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

Avoidance

A home care nurse makes a new-baby visit to a young husband and wife. The visit takes 2.5 hours because the parents are so detailed in giving information and asking questions of the nurse. Which intervention by the nurse would be therapeutic?

Blocking out more time for the next visit and scheduling a follow-up visit as soon as possible to assess how they are coping and gauge their level of anxiety

A client who has been admitted to a surgical unit with a diagnosis of cancer is scheduled for surgery in the morning. When the nurse enters the room and begins the surgical preparation, the client states, "I'm not having surgery—you must have the wrong person! My test results were negative. I'll be going home tomorrow." The nurse recognizes that the client is engaging in the use of which defense mechanism?

Denial

A nurse is attending a care planning conference for a client who recently received a diagnosis of acquired immunodeficiency syndrome and is experiencing difficulty adjusting to the illness. The nurse should question which planned intervention for this client?

Discouraging social networking to prevent the spread of infection

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

Displacement

A nurse coordinates the use of hospice care to visit a dying client who will be going home with his family. The nurse tells the family that which is one function of hospice services?

Providing bereavement support to the family after the client's death

A young adult client who is dying says to the nurse, "I keep asking my wife what I can do for her and our daughter before I die, but she refuses to tell me." On the basis of the client's statement, what is the appropriate nursing intervention?

Talking with both the client and his wife about the importance of expressing their feelings and how to do it in healthy ways

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

Wishful thinking

A client says to the nurse, "I've started a journal because my health care provider suggested it, and I'm writing about the things that bother me each day. Sometimes I dictate my feelings and what happened during the day into a recorder and write them up before I go to bed—and, do you know, they seem silly to me then. Is this helping me?" Which response by the nurse would be appropriate?

"It seems that people who write in their journals and can share traumatic events improve their self-awareness."

A survivor of a nightclub fire that killed more than 100 people says to the nurse, "It should have been me. How come I got out and they didn't?" Which response by the nurse is appropriate?

"It seems that you're blaming yourself for something that was beyond your control."

During a mental health intake interview, a young adult client who lives with his family rent free says, "I'm tired of not being able to offer my friends a beer just because my folks don't believe in taking a drink socially." Which nursing response would be therapeutic?

"It seems that your parents expect you to follow their rules when you live under their roof."

A client says to the nurse, "I have to do everything. My family can't plan or organize anything. My wife just wants to go out and socialize. My grown son and his wife live with us. They never do anything around the house but 'their' stuff, because they say they pay rent. We really need their rent money since I lost my job. My wife could work but she says 'it's too late to start over' for her. Well, that's what I'm doing—more work at far less money." Which response by the nurse would be therapeutic?

"You seem to be going through quite a lot recently. I'd like to hear more from you about your concerns. Would your family come in and talk with us?"

A client who has been referred for group therapy asks the nurse about the therapy. The nurse tells the client that this type of therapy is focused on which aspect(s)?

The development of interpersonal skills, resolution of family problems, and effective use of community support

The 45-year-old husband of a client with breast cancer who just died says to the nurse, "If our health care provider had operated sooner, my wife would be alive now." Which statement by the nurse would be therapeutic?

"Sounds as if you're feeling angry and pretty helpless right now."

The wife of a victim of a gas explosion says, "It's not bad enough that I've been left alone to care for two children; now the company is denying our claim for compensation, and we have to join a class-action suit to get my husband's pension." Which statement by the nurse would be therapeutic?

"You're saying that being left a widow with children is difficult enough, but now you've got to fight for your benefits."

During a nursing interview, a client says, "My daughter was murdered in her apartment, and her estranged husband called to tell me. I can't stop myself from wondering whether he killed her, but the police have ruled him out as a suspect." Which response by the nurse would be therapeutic?

"It feels terrible to lose a daughter."

The wife of a dying man is ignoring his rapid physiological decline and imminent death. She continues with her usual activities, exhibits inability to remember what others have just told her, and misses important appointments. Which therapeutic statement should the nurse make to the wife?

"It isn't unusual for family to suffer from anticipatory grief when a loved one is dying."

A client who was recently admitted to the mental health unit has a history of paranoia. When the meal tray is delivered, the client refuses to eat and tells the nurse that someone is poisoning the food. Which statement by the nurse is appropriate?

"It must be frightening to you. Has something made you feel that your food is poisoned?"

A client says to a nurse, "Do you know that after 24 years of marriage I still serve my husband breakfast in bed? After all I do for him, he still doesn't treat me well. He should treat me better." Which nursing response is appropriate?

"It seems that you feel that your husband could treat you well just as you treat him."

The family of a client who is being discharged after trying to kill himself with one of his father's guns asks for a family meeting with the nurse to discuss their son's situation. Which statement by the nurse would be the most therapeutic start to the meeting?

"I am going to begin by talking in general terms about your son's return home and some of the things that might happen. I can suggest measures that might be helpful, and then you can ask questions."

A 61-year-old client whose two sons and daughter-in-law died in a nightclub fire says to the nurse, "We were going to retire early, but now we are the only ones who can care for our two grandchildren." Which response by the nurse would be therapeutic?

"I am sorry you've had so many losses."

A 74-year-old widower of 3 months says to the nurse, "When my wife died, I lost my love and my best friend. Everyone I cared about is dead. We both were only children, and we had no kids. I'm more than ready to go when the time comes." Which nursing response should the nurse make?

"Are you thinking of ending your life because your time has come?"

A university professor meeting with the mental health nurse for his weekly therapy session says, "I have a very intelligent student who keeps disrupting my classroom by bragging, and all I want to do is say, 'OK, you're great and you know it all! Now shut up!' But I just don't want to be rude." Which statement by the nurse is therapeutic?

"Sounds like you feel pretty helpless, yet you are the professor here."

A victim of sexual assault is being seen in the crisis center. The client states that she still feels "as though the assault just happened," even though it has been a few months since she was attacked. Which supportive statement should the nurse make to the client?

"Tell me more about feeling like the assault just occurred."

A client who is experiencing suicidal thoughts says to the nurse, "Life is just not worth it anymore." What is the appropriate initial response?

"Tell me what you mean by that."

A 52-year-old client is admitted to the hospital for surgery to treat lung cancer. The client says to the nurse, "I was an alcoholic for 15 years, and now that I'm 25 years sober, I'm being punished." Which statement by the nurse would be therapeutic?

"Because you seem to be blaming yourself unnecessarily, perhaps we can talk about your illness and what caused it."

A client comes to the mental health clinic after losing all of his personal belongings in a hurricane. The client tells the nurse that the loss of his possessions is his fault because he didn't prepare for the storm. The nurse determines that the client is coping ineffectively and develops goals with the client. Which goal is the least realistic?

The client will stop blaming himself for the loss of his belongings.

A young widow of 18 months says to the nurse, "I'm going to need a babysitter because I'm going on a blind date at my brother and sister-in-law's house. They fixed me up, but I think it may be too soon." Which statement by the nurse would be therapeutic?

"By the end of a year, most people are able to renew their interest in other people and activities."

A client who delivered a baby 4 weeks ago says, "I'm feeling as if I'm hanging on by a thread to keep my wits about me." Which statement by the nurse would be therapeutic?

"Can you share with me more specifically how you feel that you're hanging on by a thread? Are you having thoughts of hurting yourself?"

A female victim of incest says to the nurse, "I've had tons of therapy but still can't let my fiancé get too close. He knows I've been sexually abused by my dad and older brother, but I'm wondering whether I'll ever be able to lead a normal sexual life." Which statement by the nurse would be therapeutic?

"Can you share with me some of the strategies you've been using?"

A client who was formerly a workaholic has lost his job and is being supported financially by his wife. The client says to the nurse, "I know that my wife is disappointed in me, but I can't seem to get a job doing what I've done for 25 years. Why should I take a low-level job when she's able to support us financially?" Which response by the nurse would be therapeutic?

"Can you tell me a little more about this?"

A 35-year-old recently divorced parent of twins comes to the intake office of the psychiatric clinic for the first time with a possible diagnosis of generalized anxiety disorder. The client says to the nurse, "My mother always called me a worrywart like my nana, so I guess I come by my problems naturally. I keep worrying about things I can't change, like my divorce, and blaming myself when I know I'm not the only one responsible for the divorce." Which nursing statement would be therapeutic?

"Can you tell me more about the worrying and blaming you are experiencing?

A 32-year-old married woman who recently gave birth to her first child by cesarean delivery says, "My husband and I worry about our baby all the time. We did everything right, yet he had so many problems at birth." Which statement by the nurse would be therapeutic?

"Can you tell me more about the worrying? What's been happening since you brought your baby home?"

A 35-year-old client says to the nurse, "I got divorced less than a year after getting married. I left the Navy SEALs shortly after I joined. Now I teach in the air marshal program to avoid being recalled for war, but I'd really like to quit. I start something, am great at it, then get bored and move on. I date, but I'm still living at home. I never seem to be on my own like other guys my age." Which response by the nurse is most appropriate?

"Can you tell me more about your marriage and relationships? If you leave home, what do you fear will happen?"

A 45-year-old client says to the nurse, "Since I left my wife and children, I can hardly make ends meet between child support and trying to support myself. I don't know why I bother going to work when my wife and kids take just about everything I make." Which nursing statement would be therapeutic?

"Do you feel that child support is designed to help children, not punish spouses who leave?"

A 16-year-old client says, "My dad thinks I'm evil, but we get into fights because I let things build up. He never has any time for me because he's always glued to the TV. He doesn't even look at me when he talks." Which statement by the nurse encourages the client to use assertive behavior with his father?

"Have you tried saying that directly to your dad? For example, you could say, 'I notice that you watch television when I'm telling you things that are important to me.'"

A client in the mental health unit tells the nurse, "My husband makes all the decisions about money, but I'm the one who's making the money now, not him. He needs to back off, but he's always directing every decision we make." Which nursing response would be the most therapeutic?

"How do you feel the money decisions could best be handled in your household?"

A 12-year-old client who has been reported for drawing sexually explicit scenes in her textbooks during class says to the psychiatric nurse, "I just felt like it." Which response by the nurse would be therapeutic and aid assessment of abuse-related symptoms?

"I am concerned about you. Are you being or have you ever been abused?"

A 56-year-old client says to the nurse, "I'm a guidance counselor at the middle school, and the kids like to come to see me for help, but I just found out from my wife that my 22-year-old daughter is a lesbian, and now I'm the one who needs advice. How am I supposed to accept that? She was the boy we didn't have, and I made a tomboy of her by taking her to baseball games with me. Is that why she's gay?" Which statement by the nurse would be therapeutic?

"It sounds like you and your daughter were very close but she kept her sexual orientation from you."

A client who is an attorney says to the clinic nurse, "I'm worried about my wife. She's been so distant and disorganized since our son died of leukemia 4 months ago. She never suggests that we go out or take our other children anywhere. Is this normal, or do I need to get her to a health care provider?" Which statement by the nurse would be therapeutic?

"It's normal, but by the end of a year you can expect that your wife is improving and able to redirect her energy. Have you expressed your concerns to her?"

A nurse is caring for a bereaved man with acquired immunodeficiency syndrome who lost his twin brother in a rock-climbing accident a month ago. Which statement by the client should cause the nurse to be concerned?

"Lately I've been feeling that life isn't that great."

The husband of a terminally ill client says to the nurse, "My company went bankrupt, my son is a drug addict, my daughter is an alcoholic, and now this! My health care provider wants me to try some stress reduction because my blood pressure is up. Whose wouldn't be? I've tried music and relaxation, but they don't work." Which statement by the nurse would be therapeutic?

"Let's talk more about what has been helpful to you in the past."

On the initial visit to the mental health clinic, a client says to the nurse, "When I married my husband, more than 30 years ago, he was a big, handsome, competent professional who never wanted me to work and was so loving. Well, two kids later he's a slob who gambles and loses one job after another. Now I'm the breadwinner, and he's content to be a shiftless town joke." Which statement by the nurse would be therapeutic?

"Many things have happened to you and your husband. Sounds as if you've both been struggling for some time. Would you like to have him come in with you to talk with me about all of this?"

A 68-year-old client whose husband died 2 months ago says to the nurse, "I'm having trouble sleeping lately, even though I don't nap in the daytime. I've been using warm milk without any results." Which statement by the nurse would be therapeutic?

"One of the things that I've found has helped others is a small snack with your warm milk before sleep and a moderate increase in walking during the day. Is that something you could try?"

A lesbian client says to the nurse, "I was cheating on my lover because I need the thrill of seeing someone new, and now my lover has left me to go live with this other woman. I know that this other woman wants more than friendship from my lover, and I can't make my lover see that I love her and that my affairs are meaningless. I don't want to lose her, but I can't stop cheating because I need the thrill it brings." Which statement by the nurse would be therapeutic?

"Perhaps your task is not to make your lover see that your dalliances are meaningless but to look at your own behavior and determine what you would like or not like to be different."

A client says to the nurse, "I've been following my diet and taking my medication. What else do you want to talk about today?" Which response would be most helpful during the working phase of the therapeutic alliance?

"Some people have added exercise to diet and medication therapy and gotten positive results. Do you think that this would work for you?

A client whose husband died 2 months ago says to the nurse, "After church, I visit my husband's grave and talk to him. It comforts me, but my daughter thinks I'm morbid and crazy and is upset with me because I don't want to meet her for coffee after church like I used to." Which statement by the nurse would be therapeutic?

"Sounds as if you have had difficulty letting your husband go from your life. What would happen if you visited his grave less frequently?"

A dying client says to the nurse, "How do I tell my parents that I am dying of AIDS when they don't even know that I'm gay?" Which statement by the nurse would be therapeutic?

"Sounds as if you're thinking that it's time for you to tell your parents about your disease."

A client with an alcohol problem who has been sober for 8 months asks the nurse, "Do you think I should add individual therapy to my treatment plan?" Which response by the nurse would be therapeutic?

"The best time to add individual therapy seems to be after 2 to 5 years of sobriety. Individuals vary, though, and it may be that you are asking because you feel ready to work on your issues."

The wife of an client who is an alcoholic says to the nurse, "I can't afford to bail my husband out of this mess. Our business is filing for bankruptcy, and the Internal Revenue Service has posted a notice of auction on our home." Which statement by the nurse would be therapeutic?

"The lack of money has stopped you from saving your husband? It sounds like you are very frustrated right now. What do you think?"

A single parent whose son was suspended from school for carrying a gun into the school says to the nurse, "I know he has no dad, but I've brought him up to know better, and anyway, where did he get the stupid gun? What should I do? He just won't listen to me." Which nursing response would be helpful at this time?

"There is quite a bit that you can do. Let's talk about what you're already doing first."

The parent of a 25-year-old man who has just been found to have a left frontal brain tumor says to the nurse, "At the local hospital, our health care provider thought that his headaches were nothing and prescribed an analgesic. If I hadn't insisted on a CT scan, no one would have found the tumor." Which statement by the nurse would be therapeutic?

"You and your son are having a very trying time. What's happened since your son's diagnosis?"

A young adult client says to the nurse, "All my friends are married and have children. I can't seem to meet anyone, and I know I'll never be happy until I meet someone I can care about enough to marry." Which statement by the nurse would assist the client in reframing the situation?

"You can't seem to meet someone that you care about? You can still find enjoyment in friendships, work, books, and other things as well"

The widow of a man who was killed a week ago in a hit-and-run accident while walking the family dog says, "I should have just let the dog run in the backyard or gone with my husband. Our own parish priest hit my husband and finally surrendered to the police. He brought a lawyer with him because he's worried about himself, not my husband. I hate him so much, my stomach hurts." Which nursing statement would be therapeutic?

"You not only lost your husband but also learned it was at the hands of someone you looked up to."

A nurse is talking to a client with depression when the client says, "I don't know why my son turned out like he did. I never thought that he would rob a bank! I don't know what I did wrong. I know that he didn't grow up with a father, but I gave him everything. I wish I could start over and do things differently." Which response by the nurse would be therapeutic?

"You seem to be feeling regret."

A nurse is caring for a 39-year-old client who has experienced a mild brain attack (stroke). The client is recently widowed, is very active physically, and has two young sons. The client says to the nurse, "I don't know what my sons will do if anything permanent happens to me. We have no other relatives, even on my late wife's side." Which nursing response would be therapeutic?

"You seem to be feeling very troubled."

A mental health home care nurse says to the client, "Do you feel ready to try attending a group session at the clinic?" The client shakes his head. Which nursing statement would be therapeutic?

"You seem to be saying no. Would you tell me more about your reluctance?"

A young woman who has been divorced twice says to the nurse, "I've decided not to date men ever again! It never works out for me. Now I'm left with two children to bring up." Which nursing response would be therapeutic?

"You talk about how the divorces affected you. Tell me how your children are dealing with the loss."

A client in group therapy says to the two nurses conducting the group, "You two are great at psychoanalyzing us, but what about you two? Do you have trouble being assertive with your bosses or the health care providers like we do?" Which statement by one of the nurses would be most therapeutic?

"You're interested in talking with us about our assertiveness, but this group is for all of you here to help you to deal with problems more effectively."

A 45-year-old fireman says to the nurse, "I've worked at some fires recently that were just devastating, but last week was the worst. I carried this little girl from a fire—she was badly burned and lived just a few minutes after I brought her out, and she said to me, 'Tell my mom and Rudy I love them both very much.' Her mom told me that Rudy is their dog, and he just mopes around the house since the little girl died. I keep thinking about her and just don't know if I can go on." Which response by the nurse would be therapeutic?

"You're questioning your job because you're upset about the little girl you tried to save. Work stress can be treated and help you cope better. It is so important for you to seek treatment."

A 25-year-old client says to the nurse, "I got my degree in criminal justice. I graduated first in my class from the police academy and had just started as a patrolman when my partner and I responded to a domestic violence call in the most rural part of our patrol area. Someone started shooting at us, and I'm terrified. Maybe I'm not right for this job." Which statement by the nurse would be therapeutic?

"You're saying that because you felt afraid in a violent situation, you may not be right for the job?"

A client who witnessed her husband's being shot and killed in an incident of road rage says to the nurse, "It's been 3 months now, and I still can't drive my car without acting crazy. My sister says I grip the wheel like I'm glued to it. I can't merge with traffic until it's almost completely clear, and I'm parking a mile from the mall when there's plenty of parking close to the building." Which statement by the nurse would be therapeutic?

"You're seeking help appropriately, and there are many things you can do to get comfortable behind the wheel again. You've returned to driving, but remember, you're still grieving. It's normal to still feel this way."

A client says to the nurse at the mental health clinic, "My husband and sister-in-law both have terminal illnesses, and my family thinks that because I'm a nurse I should be able to handle everything." Which nursing response would be therapeutic?

"You've seen your loved ones dealing with some troubling events recently. Sounds as if you feel that your family expects more from you than from others in the family because you're a nurse."

A client who is a physician says to the nurse, after receiving a diagnosis of terminal lung cancer, "All my life I took care of my clients, and now my family is taking care of me." Which statement is a therapeutic nursing response?

"Your family is caring for you now."

A client's son and daughter were killed during a fellow student's murderous rampage at their high school 9 months ago. The client says to the nurse, "My wife and I just feel empty and exhausted. I can't believe that I had a vasectomy after our son and daughter were born because we wanted to give them both whatever they needed. We have college funds for both of them that they'll never use now." The nurse should make which appropriate statement to the client?

"Your loss touches me so. How truly devastated you both must be. Can you share what things you have been doing to grieve?"

he parents of a 20-year-old who was killed while driving drunk say to the nurse, "We're so devastated, but we are also angry that she would drink and drive when we told her over and over not to." Which statement by the nurse would be therapeutic?

"Your sadness over losing your daughter is mixed with anger at her driving while intoxicated."

A client whose adolescent son committed suicide by hanging himself in the family's garage says to the nurse, "The coroner just informed us that our son had AIDS." Which response to the client by the nurse is appropriate

"Your son was keeping a very troubling diagnosis to himself. I am so sorry. No matter how close and loving children are to their parents, some children just aren't able to confide in their parents."

A single mother whose only son died 2 months ago says to the nurse, "I've been bothered at work with thoughts of my son. Suddenly I'll think of something awful I said to him years ago or some punishment I gave him because he'd been bad." Which plan should the nurse include in caregiving?

Explaining that bereaved persons often describe intrusive thoughts of negative experiences with the deceased and then increasing the frequency of nurse-client visits

A nurse is caring for a 15-year-old girl who has been hospitalized on the mental health unit for bipolar disorder. The client tells the nurse that she had her hair styled just like her young math teacher, whom she admires. The nurse recognizes that the client is using which defense mechanism?

Identification

A client who was admitted to the mental health unit 1 month ago with agoraphobia is cooperative, shares with peers, and makes appropriate suggestions during group discussions. The nurse concludes that this client's behavior is most consistent with:

Improvement

A client is going to receive instruction in biofeedback technique to lower his stress level. The client asks the nurse to describe this technique, and the nurse provides which information?

It is a therapeutic modality that enables an individual to monitor skin temperature, muscle activity, heart rate, blood pressure, and other bodily functions, then learn to control these physiologic responses to stressful or challenging events.

A nursing student is assigned to work in the emergency department to assist victims after a tornado. The student says to the nurse in charge, "I don't know how to help these parents. Their son was just decapitated by a flying piece of glass, and they won't leave him. They did mention that they are Catholic." Which intervention does the nurse suggest for inclusion in a plan of immediate care for the family?

Joining the family and, after they have been able to be with their son for some time, helping them relinquish their son's body to the nurses

How does a client who has lost a spouse show that she is successfully completing the tasks of mourning? Select all that apply.

Reporting that sleeping alone was hard at first Purchasing a smaller car she is comfortable driving Heard explaining to family that illness "took" her husband Heard explaining to family that illness took her husband