Senior Seminar - Module 3: Mental Health Concepts

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 of the following nursing responses should the nurse make?

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

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

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

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

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

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

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

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

A "Have you shared your feelings with your wife?"

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

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

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

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

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

B Reporting that sleeping alone is so hard now C Purchasing a smaller car she is comfortable driving D Placing a picture of her husband on the bedside stand E Heard explaining to family that illness "took" her husband

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 of the following responses by the nurse would be therapeutic?

D "Have you shared your concerns with the police?"

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?

D "One of the things that I've found has helped others is a small snack with your warm milk before sleep and a moderate increase in walking during the day. Is that something you could try?" Rationale: The therapeutic statement is the one that offers additional strategies to aid sleep and gauges whether the client can follow the suggestion.

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

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

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

D "Tell me more about why you feel like the assault just occurred."

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?

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

A nurse is developing a plan of care for a client who recently received a diagnosis of acquired immunodeficiency syndrome and is experiencing difficulty adjusting to the illness. Which of the following actions is an inappropriate intervention for this client?

D Discouraging social networking to prevent the spread of infection Correct Rationale: In planning care for a client experiencing difficulty in adjusting to an illness, the nurse develops interventions to promote (not discourage) social networking that will provide needed information to the client.

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

B "Tell me what you mean by that."

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

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

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

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

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

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

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

A "What's being planned for your son now?" Rationale: The therapeutic statement is the one in which the nurse demonstrates empathy, acknowledges the trauma and stress of the young man's diagnosis, and encourages verbalization.

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

A "You seem to be feeling regret."

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

A "You seem to be feeling very troubled."

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

A "You're saying that because you felt afraid in a violent situation, you may not be right for the job?" Rationale: The therapeutic response is the one that reflects what the client says so that the client can reexamine his feelings in a more reflective context. The client is surprised that he felt fear when placed in the actual situation and believes that policemen should not be afraid. If he reexamines his feelings, he will realize that his thinking is irrational.

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

A "Your family is caring for you now."

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

A Denial Rationale: Defense mechanisms protect us against anxiety. Denial is the defense mechanism used to block out painful or anxiety-inducing events or feelings. In this case, the client cannot deal with the upcoming cancer surgery and therefore denies that he or she is ill. Psychosis and delusions are not defense mechanisms. Displacement is acting out in anger or frustration with people who did not arouse the feelings.

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

A The client plans to attend a community grief group.

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

B Avoidance Rationale: The negative stress response of avoidance is when a client elects not to deal directly with negative feelings about a situation.

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

B Improvement

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

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

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

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

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

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

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

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

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

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

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

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

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

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?

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

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

D "You've seen your loved ones dealing with some troubling events recently. Sounds as if you feel that your family expects more from you than from others in the family because you're a nurse." Rationale: The therapeutic response is the one in which the nurse makes observations and then clarifies his or her perception of what the client has said.

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

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

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

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

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 of the following statements by the nurse would be therapeutic?

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

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

B "Have you shared your feelings with your husband?"

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?

B "It seems that you're blaming yourself for something that was beyond your control." Rationale: The correct option involves the use of the communication technique of reflection and encourages the client to further verbalize his thoughts and feelings.

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

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

A nurse developing a plan of care for a client whose spouse recently died formulates a nursing diagnosis of dysfunctional grieving. Which priority intervention does the nurse incorporate into the plan?

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

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

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

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?

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

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

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

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:

D The development of interpersonal skills, resolution of family problems, and effective use of community support Rationale: Group therapy is especially effective in helping clients develop interpersonal skills, resolve family problems, and use community support effectively. Group therapy is also used to solve everyday problems, to express feelings and emotions, to ask questions, and to share experiences.

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?

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

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

D Wishful thinking

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

C Talking with both the client and his wife about the importance of expressing their feelings and how to do it in healthy ways Rationale: The appropriate nursing intervention is to help the client and spouse describe feelings that, left unspoken, might cause disruption and delay resolution.

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

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

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

A client who 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 of the following statements by the nurse would be therapeutic?

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

D "Journal-keeping that identifies what seems to cause a strain in a person's life is a good way of improving one's health." Rationale: Journal-keeping can help the client identify situations that produce stress

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?

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

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

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

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

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

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?

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

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

B "What did your doctor tell you about your condition? Can you tell me what you're thinking about?" Rationale: When communicating with the dying client and those who grieve, the nurse should use statements that indicate a willingness to follow the client's lead.

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?

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

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?

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

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

B Providing bereavement support to the family after the client's death Correct Rationale: Hospice care includes holistic care that respects the client's dignity and control, provides pain-free support, and encourages choice while treating the client and family before and after death.

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 of the following responses by the nurse would be most helpful?

C "Perhaps you can start by sharing some of your most recent concerns." Rationale: The intake interview is usually the first contact with the client. It is intended to establish rapport, to help the nurse understand the client's current problem and level of functioning, and to help the nurse formulate a nursing care plan. The clinician usually allows the client to set the pace of the interview and uses open-ended questions to elicit a comprehensive diagnostic picture of the client's problems and level of coping.

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?

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

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

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

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

C "Perhaps your task is not to make your lover see that your dalliances are meaningless but to look at your own behavior and determine what you would like or not like to be different." Rationale: The client is taking a narcissistic and entitled approach to her intimate relationship. The nurse needs to focus the client on her own behaviors and desires in a neutral way. Although the nurse's neutrality may produce anger, the nurse must set boundaries and delimit the sphere of treatment to be covered. In the correct option, the nurse uses the therapeutic technique of summarizing and refocusing. In the remaining options, the nurse is judgmental.

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

C "The lack of money has stopped you from saving your husband? It sounds like you need to help yourself right now. What do you think?"

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?

D "Your family is learning about depression and how best to help you so that they can be supportive of you. We do not talk about you or anything confidential about you." Rationale: The therapeutic response is the one that helps the client understand that the family meetings are educational. This openness and the assurance of confidentiality will help allay the client's fears and build trust.

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

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

A client 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?

C "You're interested in talking with us about our assertiveness, but this group is for all of you here to help you to deal with problems more effectively." Correct Rationale: The correct option is the most therapeutic response: The nurse makes observations of what the client's behavior is and restates the goals of the group.

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 of the following statements by the nurse would be therapeutic?

C "You're saying that being left a widow with children is difficult enough, but now you've got to fight for your benefits." Rationale: In the correct option, the nurse uses the therapeutic communication technique of seeking clarification to facilitate the expression of feelings by the widow.

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

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

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 of the following interventions by the nurse would be therapeutic?

D "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 therapeutic intervention is the one that explains the clinic's procedure to the parents and moves on from there.

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?

D "Your son was keeping a very troubling diagnosis to himself. I am so sorry. No matter how close and loving children are to their parents, some children just aren't able to confide in their parents." Rationale: The therapeutic response is the one that makes observations and is helpful in supporting the client as he or she grieves.

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

A "What do you think? What is the individual therapy all about?" Rationale: The appropriate response is the one that provides information to the client about individual therapy. In asking, "What do you think? What is the individual therapy all about?" the nurse makes a sincere query without doubting and probing but does not provide any information to the client, which is not helpful.

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?

C "Your loss touches me so. How truly devastated you both must be. Can you share what things you have been doing to grieve?" Rationale: The parents in this question have experienced a truly devastating loss. Although there are no set strategies for this situation, certain actions are important. First, the nurse communicates to the parents that the terrible loss is sad for others and offer empathy. Second, the nurse gathers data about what has happened to the parents over the 9 months since the loss.

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?

C Displacement Rationale: The defense mechanism of displacement involves the discharge of intense feelings for one person onto a substitute person or object that is less threatening to satisfy an impulse.

A 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 young math teacher, whom she admires. The nurse recognizes that the client is using the defense mechanism of:

C Identification

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?

C Problem-solving

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

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

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?

C "Are there other options for you in taking work leave? Perhaps you could simply reduce your work hours at first so that you can extend your compassionate leave." Rationale: In end-of-life nursing care, the caregiver is often asked, "How long?" or "What should I do?" by family members and the dying clients themselves. The nurse can convey information and make limited but realistic predictions, such as presenting the client's stable or deteriorating physiological condition. Discussing options and alternative solutions with the family that can be added to the process of decision-making can be helpful. Simple alternatives can be used as examples if the family or client seems unable to begin to problem-solve.

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?

C "Can you share with me more specifically how you feel that you're hanging on by a thread? Are you having thoughts of hurting yourself?" Rationale: The correct option is therapeutic because the client is asked to clarify her feelings.

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

C "Can you tell me more about the worrying? What's been happening since you brought your baby home?" Rationale: The most therapeutic statement is the one that further explores the excessive worrying of the two new parents.

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?

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

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

C "I won't ever be depressed again." Rationale: Depression may be a recurring illness for some people. The client needs to understand the symptoms and recognize when or if treatment needs to be started again.

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

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

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

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

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

D "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 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?

D "You can't seem to meet someone that you care about? You can still find enjoyment in friendships, work, books, and other things as well." Rationale: Focus on the subject, reframing. Recalling that reframing is a positive response in which the client redefines the situation to view both its positive and negative sides will direct you to the correct option. Review this coping behavior if you had difficulty with this question.

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

D "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." Rationale: The fireman may be experiencing work-related stress that, if untreated, could evolve into posttraumatic stress disorder. In the correct option, the nurse offers an observation in a neutral style, stressing that the fireman will benefit from seeking treatment.

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

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

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

D "Have you tried saying that directly to your dad? For example, you could say, 'I notice that you watch television when I'm telling you things that are important to me.'" Rationale: Assertiveness is a good way to ease the anxiety and conflict that result from stressful interpersonal relationships. Assertiveness helps the client express opinions that may have emotionally charged feelings attached to them and to express those feelings without using hurtful, aggressive language.

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

D "I am concerned about you. Are you being or have you ever been abused?" Rationale: The behavior that this child has engaged in is a signal of distress. The correct option is the only option that specifically addresses abuse and demonstrates the nurse's concern about the client.

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?

D "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 client says to the nurse, "I've started a journal because my physician 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?

D "It seems that people who write in their journals and can share traumatic events improve their self-awareness." Rationale: Journaling is a cognitive stress-management technique in which one expresses oneself in written form, increasing self-awareness and improving the writer's capacity for coping.

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

D "It sounds like you and your daughter were very close but she kept her sexual orientation from you." Rationale: The therapeutic response is the one that reflects the client's thinking back to the client and makes observations for the client to organize, reflect on, and validate or discount. This will help place the information that the client's daughter is a lesbian into perspective.

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

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

A client is going to receive instruction in biofeedback technique to lower his stress level. The client asks the nurse to describe this technique, and the nurse tells the client that:

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

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

D 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 Rationale: This question presents a sad and troubling story of a family needing time to grieve in the face of a catastrophic loss. The nurse's plan to join the family will provide support to the family. The nurse should call the family priest but first must ascertain that the family does wish to talk to a priest.

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

D The client engages in purposeful movement. Rationale: Eustress is demonstrated confidence in one's ability to master given demands or tasks with success. Examples include positive motivating energy and purposeful movement.