Module 3: Mental Health Concepts

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 dx of GAD. The client says to the nurse, "My mother always calls 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 c-section says, "my husband and I worry about our baby all the time. We did everything right yet he had so many problems at birth". Which statement by the nurse would be therapeutic

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 marshall 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 can leave home, what do you fear will happen

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 TV when I'm telling you things that are important to me".

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 so sorry you've had so many losses

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 smelting 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 b/c 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 56 year old client says to the nurse, "I'm a guidance counselr 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 adivce. 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 doctor?" 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 nursing student is assigned to work in the ED 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

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 university professor meeting with the mental health nurse for his weekly therapy sessions says, "I have a very intelligent student who keeps disrupting my classroom by bragging and all I want to do is say, 'Okay, you're great and you know it all!' Now shut up!' But I 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 client with alcohol problems who has been sober for 8 months asks the nurse, "do you think I should add individual therapy to my tx plan?" which response by the nurse would be therapeutic

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

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

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

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 the hands of someone you looked up to

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

You seem to be feeling regret

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 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 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

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

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 tells the nurse that he is experiencing a great deal of work related stress and is taking an anxiolytic med. He tells the nurse that he read on the internet that St. John's wort, an herbal product, is helpful in reducing stress and says that he would like to try taking it. Which is the best response for the nurse to give the client

You'll need to discuss the use of St. John's wort with your HCP

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

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

A 45 year old fireman says to the nurse, "I've worked at some fires recently that are just devastating, but last week was the worse. 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". 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

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 gotta fight for your benefits

The nurse is providing physical care to a client who has recently been told that he has an inoperable lung cancer with a poor prognosis. The client says to the nurse, "I am so scared of dying. You hear so many stories about death. If only someone could tell me what it is really like". Which response should the nurse give the client

You're scared of dying. Let's talk about what makes you scared

The slightly overweight mother of a morbidily obese 11 year old girl says, "my family HCP 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 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 your or anything confidential about you

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

The parents of a 20 year old who was killed while driving drunk say to the nurse, "We're so devastated, but we are also angry that she would drink and drive when we told her over and over not oto." 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 dx to himself. I am so sorry. No matter how close and living children are to their parents, some children just aren't able to confide in their parents

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

denial

The nurse coordinates the use of hospice care to visit a dying client who will be going home with his family. Which is a function of hospice services that the nurse should tell the family

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

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

What did you HCP tell you about your condition? Can you tell me what you're thinking about

the nurse employed in hospice care is reading the records of her assigned clients. Which client does the nurse identify as being at risk for disenfranchised grief

A same-sex partner of a client with AIDS

which situation is an example of the maladaptive defense mechanism known as identification

A young boy thinks that a neighborhood gang leader who sells illegal drugs is someone to look up to

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

Are there other options for you to take in work leave? Perhaps you could simply reduce your work hours iat first so that you can extend your compassionate leave

The nurse developing a plan of care for a client whose spouse recently died determines the client has a problem with dysfunctional grieving. Which priority intervention does the nurse incorporate into the plan

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

The HHC nurse makes a new-baby visit to a young husband and wife. The visit takes 2.5 hours b/c 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 ASAP to assess how they are coping and gauge their level of anxiety

A client with an anxiety disorder who has been prescribed an abx for otitis media asks the nurse, "Why'd the doctor tell me not to d/c the med 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

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

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

The nurse is evaluating the coping skills of a client with a dx 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

In planning the care of a client dying of cancer, the nurse seeks to have the client verbalize acceptance of his impending death. Which statement indicates to the nurse that this goal has been met

I'd like to have family here when I die

The 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 dying client with agoraphobia says to the nurse, "I've been unable to leave this home 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

The nurse is developing a plan of care for a client who recently received a dx of AIDS and is experiencing difficulty adjusting to the illness. Which action is an inappropriate intervention for this client

Discouraging social networking to prevent the spread of infection

two police officers arrive at the ED with a client who has been displaying violent behavior in a local park. The police report to the nurse that they tried unsuccessfully to reason with the client and that the client continued to direct violent behavior at other individuals in the park. After a thorough psychosocial assessment of the client, the HCP determines that the client requires emergency involuntary admission to the mental health facility. What determination does the nurse make with regard to this type of admission

It is necessary for a client who is a danger to self or others

The husband of a terminally ill client says to the nurse, "My company went bankrupt, my son is a drug addict, my daughter is an alcoholic and now this! My doctor wants me to try some stress reduction because my BP 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

The psychiatric nurse is caring for a 15 year old girl who has been hospitalized for bipolar disorder. The client tells the nurse that she had her hair styled just like her math teacher, whom she admires. Which defense mechanism should the nurse recognize that the client is using

identification

A client who was admitted to the mental health unit 1 month ago with agoraphobia is cooperative, chairs with peers and makes appropriate suggestions during group discussions. Which is most consistent with the client's behavior

improvement

the nurse employed in the mental health unit of a hospital is leading a group psychotherapy session. Which is the nurse's role in the termination of stage of group development

Acknowledge the contributions of each group member

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 b/c your time has come

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

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

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 45 year old client says to the nurse, "Since I left my wife and children, I can hardly make ends meet b/w 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

The nurse is performing an assessment of an African-American client who is being seen in the clinic for the first time. Which question should the nurse ask to elicit information on a health risk associated with this cultural group

Does anyone in your family have high blood pressure

the nurse is assigned to work with a client who has just been admitted to the mental health unit. Which action should the nurse plan to take in the orientation or introductory phase

Establish a contract with the client

the nurse provides information to a client about stress mgmt techniques. Which statement by the client indicates a need for further information

Everyone thinks that caffeine can make the stress worse but that's a myth

A single mother whose only son died two months ago says to the urs, "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 b/c he'd been bad." Which plan should the nurse include in caregiving

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

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

Have you shared your concerns with the police

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

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 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 be best handled in your household

A 12 year old who has been reported for drawing sexually explicit scenes in her textbooks during class says to the psychiatric nurse, "I just feel 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 client with claustrophobia is seen in the mental health clinic and is told that one tx for the disorder is systematic desensitization. When the client asks the nurse to describe the tx, what information does the nurse provide

It involves exposure to the phobic situation, starting with short periods and gradually increasing, until the fear is ceased

A client is going to receive instruction in biofeedback technique to lower his stress level. The client asks the nurse to describe this technique. What should the nurse tell the client

It is a therapeutic modality that enables an individual to monitor skin temp, muscle activity, HR, BP and other bodily functions, then learn to control these physiologic responses to stressful or challenging events

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 hx 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 the nurse, "I've started a journal b/c my HCP 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

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

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

A client says to the nurse, "my doctor wants me to start keeping a journal everyday 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

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

Lately, I've been feeling that life isn't that great

A client says to the nurse, "I was cheating on my lover b/c I need the thrill of seeing someone new and now my left 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 79 year old client, recently widowed says to the nurse, "My wife kept up our condo 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 10lbs this month." Which initial nursing statement should the nurse make to this client

Seems as if you feel lost without your wife and maybe a bit ignored by your children

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 two months ago says to the nurse, "After church, 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 b/c 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

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

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

A dying client says to the nurse, "How do I let my parents know that I'm dying of AIDS?" 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

the nurse is talking to a client in the mental health unit. The client says, "I'm really angry with my boyfriend about the things he says to me. Women always get put down, as if we don't matter or have anything important to offer." which response is the most appropriate one for the nurse to make

Tell me how you feel as a woman

of sexual assault is being seen in the crisis center. The client states that she still feels "as though the assaut 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 why you feel like the assault just occured

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 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 b/c 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

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

The doctors here feel that clients are best served when I conduct the initial assessment, after which the psychiatrist will see you with complete information

The wife of an alcoholic client says to the nurse, "I can't afford to bail my husband out of this mess. Our business if filing for bankruptcy and the IRS 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 need to help yourself right now. What do you think?

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 Today we know that all mental illness is genetically inherited

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

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 client is the wife of a former workaholic who now has not worked in year, refusing to get a job or help with chores around the house. The man watches TV and snacks all day. The client tells the nurse that her husband now weighs more than 300 lbs 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 b/c 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 terminally ill hispanic client is surrounded at the bedside by his family members. Which behavior, a characteristic of hispanic culture should the nurse expect to encounter

Women openly expressing their grief

The parent of a 25 year old man who has just been found to have a left frontal brain tumor says to the nurse, "at the local hospital, our doctor thought that his h/a 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 dx

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 that you feel useless without your hand

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

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 b/c 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 others in the family b/c you're a nurse

A client who is a HCP says to the nurse, after receiving a dx 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

The nurse monitoring a chinese-american client who is dying of gastric cancer. The nurse notes that the client's husband and two teenage children visit the client frequently but do not display affection toward the client. How should the nurse interpret this behavior

a cultural norm

How does the client who has lost a spouse show that she is successfully completely the tasks of mourning SATA a) Reporting that sleeping alone is so hard now b) Purchasing a smaller care she is comfortable driving c) Heard explaining to family that illness "took" her husband d) Relating that it's better "he went first" e) Placing a picture of her husband on the bedside stand

a, b, c, e

Which characteristics describe constructive coping mechanisms SATA a) It is a protective response b) It is an effort to relieve anxiety c) It may involve behaviors such as using relaxation techniques d) It involves repression of a painful experience into the unconscious e) It is a mechanism used by the individual to consciously confront a threat

a, b, c, e

which choices are therapeutic nursing actions in dealing with the husband of a client who is dying SATA a) Encouraging the husband to express his feelings and concerns b) Making decisions for the husband to lessen his burden of grief c) Determining how much the husband wishes to know about the care being provided d) Refraining from demonstrating emotion over the client's terminal situation in the presence of the husband e) Telling the husband that it will be easier to accept the loss if he avoids reminiscing and talks about his life with his wife

a, c

the HHC nurse making a visit to a client who is receiving hospice care understands that hospice care is intended to achieve certain outcomes. What are these outcomes SATA a) Relief of symptoms b) Postponement of death c) Hastening of disease remission d) Facilitation of a peaceful death e) Provision of the best possible quality of life

a, d, e

a client is told that the CT scan she just underwent has revealed a pancreatic mass that is most likely cancer. The client becomes upset and anxious on hearing this news and tells the nurse that she feels nauseated. Checking the client's vital signs, the nurse notes that the client's HR, resp rate and BP are increasing compared with previous readings. Which stage of Selye's general adaptation syndrome is the client experiencing

alarm reaction

During a one-to-one client nurse 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 behaviors

avoidance

The nurse plans care for a client experiencing stress. Which characteristics are associated with the stage of resistance in Selye's description of general adaptation syndrome SATA a) All energy for adaptation has been expended b) The body makes some effort to resist the stressor c) When resources are adequate the person may successfully recover d) Successful adaptation depends on the adequacy of the person's internal and external resources e) The person in this stage may become ill and die if assistance from an outside source is not available

b, c, d

which statements about Amish culture are correct SATA a) The amish do not use alternative health care measures b) The amish believe that clean living and a balanced diet help maintain health c) The amish have more risk factors for disease than do members of the general American population d) Barriers to modern health care for many amish people include distance, lack of transportation, cost and language e) Some amish people do not carry health insurance b/c it is a "worldly product" showing a lack of faith in God f) Amish people generally must have church permission to be hospitalized b/c it is the community that will pay the costs

b, d, e, f

the nurse is evaluating the grief process for a woman whose husband died in a MVA 2 months ago. Which outcomes would the nurse identify as successful SATA a) The client refuses to take on new responsibilities b) The client demonstrates lengthening periods of stability c) The client expresses positive expectations about the future d) The client reports decreased preoccupation with the loss of her husband e) The client's daughter reports that he mother has not paid any bills the death of her husband

b-d

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

b/c you seem to be blaming yourself unnecessarily, perhaps we can talk about your illness and what you can expect after surgery

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 client is seen in the ED for complaints of chest pain and difficulty breathing. The results of lab and diagnostic tests are normal, indicating that there is no physiological basis for the complaints. On further assessment, the client tells the nurse that CP and difficulty breathing are the symptoms that his wife had before she died. Which type of defense mechanism does the nurse recognize in this behavior

introjection

the client conducts an assessment of a 98 year old client with end stage cardiac disease who is dying. Which findings is a physical manifestation of approaching death

mottling around the knees

the nurse is providing pre op instructions for a day surgery scheduled in 1 week to a client who speaks Spanish. Which is the best way for the nurse to ensure that the client understands the instructions

Calling for a hospital-designated interpreter to communicate with the client

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 fiance 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

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

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

A client says to the nurse, "My doctor says he thinks I'm ready to taper off my pain meds, but the new painkiller he prescribed does not 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 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 nurse providing information to the wife of a client who abuses alcohol encourages the woman to attend an Al-Anon support group. The wife tells the nurse that she is embarrassed by her husband's behavior and that it would be difficult for her to face other people. Which response should the nurse give the woman to help alleviate her concerns

The members of the group have experience or are experiencing the same problem she is facing

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

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

he nurse is reading the medical record of a client who has a dx of moderate anxiety and notes that the HCP has documented that the client exhibits eustress. Based on this information, which finding would the nurse expect to encounter while assessing the client

The client engages in purposeful movement

the nurse in a mental health clinic is interviewing a client who was referred to the clinic by the client;s primary HCP. which finding indicates to the nurse that the client needs assistance to restore and maintain mental health

The client has a distorted view of the world and communicates inappropriately

The nurse reviews the health 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 tx plan for this client

The client plans to attend a community grief group

several family members are sitting at the hospital with a client who is dying of bladder cancer. The dying client's roommate is found waiting outside the room after visiting hours have ended. He tells the nurse that he wants to give his roommate's family privacy. Which action should the nurse take

Transferring the roommate to another room

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 you care about? You can still find enjoyment in friendships, work, books and other things as well

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

the nurse is performing an assessment of a client who is an alcoholic. During the assessment, the client preaches about the evils of drinking. Which adaptive defense mechanism should the nurse recognize in the client's behavior

realistic formation

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

you seem to be feeling troubled