2204 Relaxation Therapy, NURS 260 Exam 4 - 2204 Therapeutic Communication, Exam 4 PPQ's, Chapter 10. Therapeutic Groups, Chapter 11. Intervention With Families, Chapter 14. Assertiveness Training, Chapter 16. Anger/Aggression Management, Chapter 18....

A nurse working for a large corporation is teaching relaxation therapy to employees. Which relaxation technique should the nurse initially teach? A. Deep-breathing exercises B. Mental imagery C. Biofeedback D. Meditation

ANS: A Deep breathing is a simple skill and is basic to other relaxation techniques and therefore should be taught first.

Which action should a nurse take prior to educating clients about relaxation techniques? A. Assisting the client in identifying triggers or sources of stress B. Performing a physical examination to qualify the client as a candidate for this therapy C. Obtaining an order from the physician D. Educating the client's family so they can be active participants in the therapy

ANS: A Initially helping clients to identify triggers and sources of stress will enable the client to anticipate the need for implementing relaxation techniques at appropriate times.

A client diagnosed with major depressive disorder refuses to get out of bed. Which nursing statement appropriately educates the client about the benefits of physical activity? A. "Depression is caused by the lack of certain brain chemicals that can increase with exercise." B. "Physical activity is good for everyone regardless of their diagnosis." C. "Low-intensity exercise is more beneficial than high-impact exercise." D. "When you are physically active, it helps to lower your beta endorphins."

ANS: A Physical activity can stimulate the secretion of norepinephrine and serotonin. Depression has been linked to low levels of these neurotransmitters.

After suffering a myocardial infarction, a 37-year-old executive demands premature discharge from the hospital. He tells the nurse, "Just give me my prescriptions and let me get back to work." Which is the most appropriate nursing reply? A. "To ensure improved health, we need to discuss diet, medication, exercise, and lifestyle changes before you are discharged." B. "You will not be allowed to leave the hospital without getting your physician's approval for early discharge." C. "We will discharge you quickly so that the stress you are experiencing will not cause more serious heart damage." D. "Prior to discharge, we will need to discuss job stress, your finances, and the possibility of an early retirement."

ANS: A The client's statements reflect a great deal of stress that can contribute to further cardiovascular disease. Helping him to look at a variety of measures to improve his health would be most beneficial.

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

ANS: A The group leader has employed the nontherapeutic technique of giving approval. Giving approval implies that the nurse has the right to pass judgment on whether the client's ideas or behaviors are "good" or "bad." This creates a conditional acceptance of the client.

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

ANS: A The nurse is making an observation when stating, "You appear to be talking to someone I do not see." Making observations involves verbalizing what is observed or perceived. This encourages the client to recognize specific behaviors and make comparisons with the nurse's perceptions.

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

ANS: A The nurse is using the therapeutic communication technique of restatement. Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client's statement has been heard and understood.

A 10-week, prenuptial counseling group composed of five couples is terminating. At the last group meeting, a nurse notices that the two most faithful and participative couples are absent. When considering concepts of group development, what might explain this behavior? A. They are experiencing problems with termination, leading to feelings of abandonment. B. They did not think any new material would be covered at the last session. C. They were angry with the leader for not extending the length of the group. D. They were bored with the material covered in the group.

ANS: A The nurse should determine that the clients' absence from the final group meeting may indicate that they are experiencing problems with termination. The termination phase of group development may elicit feelings of abandonment and anger. Successful termination may help members develop skills to cope with future unrelated losses. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

During an inpatient educational group, a client shouts out, "This information is worthless. Nothing you have said can help me." These statements indicate to the nurse leader that the client is assuming which group role? A. The group role of aggressor B. The group role of initiator C. The group role of gatekeeper D. The group role of blocker

ANS: A The nurse should identify that the client is assuming the group role of the aggressor. The aggressor expresses negativism and hostility toward others in the group or to the group leader and may use sarcasm in an effort to degrade the status of others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating? A. Democratic B. Autocratic C. Laissez-faire D. Bureaucratic

ANS: A The nurse who encourages clients to present problems and discuss solutions is demonstrating a democratic leadership style. Democratic leaders share information with group members and promote decision making by the members of the group. The leader provides guidance and expertise as needed. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both of the clients from the group. The nurse has demonstrated which leadership style? A. Autocratic B. Democratic C. Laissez-faire D. Bureaucratic

ANS: A The nurse who excuses clients from the group has demonstrated an autocratic leadership style. An autocratic leadership style may be useful in certain situations that require structure and limit-setting. Democratic leaders focus on the members of the group and group-selected goals. Laissez-faire leaders provide no direction to group members. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment: Management of Care

In defiance of parental wishes, a Japanese teenager succumbs to peer pressure and gets a tattoo. According to Bowen's family systems theory, how should the community health nurse interpret the teenager's action? A. The teenager is attempting to differentiate self. B. The teenager is triangulating self. C. The teenager is cutting self off emotionally. D. The teenager is exhibiting antisocial traits.

ANS: A The teenager is taking on some of the cultural values of peers and is beginning to develop a unique identity. This process is called differentiation and is a normal task of adolescence. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

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

ANS: A This is an example of the therapeutic communication technique of formulating a plan of action. By the use of this technique, the nurse can help the client plan in advance to deal with a stressful situation which may prevent anger and/or anxiety from escalating to an unmanageable level.

A client is struggling to explore and solve a problem. Which nursing statement would verbalize the implication of the client's actions? A. "You seem to be motivated to change your behavior." B. "How will these changes affect your family relationships?" C. "Why don't you make a list of the behaviors you need to change." D. "The team recommends that you make only one behavioral change at a time."

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

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

ANS: A This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occur when the nurse misjudges the degree of the client's discomfort, thus a lack of empathy and understanding may be conveyed.

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

ANS: A This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking "why" a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings.

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

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

During a group discussion, members freely interact with each other. Which member statement is an example of Yalom's curative group factor of imparting information? A. "I found a Web site explaining the different types of brain tumors and their treatment." B. "My brother also had a brain tumor and now is completely cured." C. "I understand your fear and will be by your side during this time." D. "My mother was also diagnosed with cancer of the brain."

ANS: A Yalom's curative group factor of imparting information involves sharing knowledge gained through formal instruction as well as by advice and suggestions given by other group members. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nurse is using covert sensitization to help a client control compulsive overeating. Which nursing intervention reflects this behavior therapy? A. Asking the client to visualize and imagine smelling a rotting potato B. Encouraging the client to practice relaxation exercises when tempted to eat C. Introducing the client to a peer who has overcome obesity D. Providing small rewards for periodic weight loss

ANS: A Covert sensitization relies on the individual's imagination to produce unpleasant symptoms as negative stimuli. The mental image (rotting potatoes) is visualized when the individual is about to succumb to an attractive (ice cream sundae) but undesirable behavior (compulsive eating). The technique is under the client's control and can be used whenever and wherever it is required.

Which contemporary family therapy emphasizes the role of the stories people construct about their experiences? A. Narrative therapy B. Feminist family therapy C. Social constructionist therapy D. Psychoeducational family therapy

ANS: A Narrative therapy is an approach to therapy that emphasizes the role of the stories people construct about their experiences.

A client with a new ileostomy tells the nurse, "I'm disgusting. This ileostomy makes me so ugly." Which correctly written nursing diagnosis would be appropriately assigned to address this client's problem? A. Situational low self-esteem related to disturbed body image evidenced by client statement "I'm disgusting" B. Risk for complicated grieving related to loss of normal GI function evidenced by expressions of anger C. Disturbed thought processes related to ileostomy evidenced by altered body image D. Anxiety related to cancer of the colon evidenced by ileostomy

ANS: A The client's statement of "I'm disgusting" is evidence of the client's negative perception of self brought about by the new ileostomy (a current situation). This has impaired the client's self-esteem. This is a correctly written nursing diagnosis.

A client diagnosed with alcoholism has recently been prescribed disulfiram (Antabuse). The nurse recognizes this as which type of behavior therapy? A. Overt sensitization B. Flooding C. Reciprocal inhibition D. Systematic desensitization

ANS: A The nurse recognizes the use of Antabuse as overt sensitization behavior therapy. This is a type of aversion therapy that produces unpleasant consequences for undesirable behavior. Instead of the euphoric feeling normally experienced from alcohol (the positive reinforcement for drinking), an individual taking Antabuse will experience nausea, vomiting, palpitations, and headache if alcohol is consumed. The client receives a severe punishment that is intended to extinguish the unacceptable behavior (drinking alcohol).

A client diagnosed with severe depression states, "When I wasn't invited to my niece's wedding, it was obvious that the in-laws did not think I was good enough to be included." The nurse understands that this automatic thought is an example of which common cognitive error? A. Arbitrary inference B. Overgeneralization (absolute thinking) C. Dichotomous thinking D. Personalization

ANS: A This client statement indicates the use of arbitrary inference. When arbitrary inference is used, the individual automatically comes to a conclusion about an incident without supporting facts.

A nurse is using decatastrophizing techniques to help a client modify automatic thoughts and schemas. Which nursing statement could be used in this process? A. "First you must decide if this negative thought is valid." B. "Let's really look at that thought pattern. What evidence made you come to that conclusion?" C. "When you start to have a negative thought, start visualizing a pleasant experience." D. "Let's explore some other possibilities related to this thinking."

ANS: A This nursing statement could be used during the technique of decatastrophizing. Decatastrophizing assists the client to examine the validity of a negative automatic thought. Even if some validity exists, the client is then encouraged to review ways to cope adaptively, moving beyond the current crisis situation.

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

ANS: A, B, C, D The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal.

Which of the following observed client behaviors would lead a nurse to evaluate a member as assuming a maintenance group role? Select all that apply. A. A client decreases conflict within the group by encouraging compromise. B. A client offers recognition and acceptance of others. C. A client outlines the task at hand and proposes solutions. D. A client listens attentively to group interaction. E. A client uses the group to gain sympathy from others.

ANS: A, B, D The nurse should identify clients who decrease conflict within the group, offer recognition and acceptance of others, and listen attentively to group interaction as assuming a maintenance group role. There are member roles within each group. Maintenance roles include the compromiser, the encourager, the follower, the gatekeeper, and the harmonizer. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nurse is teaching principles of mental imagery to a group. On which relaxing environments should the nurse appropriately recommend client focus? (Select all that apply.) A. Visualizing the seashore B. Visualizing a snowy cabin C. Driving home from the beach on Sunday evening D. Floating through the air on a cloud E. Lying at home in front of the fireplace

ANS: A, B, D, E Any environment that the client finds relaxing is appropriate. It is unlikely that a client would consider driving home from the beach on Sunday evening to be a relaxing environment.

A client who has been referred for stress management asks the nurse, "Which one of these relaxation techniques requires reimbursement from my health insurance?" Which is the appropriate nursing reply? A. "Meditation requires reimbursement from health insurance." B. "Biofeedback requires reimbursement from health insurance." C. "Physical exercise requires reimbursement from health insurance." D. "Deep breathing requires reimbursement from health insurance."

ANS: B Biofeedback is costly and would require reimbursement from health insurance. It requires the use of a machine that gives immediate information about the client's physical state and a biofeedback technician to interpret the results.

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

ANS: B Giving advice tells the client what to do or how to behave. It implies that the nurse knows what is best and that the client is incapable of any self-direction. It discourages independent thinking.

A nurse is teaching a client deep breathing exercises. The client asks, "Why do I need to make that funny shape with my lips when I breathe out?" What is the most appropriate nursing reply? A. "You can actually exhale anyway you like; the lip shape is not important." B. "Pursed lip breathing helps you control the exhalation and helps to keep your airways open." C. "Don't worry about the lip shape; concentrate instead on the pace of your breathing." D. "The shape of the lip decreases the cough and choking reflex."

ANS: B Pursed lip breathing is controlled, allowing for longer exhalation because it is more effective in keeping the airways open.

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

ANS: B The best response by the nurse is, "You're experiencing feelings of guilt because you weren't able to save your children." This response utilizes the therapeutic communication technique of reflection which identifies a client's emotional response and reflects these feelings back to the client so that they may be recognized and accepted.

During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development? A. "It's hard for me to tell my story when I'm not sure about the reactions of others." B. "I think Joe's Antabuse suggestion is a good one and might work for me." C. "My situation is very complex, and I need professional, not peer, advice." D. "I am really upset that you expect me to solve my own problems."

ANS: B The nurse should determine that group members have progressed to the working phase of group development when members begin to look to each other instead of to the leader for guidance. Group members in the working phase begin to accept criticism from each other and then use it constructively to foster change. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

During a therapeutic group, a client talks about personal accomplishments in an effort to gain attention. Which group role, assumed by this client, should the nurse identify? A. The task role of gatekeeper B. The individual role of recognition seeker C. The maintenance role of dominator D. The task role of elaborator

ANS: B The nurse should evaluate that the client is assuming the individual role of the recognition seeker. Other individual roles include the aggressor, the blocker, the dominator, the help seeker, the monopolizer, and the seducer. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

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

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

Which situation should a nurse identify as an example of an autocratic leadership style? A. The president of Sigma Theta Tau assigns members to committees to research problems. B. Without faculty input, the dean mandates that all course content be delivered via the Internet. C. During a community meeting, a nurse listens as clients generate solutions. D. The student nurses' association advertises for candidates for president.

ANS: B The nurse should identify that mandating decisions without consulting the group is considered an autocratic leadership style. Autocratic leadership increases productivity but often reduces morale and motivation due to lack of member input and creativity. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Safe and Effective Care Environment

The nurse should utilize which group function to help an extremely withdrawn, paranoid client increase feelings of security? A. Socialization B. Support C. Empowerment D. Governance

ANS: B The nurse should identify that the group function of support would help an extremely withdrawn, paranoid client increase feelings of security. Support assists group members in gaining a feeling of security from group involvement. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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

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

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

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

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

ANS: B This is an example of the therapeutic communication technique of offering self. Offering self makes the nurse available on an unconditional basis, increasing client's feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self.

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

ANS: B This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client.

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

ANS: B This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both.

A man diagnosed with alcohol dependence experiences his first relapse. During his AA meeting, another group member states, "I relapsed three times, but now have been sober for 15 years." Which of Yalom's curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Catharsis D. Universality

ANS: B This scenario is an example of the curative group factor of instillation of hope. This occurs when members observe the progress of others in the group with similar problems and begin to believe that personal problems can also be resolved. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

Which psychiatric diagnosis is common within the Native American culture? A. Schizophrenia B. Alcohol abuse and dependence C. Posttraumatic stress disorder D. Impulse control disorder

ANS: B A variety of physical, sociocultural, and environmental causes have been linked to the high rate of alcoholism among Native Americans

A client expresses a desire to begin attending the self-help group Alcoholics Anonymous (AA). Which nursing response gives the client pertinent information about this type of group? A. "In this type of group, membership is always within a fixed time frame." B. "Group members receive comfort and advice from others undergoing similar experiences." C. "The purpose of this type of group is to convey information to a number of individuals." D. "The function of this type of group is to accomplish a specific outcome."

ANS: B AA is a type of self-help group. In this type of group members share their experiences and strengths and receive comfort and advice from others undergoing similar experiences. The nurse is giving the client pertinent information about AA.

A mother berates her child for breaking a cup and says, "You are bad and so destructive." This statement discourages the development of positive self-esteem by not meeting which parenting focus as described by Warren? A. A sense of competence B. Unconditional love C. A sense of survival D. Realistic goals

ANS: B According to Warren, parents promote self-esteem when they provide unconditional love for their children. Children need to know that they are loved and accepted regardless of successes or failures. Criticism of behavior should not be linked with criticism of the child. In the situation presented, the mother discourages the development of positive self-esteem by not meeting the child's need for unconditional love.

Two clients disagree on what movie to watch during free activity time. One client says to the other, "I would like to watch the comedy instead of the murder mystery." The nurse recognizes this as which form of communication response pattern? A. Nonassertive B. Assertive C. Aggressive D. Passive-Aggressive

ANS: B Assertive individuals express feelings openly and honestly. Individuals using this communication pattern use "I" statements and communicate tactfully. The example presented in the question demonstrates the use of an assertive communication pattern.

In assessing a family, which behavior would thenurse identify as a functional family interaction pattern? A. Triangling B. Differentiation of self C. Family projection process D. Scapegoating family members

ANS: B Differentiation of self is the ability to define oneself as a separate being and is a functional family interaction pattern.

After his wife left him, the husband, diagnosed with depression, is admitted to a psychiatric unit. He states that he was proud of receiving job commendations that led to a promotion. Which condition that would affect self-esteem has contributed to the client's depression? A. The lack of power B. The lack of significance C. The lack of virtue D. The lack of competence

ANS: B Significance is a condition that enhances self-esteem by promoting feelings of love, respect, and care. The client has a lack of significance due to the fact that his significant other has abandoned him.

During a group meeting, a client raises the concern that noise at the nurses' station keeps him awake at night. The nurse, present in the meeting, interrupts, stating, "I'll handle this matter. We need to move on." The nurse is demonstrating which type of leadership style? A. Democratic B. Autocratic C. Laissez-faire D. Surrogate

ANS: B This is an example of an autocratic leadership style that restricts client participation in planning care. The nurse is in control and client autonomy is limited.

After repeated requests for a client to unpack and get settled on the psychiatric unit, the client states, "I have no intention of unpacking and staying on this unit." To avoid a confrontation, the nurse unpacks the client's belongings. Which nursing behavior is exemplified? A. Positive role modeling B. Negative operant conditioning C. Assertiveness D. Aggressiveness

ANS: B This situation illustrates negative operant conditioning. The client's negative behavior has been reinforced and rewarded by the nurse's action of unpacking for the client.

Which of the following behavioral skills should a nurse implement when leading a group that is functioning in the orientation phase of group development? Select all that apply. A. Encouraging members to provide feedback to each other about individual progress B. Ensuring that rules established by the group do not interfere with goal fulfillment C. Working with group members to establish rules that will govern the group D. Emphasizing the need for and importance of confidentiality within the group E. Helping the members to resolve conflicts and foster cohesiveness within the group

ANS: B, C, D During the orientation phase of group development, the nurse leader should work together with members to establish rules that will effectively govern the group. The leader should ensure that group rules do not interfere with goal fulfillment and establish the need for and importance of confidentiality within the group. Members need to establish trust and cohesion to move into the working phase of group development. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Without further education, which group is this nurse most qualified to lead? A. A psychodrama group B. A psychotherapy group C. A parenting group D. A family therapy group

ANS: C A psychiatric registered nurse is qualified to lead a parenting group. A parenting group can be classified as either a teaching group or therapeutic group. Psychodrama, psychotherapy, and family therapy are forms of group therapy that must be facilitated by qualified leaders who generally have advanced degrees in psychology, social work, nursing, or medicine. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment

Which response is known to be a physiological manifestation of relaxation? A. Increased levels of norepinephrine B. Pupil dilation C. Reduced metabolic rate D. Increased levels of blood sugar

ANS: C During relaxation, the metabolic rate decreases.

A client asks a nurse what is the difference between modified (or passive) progressive relaxation and progressive relaxation. Which is the most appropriate nursing reply? A. "There is an increased focus on deep breathing in the modified version." B. "Only large muscle groups are targeted in the modified version." C. "There is no muscle contraction in the modified version." D. "The modified version is for clients with preexisting cardiovascular disease."

ANS: C In modified (or passive) progressive relaxation, the muscles are not tensed before relaxing them.

The nurse should recognize that improvement in concentration and attention occurs with which relaxation technique? A. Biofeedback B. Physical exercise C. Meditation D. Mental imagery

ANS: C Meditation has been found to improve concentration and attention.

Which positive physical benefit would relaxation provide for a client who has experienced stress-related asthma? A. Decreased neurotransmitters B. Decreased blood pressure C. Increased oxygen saturation levels D. Decreased alpha brain waves

ANS: C Relaxation results in increased lung capacity and stable respiratory rate leading to increased oxygen saturation levels.

In a family that is in the life cycle stage called "The Family with Adolescents," which changes must occur for the family to proceed developmentally? A. Making adjustments within the marital system to meet the responsibilities of parenthood B. Establishing a new identity as a couple by realigning relationships with extended family C. Redefining the level of dependence so that adolescents are provided with greater autonomy D. Reestablishing the bond of the dyadic marital relationship

ANS: C Stage IV of the family life cycle is described as "The Family with Adolescents." The task of this stage is to redefine the level of dependence so that adolescents are provided with greater autonomy while parents remain responsive to teenagers' dependency needs. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A home health nurse is visiting an Asian family. A married couple, their three children, and the maternal grandparents all live in the home. How should the nurse interpret the presence of the grandparents in the home? A. The parents have diffuse boundaries and have allowed the grandparental subsystem to be present. B. The grandparental subsystem is not successfully managing separation from the parental subsystem. C. Extended family living arrangements are common in some cultures. D. The nuclear family living arrangement is the preferred environment for childrearing.

ANS: C The Asian culture highly respects the elderly. Having the grandparents living in the home is not uncommon in this culture. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Analysis | Client Need: Psychosocial Integrity

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

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

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

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

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

ANS: C The nurse is using the therapeutic communication technique of formulating a plan of action to help the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the client's poor coping choice, may serve to prevent anger or anxiety from escalating.

During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style? A. The nurse mandates that all group members reveal an embarrassing personal situation. B. The nurse asks for a show of hands to determine group topic preference. C. The nurse sits silently as the group members stray from the assigned topic. D. The nurse shuffles through papers to determine the facility policy on length of group.

ANS: C The nurse leader who sits silently and allows group members to stray from the assigned topic is demonstrating a laissez-faire leadership style. This style allows group members to do as they please with no direction from the leader. Group members often become frustrated and confused in reaction to a laissez-faire leadership style. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Safe and Effective Care Environment: Management of Care

A nurse believes that the members of a parenting group are in the initial, or orientation, phase of group development. Which group behaviors would support this assumption? A. The group members manage conflict within the group. B. The group members use denial as part of the grief response. C. The group members compliment the leader and compete for the role of recorder. D. The group members initially trust one another and the leader.

ANS: C The nurse should anticipate that members in the initial, or orientation, phase of group development often compliment the leader and compete for the role of recorder. Members in this phase have not yet established trust and have a fear of not being accepted. Power struggles may occur as members compete for their position in the group. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

A fatherless, 11-year-old African American girl lives with her grandmother after the death of her mother. Her older stepbrother is very involved in her life. How should the community health nurse view this family constellation, and why? A. Abnormal; the grandmother should be concerned with issues other than childrearing. B. Abnormal; a two-parent household is the most advantageous arrangement for parenting. C. Normal; cultural variations exist in the family life cycle. D. Normal; because of their wisdom, older adults make better parenting figures.

ANS: C The nurse should be aware that cultural differences and specific events may lead to variety in family constellations. This is normal. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nursing instructor is teaching about psychodrama, a specialized type of therapeutic group. Which student statement indicates that further teaching is necessary? A. "Psychodrama provides a safe setting in which to discuss painful issues." B. "In psychodrama, the client is the protagonist." C. "In psychodrama, the client observes actor interactions from the audience." D. "Psychodrama facilitates resolution of interpersonal conflicts."

ANS: C The nurse should educate the student that in psychodrama the client plays the role of himself or herself in a life-situation scenario and is called the protagonist. During psychodrama, the client does not observe interactions from the audience. Other group members perform the role of the audience and discuss the situation they have observed, offer feedback, and express their feelings. Leaders of psychodrama must have specialized training to become a psychodramatist. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Psychosocial Integrity

When planning group therapy, a nurse should identify which configuration as most optimal for a therapeutic group? A. Open-ended membership; circle of chairs; group size of 5 to 10 members B. Open-ended membership; chairs around a table; group size of 10 to 15 members C. Closed membership; circle of chairs; group size of 5 to 10 members D. Closed membership; chairs around a table; group size of 10 to 15 members

ANS: C The nurse should identify that the most optimal conditions for a therapeutic group are when the membership is closed and the group size is between 5 and 10 members who are arranged in a circle of chairs. The focus of therapeutic groups is on relationships within the group and the interactions among group members. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Planning | Client Need: Safe and Effective Care Environment: Management of Care

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

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

A client's younger daughter is ignoring curfew. The client states, "I'm afraid she will get pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about life?" This is an example of which communication block? A. Requesting an explanation B. Belittling the client C. Making stereotyped comments D. Probing

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

The nurse asks a newly admitted client, "What can we do to help you?" What is the purpose of this therapeutic communication technique? A. To reframe the client's thoughts about mental health treatment B. To put the client at ease C. To explore a subject, idea, experience, or relationship D. To communicate that the nurse is listening to the conversation

ANS: C This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.

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

ANS: C This is an example of the therapeutic communication technique of giving recognition. Giving recognition acknowledges and indicates awareness. This technique is more appropriate than complimenting the client which reflects the nurse's judgment.

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

ANS: C This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted.

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

ANS: C When interviewing a client, the nurse should employ the nonverbal behavior of sitting squarely, facing the client. Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

Prayer group members at a local Baptist church are meeting with a poor, homeless family they are supporting. Which member statement is an example of Yalom's curative group factor of altruism? A. "I'll give you the name of a friend that rents inexpensive rooms." B. "The last time we helped a family, they got back on their feet and prospered." C. "I can give you all of my baby clothes for your little one." D. "I can appreciate your situation. I had to declare bankruptcy last year."

ANS: C Yalom's curative group factor of altruism occurs when group members provide assistance and support to each other, creating a positive self-image and promoting self-growth. Individuals increase self-esteem through mutual caring and concern. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

The nurse is preparing to help a client use mental imagery. Which nursing statement most accurately describes this process? A. "As you focus on an object across the room, begin to breathe deeply." B. You must focus only on the ocean waves when performing mental imagery." C. "You may choose to focus on anything that makes you feel relaxed." D. "Continue taking short, shallow breaths during the exercise."

ANS: C A key component of mental imagery is the ability to focus on something that relaxes the individual.

After a supportive-therapeutic group, a nurse hears one client say to another, "I never thought that other people had the same problems that I have." The nurse ascertains that this statement represents which curative factors described by Yalom? A. Catharsis B. Group cohesiveness C. Universality D. Imitative behavior

ANS: C According to Yalom, the curative factor of universality occurs when group members realize that they are not alone in their feelings and experiences.

A client states, "I just failed my college English course. I've never failed a class before so when my parents find out they are going to disown me. They'll hate me and never forgive me for this." The nurse recognizes this client's statement as which type of automatic thought? A. Arbitrary influence B. Minimization C. Catastrophic thinking D. Personalization

ANS: C Catastrophic thinking involves always thinking that the worst will occur without considering the possibility of more likely positive outcomes. By stating "...when my parents find out they are going to disown me. They'll hate me and never forgive me for this," the client is expressing the automatic thought of catastrophic thinking.

Which value of the Northern European American culture should a nursing instructor include when teaching about cultural diversity? A. Northern European Americans are present oriented. B. Northern European Americans are highly religious, and church attendance is critical. C. Northern European Americans value punctuality and efficiency. D. Northern European Americans emphasize family cohesiveness due to increased technology.

ANS: C Punctuality and efficiency are highly valued in Northern European American culture.

A client has not received what was expected for lunch and directs an angry verbal outburst at the nurse. Which is an accurate description of this display of emotion? A. Anger is a primary emotion that is automatically experienced. B. Anger is a psychological arousal. C. The expression of anger can come under personal control. D. The expression of anger and aggression are closely related.

ANS: C The expression of anger can come under personal control and is a learned behavior.

A client who has been undergoing stress management training asks a nurse how long practicing stress reduction should last. Which is the most appropriate nursing reply? A. "Until this stressor has resolved." B. "Usually it takes several months before stress is eliminated." C. "Whenever you feel better, you can stop." D. "Managing stress is a lifelong function."

ANS: D Management of stress must be considered a lifelong function. Nurses can help individuals recognize the sources of stress in their lives and identify methods of adaptive coping.

During a psychoeducational group on stress management, a client asks about meditation. Which nursing statement is most accurate regarding meditation? A. "It is a procedure whereby various muscle groups are contracted and relaxed, bringing about an overall sense of relaxation." B. "The procedure is one whereby you use your imagination to relax and reduce the tension in your body." C. "The purpose is to become aware of one's bodily processes and to bring them under conscious control." D. "The goal is to gain mastery and control over one's attention, bringing about a special state of consciousness."

ANS: D Meditation creates a special state of consciousness because attention is concentrated on one thought or object.

Which should a nurse recognize as the reason that physical exercise is an effective relaxation technique? A. Physical exercise stresses and strengthens the cardiovascular system. B. Physical exercise decreases the metabolic rate. C. Physical exercise decreases levels of norepinephrine in the brain. D. Physical exercise provides a natural outlet for releasing muscle tension.

ANS: D Physical exercise is an effective relaxation technique because it provides a natural outlet for releasing muscle tension produced by the body when stressed.

A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After the client received a college acceptance, the mother repeatedly states, "That's wonderful. I'll be fine all alone." How would the nurse interpret the mother's statements? A. The mother is withholding supportive messages. B. The mother is expressing denigrating remarks. C. The mother is communicating indirectly. D. The mother is using double-bind communication.

ANS: D The client's mother says she is fine with him going away to college but then tries to make him feel guilty about her being left alone. The client is in a no-win situation because his mother has given a mixed message—a double-bind communication. KEY: Cognitive Level: Application | Integrated Process: Nursing Process: Analysis | Client Need: Psychosocial Integrity

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

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

Which group leader activity should a nurse identify as being most important in the final, or termination, phase of group development? A. The group leader establishes the rules that will govern the group after discharge. B. The group leader encourages members to rely on each other for problem solving. C. The group leader presents and discusses the concept of group termination. D. The group leader helps the members to process feelings of loss.

ANS: D The most effective intervention in the final, or termination, phase of group development would be for the group leader to help the members to process feelings of loss. The leader should encourage the members to review the goals and discuss outcomes, reminisce about what has occurred, and encourage members to provide feedback to each other about progress. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

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

ANS: D The nurse is providing appropriate feedback when stating, "During group, you raised your voice, yelled at a peer, left, and slammed the door." Giving appropriate feedback involves helping the client consider a modification of behavior. Feedback should give information to the client about how he or she is perceived by others. Feedback should not be evaluative in nature or be used to give advice.

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

ANS: D The nurse is using the therapeutic communication technique of making observations when noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse.

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

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

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

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

During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader? A. To referee the debate B. To adamantly oppose physical discipline measures C. To redirect the group to a less controversial topic D. To encourage the group to solve the problem collectively

ANS: D The role of the group leader is to encourage the group to solve the problem collectively. A democratic leadership style supports members in their participation and problem-solving. Members are encouraged to cooperatively solve issues that relate to the group. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Implementation | Client Need: Psychosocial Integrity

A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yalom's curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Altruism D. Universality

ANS: D The scenario is an example of the curative group factor of universality. Universality occurs when individuals realize that they are not alone in the problems, thoughts, and feelings they are experiencing. This realization reduces anxiety by the support and understanding of others. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Assessment | Client Need: Psychosocial Integrity

A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred? A. "There is little research to support AA's effectiveness." B. "Self-help groups used to be the treatment of choice, but their popularity is waning." C. "These groups have no external regulation, so clients need to be cautious." D. "Members themselves run the group, with leadership usually rotating among the members"

ANS: D The student indicates an understanding of self-help groups when stating, "Members themselves run the group, with leadership usually rotating among the members." Nurses may or may not be involved in self-help groups. These groups allow members to talk about feelings and reduce feelings of isolation, while receiving support from others undergoing similar experiences. KEY: Cognitive Level: Application | Integrated Processes: Nursing Process: Evaluation | Client Need: Health Promotion and Maintenance

A client states, "You won't believe what my husband said to me during visiting hours. He has no right treating me that way." Which nursing response would best assess the situation that occurred? A. "Does your husband treat you like this very often?" B. "What do you think is your role in this relationship?" C. "Why do you think he behaved like that?" D. "Describe what happened during your time with your husband."

ANS: D This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.

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

ANS: D This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another.

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

ANS: D This is an example of the therapeutic communication technique of restatement. Restatement is the repeating of the main idea that the client has verbalized. This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue, or clarify if necessary.

A nurse is caring for a client who has suffered a stress-related myocardial infarction. Which client statement indicates that the client is ready to learn about the relationship of stress to physical illness? A. "I just need to take my blood pressure medication religiously." B. "The first thing I will do, will be to cut down on my smoking." C. "My father had six heart attacks and survived them all. I plan to do the same." D. "I eat well and exercise. What else do you think could have led to my heart attack?"

ANS: D This response shows that the client is seeking information to improve his health and signals openness to change.

An angry client states to the nurse, "You red- headed skinny witch. You can't tell me what to do." Which appropriate intervention would the nurse implement during this outburst? A. Reprimand the client for poor judgment and derogatory remarks. B. Respond to angry expressions with matching verbalizations. C. Offer support by the use of empathy and therapeutic touch. D. Ignore initial derogatory remarks.

ANS: D During expressions of anger and aggression, ignoring initial derogatory remarks can be an appropriate nursing intervention. Lack of feedback often extinguishes an undesirable behavior.

A client, diagnosed with depression, tells the nurse that marriage and children were chosen over law school. The client states, "My mother was furious with my decision." The nurse recognizes this as an example of which maladaptive family behavior? A. Avoiding B. Demanding proof of love C. Attacking D. Ignoring individuality

ANS: D Ignoring individuality occurs when one person expects another to do things or behave in ways that do not fit with the latter's individuality or current life situation. The client is fulfilling personal dreams and the mother reacts with anger because the client is not fulfilling the mother's expectations.

The nurse is monitoring a client who is performing a relaxation exercise. Which of thefollowing is not indicative of physiological manifestations of relaxation? A. Respiration rate decreases B. Blood pressure decreases C. Increased temperature in the extremities D. Dilation of pupils

ANS: D Pupillary constriction (not dilation) occurs in a state of relaxation.

A nurse is conducting an assertiveness training class. Which of the following characteristics of assertive behavior should the nurse include? A. Eye contact should be steady and continuous. B. Invasion of intimate space can be interpreted as assertive behavior. C. While interacting, individuals should turn slightly away from the other person. D. The facial expression is congruent with the verbal message.

ANS: D Various facial expressions convey different messages. In assertive communication, the facial expression is congruent with the verbal message.

The nurse is encouraging a child, diagnosed with autism, to verbalize needs. Which nursing intervention reflects the behavior therapy of shaping? A. The nurse provides no rewards to the child to encourage independence. B. The nurse rewards the child regardless of speech improvement. C. The nurse rewards the child at the conclusion of the therapy. D. The nurse rewards the child incrementally as improvement in speech occurs.

ANS: D. In shaping the behavior of another, reinforcements are given for increasingly closer approximations to the desired response. In this situation, the nurse is providing rewards incrementally as the child's speech begins to improve.