Saunders Therapeutic Communication Techniques

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A client diagnosed with hypothyroidism is taking levothyroxine. The client returns to the clinic 1 week after beginning the medication and tells the nurse that the medication has not helped. The appropriate nursing response to the client is based on which information? 1. A higher dosage is required. 2. The medication may need to be changed. 3. Full therapeutic effect may take 1 to 3 weeks. 4. Full therapeutic effect may take up to 4 months.

A client is receiving a continuous intravenous (IV) infusion of heparin in the treatment of deep vein thrombosis. The nurse is told that the client's activated partial thromboplastin time (aPTT) level is 65 seconds and that the client's baseline before the initiation of therapy was 30 seconds. The nurse identifies these results as characteristic of which description? 1. Low 2. Elevated 3. Abnormal 4. Within the therapeutic range

A 6-year-old child has just been diagnosed with localized Hodgkin's disease, and chemotherapy is planned to begin immediately. The mother of the child asks the nurse about radiation therapy because it was not prescribed as a part of treatment. Which is the most appropriate response to the mother? 1. "The child is too young to have radiation therapy." 2. "It's very costly, and chemotherapy works just as well." 3. "I'm not sure. I'll discuss it with the primary health care provider." 4. "The primary health care provider would prefer that you discuss treatment options with the oncologist."

A client at 32 weeks of gestation with a diagnosis of severe preeclampsia is admitted to the maternity department. The client is alone and appears very anxious. Which statement by the nurse is therapeutic? 1. "Tell me about your concerns." 2. "Your husband called to say he's coming to be with you." 3. "Many women have this problem with no further complications." 4. "You have an excellent primary health care provider; if anyone can save your baby, she can."

A client is scheduled for an amniocentesis and tells the nurse, "I'm not sure I should have this test done." Which response by the nurse is appropriate? 1. "Tell me what concerns you have." 2. "Don't worry. Everything will be fine." 3. "Why don't you want to have this test done?" 4. "The primary health care provider has scheduled this test for a reason."

A client who is suicidal tells the nurse, "All I want to do is end it all." Which is the appropriate nursing response? 1. "What do you mean by that?" 2. "Did you have a bad night?" 3. "You are just tired, and you don't really mean that." 4. "Your family would be upset if they heard you say that."

A client with a potential for violence is exhibiting agitated behavior. The client is using aggressive gestures and making belligerent comments to the other clients and is pacing continually in the hallway. Which comments by the nurse would be therapeutic at this time? 1. "What is causing you to become agitated?" 2. "Please stop so I don't have to put you in seclusion." 3. "Why are you intent on upsetting the other clients?" 4. "You are going to be restrained if you do not change your behavior."

A licensed practical nurse (LPN) is assisting in the care of a client receiving a continuous intravenous (IV) infusion of heparin sodium for deep vein thrombosis (DVT). The LPN notes that the result of a newly drawn activated partial thromboplastin time (aPTT) level is 90 seconds. The client's baseline before the initiation of therapy was 30 seconds. The LPN should take which action? 1. Notify the RN about the value immediately. 2. Ask the client about worsening pain from the DVT. 3. Check to see if additional heparin is available on the unit. 4. Leave the report for the registered nurse (RN) to review later in the day.

The nurse assisting in the labor room is preparing to care for a client with hypertonic dysfunction. The nurse is told that the client is experiencing uncoordinated contractions that are erratic in their frequency, duration, and intensity. Which nursing intervention is the priority in caring for the client? 1. Provide pain relief measures. 2. Prepare the client for an amniotomy. 3. Monitor the oxytocin infusion closely. 4. Promote ambulation every 30 minutes.

The nurse is assigned to care for a client who is traditional Chinese. The nurse enters the room and following a greeting and introduction to the client, the nurse begins to discuss the plan of care for the day. During the discussion, the client turns away from the nurse. The nurse should take which action? 1. Continue with the discussion. 2. Return later to continue with the discussion. 3. Ask the client whether he can hear the nurse. 4. Leave the room and ask for another nurse to be assigned to the client.

The nurse is assisting in developing a plan of care for a client with a psychotic disorder who is experiencing altered thought processes. On review of the client's record, the nurse notes documentation that the client believes that the food is being poisoned. The nurse plans to use which communication technique when developing strategies that will promote adequate nutrition and encourage the client to discuss feelings? 1. Use open-ended questions and silence. 2. Focus on the components of adequate nutrition. 3. Focus on the fact that the client's beliefs are untrue. 4. Instruct the client about the need for adequate nutrition.

The nurse is caring for an African-American client admitted for a planned surgery. The nurse enters the room and after a greeting and introduction to the client describes the routine for preparing for surgery. The client looks away from the nurse. Which nursing action is appropriate? 1. Continue with the explanation. 2. Tell the client that the surgery is the reason the admission. 3. Leave the room and return later to continue with the explanation. 4. Walk around to the client and ask the client what the problem might be.

The nurse is having a conversation with a depressed client in an inpatient psychiatric unit. The client says to the nurse, "Things would be so much better for everyone if I just wasn't around." Which response by the nurse would be appropriate at this time? 1. "You sound very unhappy. Are you thinking of harming yourself?" 2. "Have you talked to anyone specifically about what is bothering you?" 3. "Those feelings will go away once your medication really takes effect." 4. "I know what you mean; everyone gets that way when they are depressed."

The nurse is providing emotional support to a client who experienced a spontaneous abortion. The nurse can best assist the client by planning care that focuses on which psychosocial issue? 1. The feelings of guilt that is often associated with grief 2. Grief and loss are usually resolved within 3 months 3. The amount of pain and discomfort as a result of the abortion 4. The other children in the family and the ability to bear children in the future

The nurse is reinforcing discharge instructions to a Chinese client regarding prescribed dietary modifications. During the teaching session, the client continually turns away from the nurse. Which nursing action is most appropriate? 1. Continue with the instructions, verifying client understanding. 2. Walk around the client so that the nurse continually faces the client. 3. Identify the importance of the instructions for the maintenance of health care. 4. Give the client a dietary booklet and return later to continue with the instructions.

The nurse notices that a client with trigeminal neuralgia has been withdrawn, is having frequent episodes of crying, and is sleeping excessively. Which method is the best way for the nurse to explore issues with the client regarding these behaviors? 1. Have the client express the feelings in writing. 2. Have the primary health care provider speak to the client. 3. Conduct a group discussion with the client's family. 4. Ignore the behavior because it is expected in clients with trigeminal neuralgia.

A client with severe preeclampsia is receiving magnesium sulfate by intravenous infusion. Which criteria indicate expected findings for this medication? Select all that apply. 1. Deep tendon reflexes at 2+ 2. Magnesium level of 7 mg/dL 3. Urine output of 30 mL per hour 4. Respiratory rate of 10 breaths/minute 5. Feeling of warmth, flushing and diaphoresis

1,2,3,5

A pulmonary angiography is scheduled for a client suspected of having a pulmonary embolism. The nurse understands that which actions are an appropriate preprocedure care intervention? Select all that apply. 1. Obtain a signed informed consent form. 2. Prepare the anticipated entry site for local anesthesia. 3. Inquire whether the client has any allergies to shellfish. 4. Ensure that the client will be NPO for 12 hours before the procedure. 5. Ask whether client has ever experienced an allergy to any contrast media.

1,2,3,5

The nurse is caring for a pediatric client who sustained physical injuries following a bombing. Which actions by the nurse should help put the child at ease and decrease the child's and family's stress level? Select all that apply. 1. Tell the truth about the child's status. 2. Communicate an attitude of confidence. 3. Encourage family caregivers to stay with the child. 4. Limit communicating the child's status with the family. 5. Establish a trusting relationship with the child and the parents.

1,2,3,5

A client who has terminal cancer has been experiencing a significant increase in pain. However, today the client is no longer complaining of pain but is quiet and isolative. Which types of therapeutic communication should the nurse employ? Select all that apply. 1. Sit by client's bed holding his or her hand. 2. Reminisce with the client and share a humorous story that the client enjoys. 3. The nurse asks: "What can I do, that might make you feel more comfortable today?" 4. The nurse states: "Just think; you will soon be in a better place where you will not be in pain." 5. The nurse asks: "I noticed you grimacing earlier when I walked in your room. Are you in pain?" 6. The nurse states: "It must be very frustrating to be in pain and not be able to get complete relief from your pain."

1,2,3,5,6

An adolescent client is admitted to the inpatient unit after medical stabilization for an overdose of acetaminophen. The history identifies that her boyfriend broke up with her 2 weeks ago and that she hasn't been eating well, resulting in a loss of 15 pounds. The nurse assists in developing a plan of care that includes which interventions? Select all that apply. 1. Making nutritious snacks available anytime 2. Providing meals on an isolation tray that contains plastic utensils 3. Removing unit privileges, based on her willingness to eat appropriately 4. Ensuring that her diet consists of bland, easy-to-digest foods and beverages 5. Explaining that while being thin is desirable, she needs to eat to be healthy

1,2,4

The nurse is caring for a client who is hospitalized because of severe depression. Which statements would be most helpful in assisting this client? Select all that apply. 1. "I notice you are wearing a blue shirt." 2. "Do you have any plans of harming yourself?" 3. "I know that everything will look better tomorrow." 4. "I will sit here with you even if you choose not to talk with me." 5. "I think you need to realize that everyone has bad days from time to time."

1,2,4

The nurse is reviewing laboratory results of a digoxin level for the client taking digoxin. The digoxin level is 2.5 ng/mL, which indicates digoxin toxicity. Which signs and symptoms should the nurse note? Select all that apply. 1. Nausea 2. Syncope 3. Polyphagia 4. Bradycardia 5. Constipation

1,2,4

A client taking phenytoin has a serum phenytoin level of 30 mcg/mL. The nurse would expect to note which signs and symptoms on data collection of the client? Select all that apply. 1. Ataxia 2. Nausea 3. Tinnitus 4. Diplopia 5. Nystagmus 6. Hyperactive reflexes

1,2,4,5

A client taking phenytoin has a serum phenytoin level of 30 mcg/mL. The nurse should expect to note which signs and symptoms on data collection? Select all that apply. 1. Ataxia 2. Nausea 3. Tinnitus 4. Restlessness 5. Hyperactive reflexes 6. Respiratory rate of 9 breaths per minute

1,2,4,6

The nurse is caring for a client who was recently admitted to the inpatient unit of a psychiatric hospital with a diagnosis of delusions. Which are some therapeutic communication interventions the nurse needs to use when communicating with this client? Select all that apply. 1. Refer to hallucinations as if they are real. 2. Ask the client directly about the hallucinations. 3. Don't focus on reality-based, "here-and-now" activities such as conversations or simple projects. 4. Discourage the use of competing auditory stimuli such as listening to music through headphones. 5. Watch the client for cues that he or she is hallucinating, such as eyes tracking an unheard speaker, muttering, or talking to self. 6. Address any underlying emotion, need, or theme that seems to be indicated by the hallucination, such as fear with menacing voices or guilt with accusing voices.1,

1,2,5,6

A comatose client received therapeutic hypothermia after a cardiac arrest. The nurse anticipates which primary complications associated with this treatment? Select all that apply. 1. Infection 2. Bleeding 3. Hypoglycemia 4. Pressure ulcers 5. Renal insufficiency 6. Metabolic and electrolyte disturbances

1,2,6

After reviewing the psychosocial implications following a disaster, the nurse is assigned to care for a client who has just witnessed a mass shooting. Upon obtaining subjective information from the client, which actions should the nurse take? Select all that apply. 1. Remain calm and reassuring. 2. Allow the client to remain alone. 3. Convey caring behaviors towards the client. 4. Establish rapport and actively listen to the client. 5. Avoid discussing the disaster so that the client will not be upset.

1,3,4

The nurse is caring for a client at the end of life. The client is withdrawn and agitated and is experiencing visual hallucinations. Which actions should the nurse take to provide end-of-life psychological care? Select all that apply. 1. Provide privacy to the client and family. 2. Speak in a soft tone, but not directly to the client. 3. Encourage the family to talk with and reassure the client. 4. Encourage visits by appropriate spiritual services as desired. 5. Encourage family and visitors to avoid taking in the presence of the client to provide a calming environment.

1,3,4

The nurse is caring for a non-English-speaking client. Best practices for client safety and quality of care incorporates which actions by the nurse? Select all that apply. 1. Use interpreters who are familiar with health care. 2. Avoid eye contact with the client while communicating. 3. Avoid the use of relatives as interpreters to prevent misinterpretation. 4. Use dialect-specific interpreters who are the same gender if possible. 5. Become familiar with common health care words used in the client's language. 6. Remember most non-English-speaking clients cannot understand English phrases.

1,3,4,5

An Appalachian family has brought a toddler to the emergency department with a fractured arm. The nurse knows that nonverbal communication is important to evaluate with assessing the family. Which factors are involved in nonverbal communication? Select all that apply. 1. Touch 2. Intonation 3. Body posture 4. Use of space 5. Eye behavior 6. Facial expressions

1,3,4,5,6

Which information should the nurse provide to the client who will be receiving chemotherapy with doxorubicin? Select all that apply. 1. Alopecia can occur. 2. Stool may turn white. 3. Cardiotoxicity can occur. 4. Urine and sweat may turn red. 5. The medication is administered by the intravenous route. 6. Promptly report any signs of bleeding to the primary health care provider.

1,3,4,5,6

Which laboratory results indicate a therapeutic drug level? Refer to chart. Select all that apply. View Chart 1. 1 2. 2 3. 3 4. 4 5. 5 6. 6

1,3,5

The nurse is caring for an elderly Hispanic client who is a migrant farm worker and has been admitted for asthma. The nurse is unfamiliar with the cultural practices and beliefs of the client's home land. Which questions are appropriate for the nurse to ask when caring for this client? Select all that apply. 1. What do you believe is causing your illness? 2. Why don't you take some asthma medication? 3. Why do you wear that amulet around your neck? 4. Are there any remedies you have used in the past? 5. Who do you usually see for help when you are sick?

1,4,5

A 13-year-old child is diagnosed with osteogenic sarcoma of the femur. Following a course of chemotherapy, it is decided that leg amputation is necessary. Following the amputation, the child becomes very frightened because of aching and cramping felt in the missing limb. Which statement made by the nurse will best assist in alleviating the child's fear? 1. "The pain medication that I give you will take these feelings away." 2. "This aching and cramping are normal and temporary and will subside." 3. "This pain is not real pain and relaxation exercises will help it go away." 4. "This always occurs after the surgery, and we will teach you ways to deal with it.

A client arrives at the health care clinic for follow-up care and evaluation of the effectiveness of prazosin. Which finding indicates a therapeutic effect related to the use of this medication? 1. Increased platelet count 2. Decrease in blood pressure 3. Increased red blood cell count 4. Decrease in blood glucose level

A client taking an angiotensin-converting enzyme (ACE) inhibitor reviewed the medication information sheet and notes that the medication is used to treat hypertension. He states, "I have heart failure. Why am I taking this medicine?" The nurse responds by making which statement? 1. "There must be some mistake; I will check the medication prescriptions." 2. "The medication causes relaxation in your arteries and veins and decreases the heart's work." 3. "The medication makes your heart beat faster, and this improves blood flow to your tissues." 4. "An additional medication will be added to the ACE inhibitor to strengthen your heart muscle.

A client who has undergone femoropopliteal bypass grafting says to the nurse, "I hope I don't have any more problems that could make me lose my leg. I'm so afraid that I'll have gone through this for nothing." Which is an appropriate nursing response? 1. "There is nothing to worry about." 2. "You are concerned about losing your leg?" 3. "There are many people with the same problem, and they are doing just fine." 4. "You have the best health care provider in the city, and your health care provider will not let anything happen to you."

A client who was recently paroled as a sex offender is in therapy for pedophilia. The client says, "I've served my sentence and I'm still in therapy, so why does this group have posters of me all over the neighborhood? It has my picture on it and tells all about me." Which would be a therapeutic response by the nurse? 1. "It's sad for you, but when children are hurt as you hurt them, people want you identified and isolated." 2. "Are you saying that you understand people are afraid for their children but that you feel you are being unfairly treated?" 3. "You seem angry, but you must understand that your neighbors are frightened because of your serious crimes against children." 4. "Try to realize how fortunate you are that our society doesn't let the group escalate to more punitive measures after your crimes against children."

A client with a history of seizure disorder is having a routine serum phenytoin level drawn. The nurse who receives a telephone report of the results notes that the client's blood level of the medication is within the normal range if which value is reported? 1. 6 mcg/mL 2. 15 mcg/mL 3. 28 mcg/mL 4. 35 mcg/mL

A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. Which intervention would be appropriate to decrease the client's anxiety? 1. Administer a sedative. 2. Convey empathy, trust, and respect toward the client. 3. Ignore the signs and symptoms of anxiety so that they will soon disappear. 4. Make sure the client knows all the correct medical terms so that he or she can understand what is happening.

A client with pheochromocytoma is scheduled for surgery and says to the nurse, "I'm not sure that surgery is the best thing to do." Which response by the nurse is appropriate? 1. "I think you are making the right decision to have the surgery." 2. "You have concerns about the surgical treatment for your condition?" 3. "You are very ill. Your primary health care provider has made the correct decision." 4. "There is no reason to worry. Your primary health care provider is a wonderful surgeon."

A pregnant client experienced a uterine rupture with subsequent fetal death. After ensuring that the client is physiologically stable, the nurse should take which approach as the first step to support the client psychologically? 1. Avoid talking about the dead fetus. 2. Collect data regarding how the client perceived the event. 3. Ask the client and husband about plans for future pregnancies. 4. Suggest that family members see and hold the dead infant if they wish.

During a nursing interview, a client says, "My daughter was murdered in her New York apartment, and her estranged husband called to tell me. I can't stop myself from wondering if he killed her, but the police have ruled him out as a suspect." Which statement reflects a therapeutic nursing response? 1. "I agree. What do you want to bet he did it?" 2. "Have you shared your concerns with the police?" 3. "I don't think that you should blame yourself one little bit." 4. "It feels terrible to lose a daughter. I'd have suspicions about him, too."

The client is taking phenytoin for seizure control, and a blood sample for a serum drug level is drawn. Which laboratory finding indicates a therapeutic serum drug result? 1. 5 mcg/mL (19.84 mcmol/L) 2. 15 mcg/mL (59.52 mcmol/L) 3. 25 mcg/mL (99.2 mcmol/L) 4. 30 mcg/mL (119.0 mcmol/L)

The nurse awakens a client on the inpatient psychiatric unit for breakfast. The client replies, "Do you realize it's Sunday? I've worked hard here all week and this is my day of rest. I'll get up at 11:30." Which would be the nurse's best response? 1. "You have to get up right now. Those are the unit rules." 2. "Let me know if you change your mind, and I'll get you something to eat." 3. "I'm sorry you feel this way. I believe you are experiencing a religious delusion." 4. "Your primary health care provider expects you to participate in all the activities while you are a client here."

The nurse has been caring for a client with a diagnosis of depression. The client says to the nurse, "I wish you would just be my friend." The appropriate response by the nurse is which? 1. "I am your friend." 2. "Our relationship is a therapeutic and a helping one." 3. "I can't be your friend. I'm the nurse and you're the client." 4. "You have plenty of friends. You don't need me to be your friend, too."

The nurse is assisting in conducting a group therapy session. A client who has shared with the group at a previous session that she isolates herself when she feels depressed, suddenly gets up to leave. Which nursing action is appropriate? 1. Tell the client that it is not safe to leave. 2. Encourage the client to stay and ask the client what she is feeling. 3. Tell the client that if she leaves, she cannot return to this therapy group. 4. Lock the door so that the client cannot leave at this potentially vulnerable time.

The nurse is caring for a child with osteosarcoma following amputation of the left lower limb. The child is continually complaining of aching and cramping in the missing limb. Which action should the nurse take? 1. Request a referral for a psychiatric consultation. 2. Reassure the child that this is a temporary condition. 3. Tell the child that the prosthesis will relieve this sensation. 4. Ask the pediatrician for a prescription for a placebo.

The nurse is collecting data on a client diagnosed with mild depression. The client says to the nurse, "I haven't had an appetite at all for the last few weeks." Which response by the nurse would be therapeutic? 1. "The last few weeks?" 2. "You haven't had an appetite at all?" 3. "Once the medication begins to work, you will begin to feel better." 4. "Think about everything that you have been through. It will take time for your appetite to improve."

The nurse is collecting data on a client who was just admitted to the hospital with a diagnosis of coronary artery disease (CAD). The client reveals having been under a great deal of stress recently. Which should the nurse do next? 1. Ask whether the client wants to see a psychiatrist. 2. Explore with the client the sources of stress in life. 3. Reassure the client that everybody seems stressed these days. 4. Ask the client to write down a list of stressors to be evaluated at a later time.

The nurse working the evening shift is assisting clients in getting ready to go to sleep. A client diagnosed with obsessive-compulsive disorder (OCD) becomes upset and agitated and asks the nurse to sit down and talk. Which response by the nurse would be best at this time? 1. "No, we can't talk right now; it is bedtime." 2. "I can see that you're upset. I'm willing to listen." 3. "Try to get some sleep, and we will talk in the morning." 4. "I don't have time right now, but I'll get someone else to talk to you."

While providing one-to-one supervision, a client who attempted suicide tells the nurse, "I can never do anything right. I'm such a loser. It didn't even work when I tried to kill myself." Which is the appropriate nursing response? 1. "You're not a loser—you are just sick right now." 2. "You don't think you can ever do anything right?" 3. "Everything will get better—just you wait and see." 4. "What makes you think you can't do anything right?"

The nurse administers meclizine hydrochloride to a client diagnosed with an attack of Ménière's disease. Which observations demonstrate to the nurse that the medication is effective? Select all that apply. 1. Control of seizures 2. Decrease in nausea 3. Decrease in vertigo 4. Decrease in neck stiffness 5. Decrease in mental alertness 6. Decrease in severity of ear pain

2,3

The nurse is participating in a care plan session for a client with a terminal illness. Which nursing actions should be included? Select all that apply. 1. Follow standard care plans for end-of-life care. 2. Respond to requests from the client and family promptly. 3. Support the client's decision-making in order to promote client control. 4. Discuss sensitive topics quickly and efficiently to avoid upsetting the client and family. 5. Provide information about what to expect during the dying process to the client and family.

2,3,5

A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which findings are noted during assessment? Select all that apply. 1. Proteinuria of 3+ 2. Respirations of 10 breaths/minute 3. Presence of deep tendon reflexes 4. Urine output of 20 mL in an hour 5. Serum magnesium level of 6 mEq/L (3 mmol/L)

2,4,

A 10-year-old child in remission from leukemia is upset over the appearance of cushingoid characteristics from long-term use of corticosteroids that are currently being administered every other day. Which therapeutic statements should the nurse make to the child about the cushingoid appearance? Select all that apply. 1. "I am sure it will be all right; they hardly look unusual." 2. "Which manifestations of this condition do you find most troublesome?" 3. "You should talk to the primary health care provider about the cushingoid characteristics." 4. "The signs/symptoms are lessened by taking the prednisone every other day instead of daily." 5. "The cushingoid appearance will gradually disappear once the steroids are tapered and discontinued."

2,4,5

The nurse is assessing a client with bipolar disorder who is taking lithium carbonate and who has a lithium level of 1.7 mEq/L. The nurse would expect to find which sign/symptoms of lithium toxicity associated with this level? Select all that apply. 1. Polyuria 2. Incoordination 3. Fine hand tremor 4. Mental confusion 5. Muscle hyperirritability

2,4,5

A nurse about to give a daily dose of digoxin and notes that a serum digoxin level drawn earlier in the day measured 2.7 ng/mL. The nurse should take which actions? Select all that apply. 1. Administer the daily dose of the medication. 2. Report the finding to the registered nurse. 3. Administer foods rich in potassium to the client. 4. Record the normal value on the intershift report sheet. 5. Gather data from the client related to signs of toxicity.

2,5

The nurse on a behavioral health unit is having a therapeutic discussion with a client and recognizes that which communication techniques would be nontherapeutic? Select all that apply. 1. Offering self 2. Giving recognition 3. Minimizing feelings 4. Changing the subject 5. Asking "why" questions

3,4,5

A 5-week-old infant is brought to the well-baby clinic by the mother because the mother has noted white patches in the infant's mouth. Following examination, the infant is diagnosed with oral candidiasis (thrush). Nystatin oral suspension is prescribed. The mother is concerned because she is breastfeeding the infant and asks the nurse if breastfeeding can be continued. Which response is appropriate? 1. "Breastfeeding must be stopped immediately." 2. "You should bottle-feed the infant for 1 week and then resume breastfeeding." 3. "Breastfeeding can continue, but your breasts should also be treated with nystatin." 4. "You will need to take the oral nystatin also because the infant probably contracted the infection from you."

A client began taking amantadine approximately 2 weeks ago. A decrease in which should the nurse expect to see if the medication is having a therapeutic effect? 1. Anxiety 2. Hallucinations 3. Rigidity and akinesia 4. White blood cell count

A client brought to the emergency department is dead on arrival (DOA). The family of the client tells the primary health care provider that the client had terminal cancer. The emergency department primary health care provider examines the client and asks the nurse to contact the medical examiner regarding an autopsy. The family of the client tells the nurse that they do not want an autopsy performed. Which response to the family is appropriate? 1. "The decision is made by the medical examiner." 2. "An autopsy is mandatory for any client who is DOA." 3. "Your request will be given to the medical examiner when their office is contacted". 4. "It is required by federal law. Why don't we talk about it, and why don't you tell me how you feel?"

A client comes to the emergency department following an assault and is extremely agitated, trembling, and hyperventilating. Which initial nursing action is appropriate? 1. Begin to teach relaxation techniques. 2. Encourage the client to discuss the assault. 3. Remain with the client until the anxiety decreases. 4. Place the client in a quiet room alone to decrease stimulation.

A client is at risk for pulmonary embolism and is on anticoagulant therapy with warfarin sodium. The nurse is told that the client's prothrombin time is 18 seconds with a control of 11 seconds. Which action should the nurse plan? 1. Double the next dose of warfarin sodium. 2. Withhold the next dose of warfarin sodium. 3. Administer the next dose of warfarin sodium. 4. Cut the next dose of warfarin sodium in half.

A client is diagnosed with catatonic stupor. The client is lying on the bed, hidden under the sheets, with her body pulled into a fetal position. The nurse should take which appropriate action? 1. Ask direct questions to encourage talking. 2. Leave the client alone but check on her every 30 minutes. 3. Sit beside the client in silence with occasional open-ended questions. 4. Take the client into the dayroom with other clients for added supervision.

A client who experienced a myocardial infarction (MI) tells the nurse that he is fearful about not being able to return to a normal life. Which action by the nurse is therapeutic at this time? 1. Tell the client that his fears are not rational. 2. Tell the client that his life has not changed. 3. Explore specific concerns with the client. 4. Tell the client to talk it out with the significant other.

A client who is scheduled for surgery and who is to be placed in skeletal traction says to the nurse, "I'm not sure if I want to have this skeletal traction or if the skin traction would be best to stabilize my fracture." Based on the client's statement, the nurse should make which response to the client? 1. "There is no reason to be concerned. I have seen lots of these procedures." 2. "Skeletal traction is much more effective than skin traction in your situation." 3. "You have concerns about skeletal versus skin traction for your type of fracture?" 4. "Your fracture is very unstable. You will die if you don't have this surgery performed."

A client with Cushing's syndrome verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which response by the nurse is appropriate? 1. "Don't be concerned, this problem can be covered with clothing." 2. "This is permanent, but looks are deceiving and not that important." 3. "Usually, these physical changes slowly improve following treatment." 4. "Try not to worry about it. There are other things to be concerned about."

A pregnant woman reports to the health care clinic complaining of loss of appetite, weight loss, and fatigue. Following an assessment, tuberculosis is suspected. A sputum culture is obtained and identifies the Mycobacterium tuberculosis in the sputum. The nurse reinforces instructions to the client regarding therapeutic management of tuberculosis. Which statement is included in therapeutic management? 1. The need for therapeutic abortion is required. 2. Medication will not be started until after delivery of the fetus. 3. Isoniazid plus rifampin will be required for a total of 9 months. 4. The newborn infant must receive medication therapy immediately following birth.

A preoperative client expresses anxiety to the nurse about the upcoming surgery. Which response by the nurse is most likely to stimulate further discussion between the client and the nurse? 1. "If it's any help, everyone is nervous before surgery." 2. "I will be happy to explain the entire surgical procedure to you." 3. "Can you share with me what you've been told about your surgery?" 4. "Let me tell you about the care you'll receive after surgery and the amount of pain you can anticipate."

The nurse admitting a client to the hospital is reviewing the client's history and medications taken at home. Which condition in the client's history is being treated with tamoxifen citrate? 1. Diabetes mellitus 2. Positive tuberculin test 3. Metastatic breast cancer 4. History of cholecystectomy

A psychiatric client diagnosed with schizophrenia approaches the nurses' station and shouts, "Shut up. I told you to be quiet." Looking at the nurse, the client says, "Can't you hear them shouting at me?" Which would be the nurse's best response? 1. "How often are you hearing voices?" 2. "If you took your medications, you wouldn't be hearing voices." 3. "The voices aren't real. Go to the day room and watch television." 4. "I don't hear the voices, but I can see how upsetting it must be for you."

The nurse is caring for an older client whose husband died approximately 6 weeks ago. The client says, "There's no one left to care about me. Everyone that I have loved is now gone." The nurse should make which appropriate response? 1. "That doesn't sound like the real you talking!" 2. "I'm sure you have someone if you think hard enough." 3. "It sounds as though you are feeling all alone right now." 4. "I don't believe that, and I really don't think you do either."

The nurse is providing information to the mother of a child with nephrotic syndrome regarding the edematous appearance of the child. Which statement should the nurse make to the mother? 1. "Children always look a little bit fat, so don't be concerned." 2. "Dress the child in loose-fitting clothing to hide the extra weight." 3. "The fluid retention should be controlled by medication and diet." 4. "The child will always have this appearance, and preparing the child for the body image change is important."

The nurse working in a detoxification unit is admitting a client for alcohol withdrawal. The client's spouse states, "I don't know why I don't get out of this rotten situation." Which would be a therapeutic response by the nurse? 1. "This is not a good time to make that decision." 2. "What would your spouse think about your decision?" 3. "What aspects of this situation are the most difficult for you?" 4. "You seem to have a good grip of this situation; you probably need to get out."

The nurse working in an urgent care center is interviewing a woman with vague somatic complaints. The client states that she was raped a few weeks ago but still feels "as if it just happened to me." The nurse should make which therapeutic response to the client? 1. "It is very, very hard to get over these types of feelings after being raped." 2. "What do you think you need to do to reduce the likelihood that you will be raped again?" 3. "Tell me more about what happened that causes you to feel like the rape just occurred." 4. "It's hard, but try to keep a sense of perspective. After all, it's been a while since the rape occurred."

While the nurse is involved in preparing a client for a cardiac catheterization, the client says, "I don't want to talk with you. You're only the nurse. I want my doctor." Which response by the nurse should be therapeutic? 1. "Your doctor expects me to prepare you for this procedure." 2. "That's fine, if that's what you want. I'll call your health care provider." 3. "So you're saying that you want to talk to your health care provider?" 4. "I'm concerned with the way you've dismissed me. I know what I am doing."

While the nurse is providing care, a client angrily reports to the nurse that the primary health care provider purposefully provided wrong information about her diagnosis and states, "The doctor lied to me." Which nursing response would likely be a barrier to further communication with the client? 1. "Can you tell me more about the misinformation?" 2. "I'm not sure what information you are referring to." 3. "The primary health care provider would never lie to you." 4. "Have you thought about talking to your doctor about this?"

The 16-year-old client presents to the dermatology clinic with a diagnosis of acne vulgaris. The client says to the nurse, "I don't know what else to do! I wash my face twice a day. I wear noncomedogenic makeup. I shower after I work out. I guess I'm just going to have acne on my face forever." Which responses by the nurse would be appropriate? Select all that apply. 1. "You need to try witch hazel." 2. "I understand. When I was your age, I had acne problems, too." 3. "You feel like there's nothing else you can do to cure your acne." 4. "Your acne really isn't that bad! Our last client's acne was much worse." 5. "You seem frustrated by your acne. Please tell me what it is about your acne that is frustrating."

3,5

The nurse is preparing to care for a dying client and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply. 1. Discourage reminiscing. 2. Make the decisions for the family. 3. Encourage expression of feelings, concerns, and fears. 4. Explain everything that is happening to all family members. 5. Extend touch, and hold the client or family member's hand if appropriate. 6. Be honest and truthful, and let the client and family know that you will not abandon them.

3,5,6

A 15-year-old client who is pregnant and unwed, says, "My life was unbearable before I met Johnny. My mother beats me up every day and my dad has been sleeping with me since I was 10 years old!" Which response is appropriate for the nurse to make? 1. "Why didn't you just report your parents for abuse?" 2. "What are you saying? Your parents abused you, so you got pregnant?" 3. "Sounds like you decided to have a baby so you'd have someone for yourself." 4. "It seems that you needed help to separate from your family. Do you feel you are ready to have a baby with Johnny?"

A client admitted with depression states to the nurse, "My life has been such a failure; nothing I do turns out right." Which response by the nurse would be therapeutic? 1. "You are certainly entitled to your own opinion." 2. "I know just how you feel. I have those days myself once in a while." 3. "I disagree with you; we all have some value and accomplishments in life." 4. "You seem very discouraged. Can you think of anything recently that went as you planned?"

A client being seen in the emergency department for complaints of chest pain confides in the nurse about regular use of cocaine as a recreational drug. The nurse takes which important action in delivering holistic nursing care to this client? 1. Reports the client to the police for illegal drug use 2. Explains to the client the damage that cocaine does to the heart 3. Tells the client it is imperative to stop before myocardial infarction occurs 4. Teaches about the effects of cocaine on the heart and offers referral for further help

A client is experiencing impotence after taking an antihypertensive medication. The client states, "I would sooner have a stroke than keep living with the side effects of this medication." The nurse should make which appropriate response to the client? 1. "I can understand completely." 2. "You wouldn't really want to have a stroke." 3. "That health care provider should change your prescription." 4. "You are concerned about the side effects of your medication?"

A client is having trouble remembering his prescribed medication regimen. Which statement by the nurse is therapeutic? 1. "What is it you don't remember?" 2. "You can't always depend on your family to help." 3. "It's not really necessary for you to remember this." 4. "Let me go over your prescribed medications with you again."

A client with carcinoma of the breast is admitted to the hospital for treatment with intravenous vincristine. The client tells the nurse that she has been told by her friends that she is going to lose all her hair. After offering an open-ended question in reply, the client expresses how she feels. The nurse then gives the client information. The nurse makes which appropriate response to the client? 1. "Your friends are correct." 2. "You will not lose your hair." 3. "Hair loss may occur, but it will grow back just as it is now." 4. "Hair loss may occur, and it will grow back, but it may have a different color or texture."

A client with lung cancer says to the nurse, "I'm sick and tired of my family telling me not to worry and that a cure will be discovered before I know it." Which response by the nurse is therapeutic? 1. "Have you told your family how you feel?" 2. "They are right. You shouldn't be so worried." 3. "You certainly have enough to worry about right now." 4. "You're feeling angry that your family is hoping for a cure?"

A client with myxedema has changes in intellectual function such as impaired memory, decreased attention span, and lethargy. The client's husband is upset and shares his concerns with the nurse. Which statement by the nurse is helpful to the client's husband? 1. "Give it time. I've seen dozens of clients with this problem that fully recover." 2. "I don't blame you for being frustrated because the symptoms will only get worse." 3. "Would you like me to ask the primary health care provider for a prescription for a stimulant?" 4. "It's seems that you are concerned about your wife's condition, but the symptoms may improve with continued therapy.

A female client with myasthenia gravis comes to the primary health care provider's office for a scheduled office visit. The client is very concerned and tells the nurse that her husband seems to be avoiding her because she is very unattractive. Which is the appropriate nursing response? 1. "You need to look at the positives in life." 2. "You need to deal with this concern because it is a reality." 3. "Would you consider joining a peer support group for help?" 4. "Have you thought about sharing your feelings with your husband?"

A hospitalized client tells the nurse that a living will is being prepared and that the lawyer will be bringing the will to the hospital today for witness signatures. The client asks the nurse for assistance in obtaining a witness to the will. Which response to the client is appropriate? 1. "I will sign as a witness to your signature." 2. "You will need to find a witness on your own." 3. "Whoever is available at the time will sign as a witness for you." 4. "I will call the nursing supervisor to seek assistance regarding your request."

A nursing student notes in the medical record that a client with Cushing's syndrome is experiencing body image disturbances. A need for further teaching regarding this problem is identified when the nursing student suggests which nursing intervention? 1. Encouraging the client's expression of feelings 2. Evaluating the client's understanding of the disease process 3. Encouraging family members to share their feelings about the disease process 4. Evaluating the client's understanding that the body changes need to be dealt with

A pregnant anemic client is concerned about her baby's condition following delivery. Which nursing response best supports the client? 1. "I wouldn't worry about your baby's health; complications from this condition are generally rare." 2. "Your baby will likely need to spend a few days in the neonatal intensive care unit for observation following delivery." 3. "Your baby will not have any problems if you follow all the advice the primary health care provider has given you during your pregnancy." 4. "The effects of anemia on your baby are difficult to predict, but let's review your plan of care to ensure you are providing the best nutrition and growth potential."

A pregnant client who has gestational diabetes mellitus tells the nurse that she is concerned about what her baby's condition will be following delivery. Which nursing response best supports the client? 1. "I am sure your baby will be fine." 2. "You will not have any problems if you keep your blood sugar in control." 3. "Your baby will need to spend most of the time in the nursery after delivery." 4. "Better blood glucose control means fewer effects; let's review your plan of care."

After 5 days in the psychiatric unit, a manic client is able to tolerate short periods in the dayroom. The nurse overhears the client telling another client that he is a journalist posing as a client in order to write an article for a magazine. Which response is the nurse's best action? 1. Ignore the delusion. 2. Take the client to a quiet room. 3. Support the client's denial of illness. 4. Privately confront the client with reality.

An adolescent who has been reported for drawing sexually explicit scenes in her school textbooks says to the psychiatric nurse, "I just felt like it." Which response is therapeutic for the nurse to make in order to assess abuse-related symptoms? 1. "Well, a picture paints a thousand words." 2. "You just felt like destroying your textbooks?" 3. "Your parents and teachers are very concerned about your drawings." 4. "I am concerned about you. Are you now or have you ever been abused?"

The client diagnosed with Lyme disease tells the nurse, "I heard this disease can affect the heart. Is this true?" The nurse should make which response to the client? 1. "Where did you get your information?" 2. "Yes, that's true but it rarely ever occurs." 3. "It primarily affects the joints with the occasional facial paralysis." 4. "It can, but you will be monitored closely for cardiac complications."

The nurse is working with a client who is delusional. The client says to the nurse, "The leaders of a religious cult are being sent to assassinate me." Which is the best response by the nurse? 1. "I don't believe that what you are telling me is true." 2. "There are no religious cults in this area that are going to kill you." 3. "What makes you think that cult members are being sent to hurt you?" 4. "I don't know about a religious cult. Are you afraid that people are trying to hurt you?"

The nurse notes that a client with acquired immunodeficiency syndrome (AIDS) appears anxious and is reluctant to ask questions. Which action should the nurse take to best address these observations? 1. Minimize the time spent talking to the client. 2. Ask the client why he or she is reluctant to ask questions. 3. Ask a family member to be present when caring for the client. 4. Discuss common fears and questions expressed by other clients with the same diagnosis.

A client has been admitted to the maternity unit for a scheduled cesarean section. As she is getting into bed for preliminary preparation for surgery, the client states, "I don't need the cesarean section after all because I think my baby has moved around." Which is the appropriate response by the nurse? 1. "Tell me what you mean when you say that your baby has moved." 2. "The primary health care provider is all set to go and cannot change plans now." 3. "That would be impossible because babies don't move around this late." 4. "You need to listen to your primary health care provider; he knows what he is doing."

A client receiving chemotherapy asks the nurse, "What will I do when my hair starts to fall out?" Which action by the nurse is therapeutic? 1. Assist her to express feelings. 2. Offer to help her select a new hairstyle. 3. Ignore the comment and change the subject. 4. Tell her that people don't pay attention to such things anymore.

A client says to the home care nurse, "I can't believe that my wife died yesterday. I keep expecting to see her everywhere I go in this house ready to plan our activities for the day." Which is the therapeutic nursing response? 1. "It must be hard to accept that she has passed away." 2. "Are you saying that she made all the social plans for you?" 3. "Focus on the fact that her suffering is over and that she had a good life with you." 4. "Try to focus on the fact that you have three wonderful children and that you and your wife loved one another for years."

The parents of a 16-year-old child tell the nurse that they are concerned because the child sleeps until noon every weekend. Which is the most appropriate nursing response? 1. "Adolescents love to sleep late in the morning." 2. "The child shouldn't be staying up so late at night." 3. "If the child eats properly, that shouldn't be happening." 4. "The child should have a blood test to check for anemia."

A female victim of a sexual assault is being seen in the crisis center. The client states that she still feels "as though the rape just happened yesterday," even though it has been a few months since the incident. Which nursing response is appropriate? 1. "You need to try to be realistic. The rape did not just occur." 2. "It will take some time to get over these feelings about your rape." 3. "Tell me more about what causes you to feel like the rape just occurred." 4. "What do you think that you can do to alleviate some of your fears about being raped again?"

A Hispanic-American mother brings her child to the clinic for an examination.Which is most important when gathering data about the child? 1. Avoiding eye contact 2. Using body language only 3. Avoiding speaking to the child 4. Touching the child during the examination

A client states to the nurse, "I haven't slept at all the last couple of nights." The nurse should make which therapeutic response to the client? 1. "Go on...." 2. "Sleeping?" 3. "The last couple of nights?" 4. "Tell me about your difficulty sleeping."

The nurse is teaching the client with myasthenia gravis about prevention of myasthenic and cholinergic crises. The nurse tells the client that this is most effectively done by which activity? 1. Eating large, well-balanced meals 2. Doing muscle-strengthening exercises 3. Doing all chores early in the day while less fatigued 4. Taking medications on time to maintain therapeutic blood levels

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 32% 2. Platelet count of 400,000 mm3 3. White blood cell count of 6000 mm3 4. Blood urea nitrogen (BUN) level of 15 mg/dL

A client with chronic kidney disease is receiving epoetin alfa. Which laboratory result would indicate a therapeutic effect of the medication? 1. Hematocrit of 33% (0.33) 2. Platelet count of 400,000 mm3 (400 × 109/L) 3. White blood cell count of 6000 mm3 (6.0 × 109/L) 4. Blood urea nitrogen level of 15 mg/dL (5.25 mmol/L)

The student nurse is being taught by the registered nurse (RN) how to collect data from a client and is attempting to obtain subjective data regarding the client's sexual reproductive status. The client states, "I don't want to discuss this; it's private and personal." Which response by the student nurse indicates a need for further teaching? 1. "I am the nurse and, as such, I'll have you know that all information is kept confidential." 2. "I realize this is hard for you to speak about, but anything you tell me will be kept strictly confidential." 3. "I know that some of these questions are difficult for you, but as the nurse, I must legally respect your confidentiality." 4. "I understand you must hate being asked these sorts of questions, but I promise anything you tell me will be kept private."

A client who has just received a diagnosis of asthma says to the nurse, "This condition is just another nail in my coffin." Which response by the nurse is therapeutic? 1. "Do you think that having asthma will kill you?" 2. "You seem very distressed over learning you have asthma." 3. "I'm not going to work with you if you can't view this as a challenge rather than a 'nail in your coffin.'" 4. "Asthma is a very treatable condition. It is important to properly administer your medications. Let's practice with your inhalant."

A client with epilepsy is taking the prescribed dose of phenytoin to control seizures. A phenytoin blood level is drawn, and the results reveal a level of 35 mcg/mL. Which symptom would be expected as a result of this laboratory result? 1. Nystagmus 2. Tachycardia 3. Slurred speech 4. No symptoms, because this is a normal therapeutic level

In the prenatal clinic, the nurse is gathering data from a new client for the health history information. Which action is the best way for the nurse to elicit correct responses to questions that refer to sexually transmitted infections? 1. Use specific closed-ended questions. 2. Omit this area of questions because they are highly personal. 3. Establish a therapeutic relationship between the nurse and pregnant client. 4. Apologize for the embarrassment that these questions may cause the client.

A client is being encouraged to attend music therapy as part of the individual plan of care. The client refuses to attend and states that he "cannot sing." Which response by the nurse is therapeutic? 1. "You must go. You have no choice." 2. "Life is short! Enjoy it while you can." 3. "Why don't you really want to attend?" 4. "Perhaps you could just enjoy the music without singing."

The nurse is assigned to care for a client who is agitated. On entering the room, the client screams, "Why don't you just leave me alone?" The nurse should make which therapeutic response to the client? 1. "Don't yell at me." 2. "Why do you feel this way?" 3. "I am calling your psychiatrist!" 4. "I can see that you are upset. I'll be back in a few minutes to see how you are doing."

The nurse is assisting in conducting a group therapy session and a client with a manic disorder is monopolizing the group. The appropriate nursing action is which? 1. Ask the client to leave. 2. Refer the client to another group. 3. Tell the client to stop monopolizing the group. 4. Suggest that the client stop talking and try listening to others.

Which are appropriate interventions for caring for the client undergoing alcohol withdrawal? Select all that apply. 1. Monitor vital signs. 2. Maintain an NPO status. 3. Provide a safe environment. 4. Address hallucinations therapeutically. 5. Provide stimulation in the environment. 6. Provide reality orientation as appropriate.

1,3,4,6

A client who is experiencing suicidal thoughts says to the nurse, "It just doesn't seem to be worth it anymore. Why not just end it all?" Which initial nursing response is appropriate? 1. "Did you sleep last night?" 2. "What do you mean by that?" 3. "I'm sure your family loves you." 4. "I know you don't feel good about yourself."

Heparin sodium is prescribed for the client. Which laboratory result indicates that the heparin is prescribed at a therapeutic level? 1. Thrombocyte count of 100,000 mm3 2. Prothrombin time (PT) of 21 seconds 3. International normalized ratio (INR) of 2.3 4. Activated partial thromboplastin time (aPTT) of 55 seconds

A client taking lithium carbonate reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is checked as a part of the routine follow-up, and the level is 3.0 mEq/L (3.0 mmol/L). The nurse knows that this is which level? 1. Toxic 2. Normal 3. Slightly above normal 4. Excessively below normal

A manic client announces to everyone in the dayroom that a stripper is coming to perform that evening. When the psychiatric nurse's aide firmly states that the client's behavior is not appropriate, the manic client becomes verbally abusive and threatens physical violence to the nurse's aide. Based on the analysis of this situation, the nurse determines that the appropriate action should be which intervention? 1. Escort the manic client to his or her room. 2. Orient the client to time, person, and place. 3. Tell the client that the behavior is not appropriate. 4. Tell the client that smoking privileges are revoked for 24 hours.

Which nursing approach is important when administering an antianxiety agent to a client with acute, severe anxiety? 1. Stay with the client until the medication becomes effective. 2. Crush the medication and disguise it in the client's meal items. 3. Ask the client why he or she is experiencing so much anxiety. 4. Explain that restricting alcohol is not necessary while taking this medication.

1,2,3,5

The nurse in the mental health unit reviews the therapeutic and nontherapeutic communication techniques with a nursing student. Which are therapeutic communication techniques? Select all that apply. 1. Restating 2. Listening 3. Asking the client, "Why?" 4. Maintaining neutral responses 5. Giving advice, approval, or disapproval 6. Providing acknowledgment and feedback

1,2,4,6

The nurse has given medication instructions to the client receiving phenytoin. The nurse determines that the client understands the instructions if the client makes which comments? Select all that apply. 1. "I should not suddenly stop taking this medication." 2. "Alcohol is not contraindicated while taking this medication." 3. "Good oral hygiene is needed, including brushing and flossing." 4. "The medication dose may be self-adjusted, depending on side effects." 5. "The morning dose of the medication should be taken before a sample for a serum drug level is drawn."

1,3,

A client has died, and the nurse asks a family member about the funeral arrangements. The family member refuses to discuss the issue. Which is the appropriate nursing action? 1. Show acceptance of feelings. 2. Provide information needed for decision making. 3. Suggest a referral to a mental health professional. 4. Remain with the family member without discussing funeral arrangements.

A client is fearful about having an arm cast removed. Which action by the nurse would be the most helpful? 1. Telling the client that the saw makes a frightening noise 2. Reassuring the client that no one has had an arm lacerated yet 3. Stating that the hot cutting blades cause burns only very rarely 4. Showing the client the cast cutter and explaining how it works

A client with spinal cord injury becomes angry and belligerent whenever the nurse tries to administer care. Which is the best response by the nurse? 1. Ask the family to deliver the care. 2. Leave the client alone until ready to participate. 3. Advise the client that rehabilitation progresses more quickly with cooperation. 4. Acknowledge the client's anger and continue to encourage participation in care.

A hospitalized client who is experiencing delusions and has a diagnosis of schizophrenia says to the nurse, "I know that the doctor is talking to the CIA to get rid of me." Which should be the nurse's best response? 1. "I don't believe this is true." 2. "The doctor is not talking to the CIA." 3. "What makes you think the doctor wants to get rid of you?" 4. "I don't know anything about the CIA. Do you feel afraid that people are trying to hurt you?"

A pregnant woman reports that she has just finished taking the prescribed antibiotics to treat a urinary tract infection. The mother expresses concern that her baby will be born with an infection. Which response should the nurse make to help reduce the maternal fears that the newborn will be born with an infection? 1. "Urinary infections during pregnancy are common. Your baby will be fine." 2. "Your developing baby cannot acquire an infection from you during pregnancy." 3. "You shouldn't worry about this because you received early prenatal care and are taking your prenatal vitamins." 4. "Now that you have taken the medication as prescribed, we will continue to monitor you closely by repeating the urine culture before you leave today."

The client is taking docusate sodium. The nurse should monitor which result to determine the client is having a therapeutic effect from this medication? 1. Abdominal pain 2. Reduction in steatorrhea 3. Hematest-negative stools 4. Regular bowel movements

Which should be the anticipated therapeutic outcome of an escharotomy procedure performed for a circumferential arm burn? 1. The return of distal pulses 2. Decreasing edema formation 3. Brisk bleeding from the injury site 4. The formation of granulation tissue

The nurse is caring for a client who is suspected of being dependent on drugs. Which question should be appropriate for the nurse to ask when collecting data from the client regarding drug abuse? 1. "Why did you get started on these drugs?" 2. "How much do you use and what effect does it have on you?" 3. "How long did you think you could take these drugs without someone finding out?" 4. The nurse does not ask any questions because of fear that the client is in denial and will throw the nurse out of the room.

A client is 8 weeks pregnant and has waves of nausea accompanied by vomiting throughout the day. Food odors consistently precipitate the nausea. Her husband has an important business dinner planned, and she is reluctant to attend because of the nausea and vomiting. This has placed a strain on the husband-wife relationship. Which statement by the nurse indicates an understanding of the problem? 1. "You are afraid your husband will go to dinner without you." 2. "You feel you are having difficulty fulfilling your role as a wife." 3. "You are not physically able to go to dinner and should stay at home." 4. "You should go to dinner. Others will understand if you don't feel well."

A client is admitted to the hospital with a diagnosed bowel obstruction secondary to a recurrent diagnosed malignancy. The primary health care provider plans to insert a Miller-Abbott tube. When the nurse tries to explain the procedure, the client interrupts the nurse and states, "I don't want to hear about that. Just let the doctor do it." Based on the client's statement, which action should the nurse determine is best? 1. Leave the room. 2. Remain with the client and be silent. 3. Ask the client whether he would like another nurse to care for him. 4. Explain to the client that all clients have the right to know about medical procedures.

A client with a history of seizures is taking phenytoin for seizure control. The client arrives at the health care clinic, and a serum phenytoin drug level is drawn. The laboratory calls the nurse and reports a result of 10 mcg/mL. Which interpretation should the nurse make of this value? 1. The laboratory value represents a toxic level. 2. The laboratory value represents an inadequate drug level. 3. The laboratory value is at the low end of therapeutic range. 4. The laboratory value is at the high end of therapeutic range

A client has had extensive surgery on the gastrointestinal tract and has been started on total parenteral nutrition (TPN). The client tells the nurse, "I think I'm going crazy. I feel like I'm starving, and yet that bag is supposed to be feeding me." Which is the best response from the nurse? 1. "Don't worry. Many others in your situation say the same thing." 2. "That is unusual. I wonder if the solution is being mixed correctly?" 3. "That is because the empty stomach sends signals to the brain to stimulate hunger." 4. "Maybe you should ask your primary health care provider about that; I've never heard of that before."

A client hospitalized with a paranoid disorder refuses to turn off the lights in the room at night and states, "My roommate will steal me blind." Which is an appropriate response by the nurse? 1. "Why do you believe this?" 2. "Tell me more about the details of your belief." 3. "I hear what you are saying, but I don't share your belief." 4. "If you want a pass for tomorrow evening's movie, you'd better turn that light off this minute."

A client is somewhat nervous about having magnetic resonance imaging (MRI). Which statement by the nurse should provide reassurance to the client about the procedure? 1. "You will be able to eat before the procedure unless you get nauseated easily. If so, you should eat lightly." 2. "The MRI machine is a long, hollow narrow tube, and may make you feel somewhat claustrophobic." 3. "Even though you are alone in the scanner, you will be in voice communication with the technologist during the procedure." 4. "It is necessary to remove any metal or metal-containing objects before having the MRI done to avoid the metal being drawn into the magnetic field."

A client is admitted to the in-patient unit and is being considered for electroconvulsive therapy (ECT). The client appears calm, but the family is hypervigilant and anxious. The client's mother begins to cry and states, "My child's brain will be destroyed. How can the doctor do this?" The nurse should make which therapeutic response? 1. "It sounds as though you need to speak to the psychiatrist." 2. "Perhaps you'd like to see the ECT room and speak to the staff." 3. "Your child has decided to have this treatment. You should be supportive of the decision." 4. "It sounds as though you have some concerns about the ECT procedure. Why don't we sit down together and discuss any concerns you may have?"

A client with depression who has attempted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." The nurse should make which therapeutic response to the client? 1. "I don't see you as a failure." 2. "You have everything to live for." 3. "Feeling like this is all part of being ill." 4. "You've been feeling like a failure for a while?"

During a conversation with a depressed client on a psychiatric unit, the client says to the nurse, "My family would be better off without me." The nurse should make which therapeutic response to the client? 1. "Have you talked to your family about this?" 2. "Everyone feels this way when they are depressed." 3. "You will feel better once your medication begins to work." 4. "You sound very upset. Are you thinking of hurting yourself?"

The nurse is monitoring a client receiving furosemide 40 mg orally daily. Which indicator should inform the nurse that a therapeutic effect has occurred? 1. A sodium level of 130 mEq/L 2. A potassium level of 3.1 mEq/L 3. The presence of dependent edema 4. A blood pressure of 128/80 mm Hg

A depressed client verbalizes feelings of low self-esteem and self-worth typified by statements such as "I'm such a failure. I can't do anything right!" Which action should the nurse take? 1. Tell the client that this is not true and that we all have a purpose in life. 2. Remain with the client and sit in silence until the client verbalizes feelings. 3. Identify recent behaviors or accomplishments that demonstrate skill or ability. 4. Reassure the client that you know how the client is feeling and that things will get better.

A long-term care resident with a history of paranoid schizophrenia refuses to eat and tells the nurse that she believes that someone is poisoning the food. The nurse should make which therapeutic response to the client? 1. "Why do you think this way?" 2. "Here, I'll taste the food for you." 3. "It must be frightening to you. Has something made you feel that your food is poisoned?" 4. "Your food is not poisoned. Our kitchen staff are nice people, and they are not allowed to poison people."

During a group meeting, a client diagnosed with posttraumatic stress disorder (PTSD) verbalizes difficulty with maintaining realistic behavior. Which response by the nurse would be therapeutic? 1. "Don't worry so much." 2. "Everything is going to be all right." 3. "I can see that you are upset about this. Let's talk about this some more." 4. "Why are you having so much trouble with maintaining realistic behavior?"

A client informs the nurse that she has been taking acarbose as prescribed. The nurse determines that a therapeutic effect of the medication has occurred if which laboratory value is noted? 1. A serum lipase of 100 units/L 2. A sodium level of 140 mEq/L 3. A blood urea nitrogen (BUN) level of 15 mg/dL 4. A 2-hour postprandial serum glucose of 120 mg/dL

During an office visit, a prenatal client with mitral stenosis states she has been under a lot of stress lately. During data collection, the client questions everything the nurse does and behaves in an anxious manner. Which is the appropriate nursing response or action at this time? 1. Tell the client not to worry. 2. Refer the client to a counselor. 3. Ignore the client's unfounded concerns and continue. 4. Explain the purpose of the nurse's actions and answer all questions.

Mannitol is being administered to a client with increased intracranial pressure following a head injury. The nurse assisting in caring for the client knows that which indicates the therapeutic action of this medication? 1. Prevents the filtration of sodium and water through the kidneys 2. Prevents the filtration of sodium and potassium through the kidneys 3. Decreases water loss by promoting the reabsorption of sodium and water in the loop of Henle 4. Induces diuresis by raising the osmotic pressure of glomerular filtrate, thereby inhibiting tubular reabsorption of water and solutes

The nurse is assigned to assist in the care of a client with obsessive-compulsive disorder (OCD). The nurse should place priority on which action when planning care for this client? 1. Demand active participation in care. 2. Monitor for obsessive-compulsive behavior. 3. Educate the client about self-care demands. 4. Establish a trusting nurse-client relationship.

The nurse is caring for a hospitalized client with a mechanical heart valve who is receiving maintenance therapy of warfarin sodium. The client's international normalized ratio (INR) is 3. The nurse anticipates which prescription? 1. Adding a dose of heparin 2. Holding the next dose of warfarin sodium 3. Increasing the next dose of warfarin sodium 4. Administering the next dose of warfarin sodium

The nurse is caring for an older adult client who has recently lost her husband. The client says, "No one cares about me anymore. All the people I loved are dead." Which response by the nurse is therapeutic? 1. "Right! Why not just 'pack it in'?" 2. "That seems rather unlikely to me." 3. "I don't believe that, and neither do you." 4. "You must be feeling all alone at this point."

A stillborn was delivered in the birthing suite a few hours ago. After the birth, the family has remained together, touching the baby. Which statement by the nurse should further assist the family in their initial period of grief? 1. "Would you like to hold your baby?" 2. "We need to take the baby from you now so that you can get some sleep." 3. "Don't worry; there is nothing you could have done to prevent this from happening." 4. "We will see to it that you have an early discharge so that you don't have to be reminded of this experience."

A young pregnant woman with diabetes mellitus has lost 10 pounds during the first 15 weeks of gestation. The client tells the nurse, "I do not eat regular meals." Based on the client's statement, which is the best response by the nurse? 1. "Can you tell me more about what you are eating?" 2. "If you do not eat regular meals, you will hurt your baby." 3. "It does not matter anymore how much weight you gain." 4. "I'll have the primary health care provider review your diet history."

The home care nurse is assigned to care for the client who returned home following treatment for a sprained ankle. The nurse notes that the client was sent home with crutches that have rubber axillary pads and needs to reinforce instructions regarding crutch walking. On data collection, the nurse discovers that the client has an allergy to latex. Before providing instructions regarding crutch walking, the nurse should do which action? 1. Cover the crutch pads with cloth. 2. Contact the primary health care provider (PHCP). 3. Call the local medical supply store, and ask for a cane to be delivered. 4. Tell the client that the crutches must be removed immediately from the house.

The mother of 6-year-old twins says to the nurse, "My mother-in-law doesn't think our children should come to the funeral service for their grandfather. What do you advise?" Which response made by the nurse would be most appropriate? 1. "What do you and your husband believe is the right thing for your children?" 2. "By all means have them attend. Not to do so would promote postmortem grief." 3. "It's a difficult decision, but given their young age, perhaps omitting the wake and just including the funeral should be best." 4. "I agree with your mother-in-law. Your mother-in-law is upset enough as it is. Tell your children that their grandfather is in heaven."

A client is admitted to the nursing unit after a left below-knee amputation following a crush injury to the foot and lower leg. The client tells the nurse, "I think I'm going crazy. I can feel my left foot itching." How does the nurse correctly interpret the client's statement? 1. "It is a normal response and indicates the presence of phantom limb pain." 2. "It is a normal response and indicates the presence of phantom limb sensation." 3. "It is an abnormal response and indicates that the client is in denial about the limb loss." 4. "It is an abnormal response and indicates that the client needs more psychological support."

A woman whose husband died 2 months ago says to the visiting nurse, "My daughter came over yesterday to help me move my husband's things out of our bedroom, and I was so angry with her for moving his slippers from where he always kept them under his side of our bed. She doesn't know how much I'm hurting." Which statement by the nurse would be therapeutic? 1. "I know just how you feel because I lost my husband last summer." 2. "It's okay to grieve and be angry with your daughter and anyone else for a time." 3. "You need to focus on the many good years you both enjoyed together and move on." 4. "Although it's a troubling time for you, try to focus on your children and grandchildren."

Laboratory work is prescribed for a client who has been experiencing delusions. When the laboratory technician approaches the client to obtain a specimen of the client's blood, the client begins to shout, "You're all vampires. Let me out of here!" The nurse present at the time should respond with which question or statement? 1. "The technician is not going to hurt you but is going to help." 2. "Are you fearful and think that others may want to hurt you?" 3. "What makes you think that the technician wants to hurt you?" 4. "The technician will leave and come back later for your blood."

The client who frequently uses nonsteroidal antiinflammatory drugs (NSAIDs) has been taking misoprostol. The nurse determines that this medication is having the intended therapeutic effect if which is noted? 1. Resolved diarrhea 2. Relief of epigastric pain 3. Decreased platelet count 4. Decreased white blood cell count

The nurse is providing care for a client admitted to the hospital with a diagnosis of anxiety disorder. The nurse is talking with the client, and the client says, "I have a secret that I want to tell you. You won't tell anyone about it, will you?" Which is the appropriate nursing response? 1. "No, I won't tell anyone." 2. "I cannot promise to keep a secret." 3. "If you tell me the secret, I will tell it to your doctor." 4. "If you tell me the secret, I will need to document it in your record."

The nurse is reinforcing instructions to the mother of an 8-year-old child who had a tonsillectomy. The mother tells the nurse that the child loves tacos and asks when the child can safely eat one. The nurse should make which response to the mother? 1. "In 1 week" 2. "In 3 weeks" 3. "Two days following surgery" 4. "When the primary health care provider says it's OK"

When teaching a client who is being started on imipramine hydrochloride, when should the nurse tell the client that the medication would have the desired effects? 1. Desired effects start during the first week of administration. 2. Desired effects do not occur for 2 to 3 weeks of administration. 3. Desired effects start immediately following initial administration. 4. Desired effects do not occur until after 2 months of administration.

A client who is diagnosed with pedophilia and recently has been paroled as a sex offender says, "I'm in treatment and I have served my time. Now this group has posters all over the neighborhood with my photograph and details of my crime." Which is an appropriate response by the nurse? 1. "When children are hurt the way you hurt them, people want you isolated." 2. "You're lucky it doesn't escalate into something pretty scary after your crime." 3. "You understand that people fear for their children, but you're feeling unfairly treated?" 4. "You seem angry, but you have committed serious crimes against several children, so your neighbors are frightened."

A client with Parkinson's disease is embarrassed about the symptoms of the disorder and is bored and lonely. The nurse should plan which approach as therapeutic in assisting the client to cope with the disease? 1. Plan only a few activities for the client during the day. 2. Cluster activities at the end of the day when the client is most bored. 3. Encourage and praise perseverance in exercising and performing ADL. 4. Assist the client with activities of daily living (ADL) as much as possible.

The nurse finds a client tensing while lying in bed staring at the cardiac monitor. The client states, "There sure are a lot of wires around there. I sure hope we don't get hit by lightning!" Which is the nurse's best response? 1. "Would you like a mild sedative to help you relax?" 2. "Oh, don't worry, the weather is supposed to be sunny and clear today." 3. "Yes, this equipment is a little scary. Can we talk about how the cardiac monitor works?" 4. "I can appreciate your concerns. Your family can stay with you tonight if you want them to."

The nurse is preparing a client for an intravesical instillation of an alkylating chemotherapeutic agent into the bladder for the treatment of bladder cancer. The nurse provides instructions to the client regarding the procedure. Which client statement indicates an understanding of this procedure? 1. "I need to stay on bed rest after the procedure is completed." 2. "I will need to immediately urinate after the instillation is done." 3. "After the instillation is done, I will need to retain the fluid for 30 minutes." 4. "After the instillation is done, I will need to change position every 15 minutes from side to side."

Desmopressin acetate is prescribed for the treatment of diabetes insipidus. The nurse monitors the client after medication administration for which therapeutic response? 1. Decreased urinary output 2. Decreased blood pressure 3. Decreased peripheral edema 4. Decreased blood glucose level

The nurse is caring for a client after an autograft of a burn wound on the right knee. Which position should the nurse anticipate being prescribed for the client? 1. Placing the affected leg flat 2. Elevating and immobilizing the affected leg 3. Immobilizing the client in a dependent position 4. Placing the affected leg in a dependent position

The nurse is preparing a 2-year-old child with suspected nephrotic syndrome for a renal biopsy to confirm the diagnosis. The mother asks the nurse, "Will my child ever look thin again?" The nurse should respond by giving which statement? 1. "Do you feel guilty about your child's weight gain?" 2. "In most cases, medication and diet will control fluid retention." 3. "Wearing loose-fitting clothing should help conceal the extra weight." 4. "When children are little, it's expected that they'll look a little chubby."

A client is diagnosed with cancer and is told that surgery followed by chemotherapy will be necessary. The client states to the nurse, "I have read a lot about complementary therapies. Do you think I should try any?" The nurse should respond by making which appropriate statement? 1. "I would try anything that I could if I had cancer." 2. "No, because it will interact with the chemotherapy." 3. "Tell me what you know about complementary therapies." 4. "You need to ask your primary health care provider about it."

The nurse is caring for a client with schizophrenia who states, "I decided not to take my medication because I realize that it really can't help me. Only I can help me." Which nursing response would be therapeutic? 1. "Only you can help?" 2. "You decided not to take your medication?" 3. "Do you recall needing to be hospitalized because you stopped your medication?" 4. "If you can make this wise observation, you probably don't need your medication any longer."

The spouse of a client admitted to the hospital for alcohol withdrawal says to the nurse, "I should get out of this bad situation." The most helpful response by the nurse should be which statement? 1. "Why don't you tell your husband about this?" 2. "This is not the best time to make that decision." 3. "What do you find difficult about this situation?" 4. "I agree with you. You should get out of this situation."

After a precipitous delivery, the nurse notes that the new mother is passive and only touches her newborn briefly with her fingertips. The nurse should do which to help the woman process what has happened? 1. Support the mother in her reaction to the newborn. 2. Encourage the mother to breastfeed soon after birth. 3. Tell the mother that it is important to hold the newborn. 4. Document a complete account of the mother's reaction in the birth record.

he nurse is caring for a client who says, "I don't want you to touch me. I'll take care of myself!" The nurse should make which therapeutic response to the client? 1. "If you didn't want our care, why did you come here?" 2. "Why are you being so difficult? I only want to help you." 3. "Sounds like you're feeling pretty troubled by all of us. Let's work together so you can do everything for yourself as you request." 4. "I will respect your feelings. I'll just leave this cup for you to collect your urine in. After breakfast, I will take more blood from you."

Surgery has been recommended for the client with otosclerosis. The client tells the nurse that she would prefer not to have surgery and asks the nurse about alternative methods to improve hearing. The nurse should make which appropriate response to the client? 1. "A hearing aid may improve your hearing." 2. "There are no other methods to improve hearing." 3. "You need to have surgery because it has been recommended." 4. "Your primary health care provider is the best. You need to do what the primary health care provider suggests."

A client says to the nurse, "I'm going to die, and I wish my family would stop hoping for a 'cure'! I get so angry when they carry on like this! After all, I'm the one who's dying." Which therapeutic response should the nurse make to the client? 1. "Have you shared your feelings with your family?" 2. "I think we should talk more about your anger with your family." 3. "You're feeling angry that your family continues to hope for you to be 'cured'?" 4. "Well, it sounds like you're being pretty pessimistic. After all, years ago people died of pneumonia."

The nurse in the primary health care provider's office is measuring vital signs on a postoperative client who underwent mastectomy of her right breast 2 weeks ago. The client tells the nurse that she is very concerned because she has numbness in the area of the surgery and along the inner side of the arm from the armpit to the elbow. Which statement is appropriate for the nurse to tell the client? 1. "These sensations are signs of a complication." 2. "These sensations probably will be permanent." 3. "These sensations lessen over several months and usually are gone after 1 year." 4. "It is nothing to worry about because women who have this type of surgery experience this problem."

The nurse is caring for a client who has undergone pelvic exenteration. In addressing psychosocial issues related to the surgery, which statement by the nurse should be therapeutic? 1. "Would you like to talk?" 2. "You are looking good today." 3. "How do you feel about this surgery?" 4. "Will your family and any friends help you deal with this?"

The nurse is caring for a client who is scheduled for surgery. The client states concern about the surgical procedure. How should the nurse initially address the clients concerns? 1. Tell the client that preoperative fear is normal. 2. Explain all nursing care and possible discomfort that may result. 3. Ask the client to discuss information known about the planned surgery. 4. Provide explanations about the procedures involved in the planned surgery.

A client in a long-term care facility is being prepared to be discharged to home in 2 days. The client has been eating a regular diet for a week, yet is still receiving intermittent enteral tube feedings and will need to receive these feedings at home. The client states concern about not being able to continue the tube feedings at home with family caregivers. Which nursing response would be appropriate at this time? 1. "Your primary health care provider thinks you are ready and so do I." 2. "Try to eat more foods and maybe the tube feedings can be stopped." 3. "You are afraid to leave but once you are home things will be just fine." 4. "Tell me more about your concerns with your feedings after going home."

The nurse notes that zidovudine (AZT) has recently been prescribed for the client. The client states, "I've been getting a little nauseated, and I've had a couple of headaches since I was prescribed the AZT. Does this mean I can't take the medicine?" The nurse should make which response to the client? 1. "These symptoms may become more tolerable as you adjust to ongoing therapy." 2. "I do not see the need for you to worry because your neutrophil counts are well over 100." 3. "I know you're worried that you won't be able to take AZT, but you only have a slight neutropenia." 4. "Don't worry. There are so many other medications these days that the primary health care provider can give you."

The nurse is caring for a client with chronic heart failure who is taking digoxin 0.125 mg daily. Before administering the medication, the nurse reviews the serum digoxin level that was drawn earlier in the day. The result is 1 ng/mL. Which action should the nurse take based on this laboratory result? 1. Notify the health care provider. 2. Check the client's last pulse rate. 3. Administer the dose of the medication as scheduled. 4. Obtain another serum digoxin level to verify the results.

The nurse is preparing to care for a dying client and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply. 1. Discourage reminiscing. 2. Make the decisions for the family. 3. Encourage expression of feelings, concerns, and fears. 4. Explain everything that is happening to all family members. 5. Touch and hold the client's or family member's hand if appropriate. 6. Be honest and let the client and family know that they will not be abandoned by the nurse.

3,5,6

The nurse is caring for an older depressed client whose son was killed in an armed robbery after murdering two people. The client says, "I don't know what I did wrong. His dad died a hero in Vietnam when he was only 2 years old, but he's had everything. When he threw the cat up against the wall to see if it landed on its feet and stole money from me and denied it, his sister covered for him." The nurse plans to make which therapeutic response to the client? 1. "It seems as if you or your daughter feel regret?" 2. "Oh well, we can only love our children, do our very best, and hope they reflect our upbringing." 3. "Don't blame yourself. You seem to have been very caring. Some people just turn out evil despite all we do for them." 4. "Do I hear you saying that you feel that your son's behavior was caused by the indulgence he received from his sister?"

A client had an aortic valve replacement 2 days ago. This morning, the client tells the nurse, "I don't feel any better than I did before surgery." Which response by the nurse is most appropriate? 1. "You will feel better in a week or two." 2. "It's only the second day postop. Cheer up." 3. "This is a normal frustration. It'll get better." 4. "You are concerned that you don't feel any better after surgery?

The nurse is encouraging a client to participate in recreational therapy. The client states that it is best to stay alone and not bother others. Which statement is an appropriate response from the nurse? 1. "Can you tell me more about your feelings?" 2. "I understand you are feeling negative, tell me more." 3. "Your primary health care provider (PHCP) has prescribed this so please go." 4. "I can't make you go, but you need to think of getting better and this is one way."

The nurse is planning interventions for counseling a maternity client newly diagnosed with sickle cell anemia. The nurse understands that the important psychosocial intervention at this time is which action? 1. Provide emotional support. 2. Avoid the topic of the disease. 3. Allow the client to be alone if she is crying. 4. Provide all information regarding the disease immediately.

Saunders Therapeutic Communication Techniques

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