HESI Module 3 Mental Health Concepts

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." B. "You're having a pretty strong reaction to this student, aren't you? Why not ask the student to leave the room and use the time to write down his or her thoughts so you can give the others your complete attention?" C. "Just say, 'Gee where did you earn your doctorate?' and move on with your lecture." D. "Just smile and say nothing. Go on with your lecture and then talk with the student after class."

A. "Sounds like you feel pretty helpless, yet you are the professor here." Rationale: The correct option is the one in which the nurse facilitates the client's expression of feelings, a helpful first step toward reframing and problem-solving. In stating, "Just say, 'Gee, where did you earn your doctorate?' and move on with your lecture," the nurse gives sarcastic advice and is nontherapeutic. In stating, "Just smile and say nothing. Go on with your lecture and then talk with the student after class," the nurse gives advice to the client and advises the client to be passive, which is nontherapeutic. In stating, "You're having a pretty strong reaction to this student, aren't you? Why not ask the student to leave the room and use the time to write down his or her thoughts so you can give others your complete attention?" the nurse gives advice and is nontherapeutic.

A client who witnessed her husband being shot and killed in an incident of road rage says to the nurse, "It's been 3 months now, and I still can't drive my car without acting crazy. My sister says I grip the wheel like I'm glued to it. I can't merge with traffic until it's almost completely clear, and I'm parking a mile from in the mall when there's plenty of parking close to the building." Which statement by the nurse would be therapeutic? A. "I still grip the wheel when I merge with traffic, and I just wonder whether your sister needs to see me do it." B. "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." C. "If I were you, I'd have trouble driving the car again. Driving a car and being the victim of road rage are two very different things, and you need therapy and time to heal." D. "Smart of you to take no chances. You should see the dents and dings on my car from mall parking. Does your sister depend on you for many things? It seems like she's pushing you too hard."

B. "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." Rationale: The client in this question has witnessed an incident of violence on the road. In addition, she has lost her husband, so she is experiencing grief and the subjective feelings that accompany loss. The correct option supports the client and tells her that her actions to resolve her grief are appropriate. Even individuals with good coping and adaptive skills would need extra support after experiencing such a violent situation. In stating, "I still grip the wheel when I merge into traffic, and I just wonder whether your sister needs to see me do it," the nurse makes a nontherapeutic social response that is first off focus and does not facilitate feelings and then is sarcastic with regard to the client's sister. In stating, "If I were you, I'd have trouble driving the car again. Driving a car and being the victim of road rage are two very different things, and you need therapy and time to heal," the nurse is trying to help the client realize that her fears and anxiety are common yet personalizes the situation and gives advice. In stating, "Smart of you to take no chances. You should see the dents and dings on my car from mall parking. Does your sister depend on you for many things? It seems like she's pushing you too hard," the nurse's own anxiety (perhaps because of fear of the road rage event) produces a nontherapeutic rambling style of communication and asks questions.

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. "Can you talk about what's happening to you right now? Your behavior is not appropriate at this stage of your husband's illness. You seem to be having sympathy pains for him, like men during their wives' pregnancies." B. "I cannot emphasize how much your husband needs you to be there for him right now. He is in the stage of denial." C. "You will need to concentrate on getting to these appointments on time and write down what everyone says so you will remember." D. "It isn't unusual for family to suffer from anticipatory grief when a loved one is dying."

D. "It isn't unusual for family to suffer from anticipatory grief when a loved one is dying." Rationale: Anticipatory grief is premourning with specific clinical manifestations. The signs of anticipatory grief include feeling empty and lost, fatigued, and numb. Other behaviors include unreality and disbelief, periods of weeping or rage, a desire to run away from the situation, micromanagement of the client's care, anger at the caregivers and the dying client, pronounced dependency, and fear. By describing this syndrome as common, the nurse offers understanding and assists the spouse in becoming more aware of her feelings and behaviors. This will free her from guilt and enhance her ability to deal with the situation. In stating, "I cannot emphasize how much your husband needs you to be there for him right now. He is in the stage of denial," or "You will need to concentrate on making these appointments on time and write down what everyone says so you will remember," the nurse expresses disapproval of the spouse's behavior, a nontherapeutic response that will probably cause the client to feel guilty. In stating, "Can you talk about what's happening to you right now? Your behavior is not appropriate at this stage of your husband's illness. You seem to be having sympathy pains for him, like men during their wives' pregnancies," the nurse demeans the spouse's behavior and makes a judgmental comment that will probably result in an angry and guilty response from the spouse.

A client who is an attorney says to the clinic nurse, "I'm worried about my wife. She's been so distant and disorganized since our son died of leukemia 4 months ago. She never suggests that we go out or take our other children anywhere. Is this normal, or do I need to get her to a doctor?" Which statement by the nurse would be therapeutic? A. "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?" B. "To be safe, it would not hurt to have her see your family doctor, or maybe you have a member of the clergy she can talk to." C. "Absolutely. It sounds as if she may be experiencing a severe depression." D. "The reluctance to resume activities and overprotect your other children is a normal part of bereavement and will subside in 2 months."

A. "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?" Rationale: The nurse should provide the husband with correct information and let him know that disorganization and a depressive mood usually ease over the course of a year's bereavement and that loneliness and aimlessness usually peak 6 to 9 months after a death. In stating, "Absolutely. It sounds as if she may be experiencing a severe depression," the nurse overreacts and offers a pseudodiagnosis. This is nontherapeutic and unprofessional. In stating, "To be safe, it would not hurt to have her see your family doctor, or maybe you have a member of the clergy she can talk to," the nurse offers a good source of support as a referral, which may be helpful, but it is incorrect to allow the spouse to be concerned. Stating, "The reluctance to resume activities and overprotect your other children is a normal part of bereavement and will subside in 2 months" is a partly correct response, but because depression usually peaks between 6 and 9 months after a death, a component of the option is incorrect.

The nurse is talking to a client whose spouse died 10 months ago. Which statement by the client indicates successful mourning? A. "I must confess that I have taken to drinking more than I should at night, but a drink or two helps me to sleep alone in that big house." B. "I'm planning a trip to England next fall to tour the mansions and their gardens." C. "My son has taken over managing my money because I got into a little mischief with my charge cards. I'm restricted to one debit card now." D. "Last night they had to treat me in the emergency department because I swallowed a few too many pills. Lately I've felt as if I can't go on alone."

B. "I'm planning a trip to England next fall to tour the mansions and their gardens." Rationale: The tasks of successful mourning include acceptance of the reality of loss, sharing in the process of working through the pain of grief, adjustment to the environment without the lost loved one, reinvesting in other relationships and life pursuits, and restructuring family relationships. Therefore the client's statement about planning a trip to England indicates successful mourning. The remaining options identify clinical manifestations of dysfunctional grieving.

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. "Goodness. At 22, I supported myself and never asked my mother for anything." B. "I wonder why you're so worried about your adult son when you need to concentrate on you?" C. "Could you share your feelings with your son just as you have with me?" D. "Sounds as if your son will never grow up and learn to take care of himself."

C. "Could you share your feelings with your son just as you have with me?" Rationale: It is important for both the dying client and his or her significant others to resolve concerns by discussing issues, and the nurse needs to encourage this communication. "Sounds as if your son will never grow up and learn to take care of himself," and "Goodness. At 22, I supported myself and never asked my mother for anything" are both judgmental responses. By stating, "I wonder why you are so worried about your adult son when you need to concentrate on you?" the nurse diverts the focus from the client's expressed concerns. Changing the subject is nontherapeutic when the client's feelings are ignored.

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? A. "Be realistic. Remember, the assault didn't just happen." B. "Tell me more about why you feel like the assault just occurred." C. "Why keep thinking about this? It'll only make matters worse." D. "Things like this take time to get over."

B. "Tell me more about why you feel like the assault just occurred." Rationale: The correct option allows the client to express her ideas and feelings more fully and implies a nonhurried, nonjudgmental, supportive attitude. Clients need to be reassured that their feelings are normal and that they may freely express their concerns in a safe care environment.The statement "Things like this take time to get over" places the client's feelings on hold. "Be realistic. Remember, the assault didn't just happen," immediately blocks communication. Why keep thinking about this? It'll only make matters worse" is nonsupportive, puts the client on the defensive, and may make the client feel worthless.

The nurse is talking to a client with depression when the client says, "I don't know why my son turned out like he did. I never thought that he would rob a bank! I don't know what I did wrong. I know that he didn't grow up with a father, but I gave him everything. I wish I could start over and do things differently." Which response by the nurse would be therapeutic? A. "Do I hear you saying that you feel that your son's behavior was caused by his upbringing?" B. "You seem to be feeling regret." C. "Don't blame yourself. Some people just turn out bad no matter what." D. "All we can do is give our children love and do our very best. The rest is up to them."

B. "You seem to be feeling regret." Rationale: The therapeutic response is one that seeks to promote the client to reframe a situation. In stating, "Don't blame yourself. Some people just turn out bad no matter what," the nurse uses a social generalized response. In stating, "All we can do is give our children love and do our very best. The rest is up to them," the nurse uses trite, clichéd social, nontherapeutic communication. In asking, "Do I hear you saying that you feel that your son's behavior was caused by his upbringing?" the nurse uses an inappropriate and inaccurate interpretation, which is insensitive.

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? A. "Yet you seem to be dwelling on the thought that the divorce is all your fault." B. "I wonder whether you think you're responsible for making everything turn out right." C. "So you're a natural worrywart, divorced with twins. I guess you can be forgiven for a little worrying, but tell me about the blaming you've been doing." D. "Can you tell me more about the worrying and blaming you are experiencing?"

D. "Can you tell me more about the worrying and blaming you are experiencing?" Rationale: Generalized anxiety disorder is characterized by excessive worrying that cannot be controlled. Therefore, the therapeutic response is the one that explores and seeks clarification of the client's comment. The nurse will further assess the client for restlessness, fatigue, irritability, muscle tension, sleep disturbances, and difficulty concentrating. By focusing on the excessive worrying and blame, the nurse is checking to determine whether any of these problems is present. In stating, "Yet you seem to be dwelling on the thought that the divorce is all your fault," the nurse prematurely interprets the client's concerns. In stating, "I wonder whether you think you're responsible for making everything turn out right," the nurse asks an inappropriate question before establishing trust in a one-on-one relationship. In stating, "So you're a natural worrywart, divorced with twins. I guess you can be forgiven for a little worrying, but tell me about the blaming you've been doing," the nurse uses a social response and sarcastic humor.

A nurse is caring for a patient whose spouse has died. How does the nurse determine that a client who has lost a spouse has successfully completed the tasks of mourning? Select all that apply. A. Heard explaining to family that illness "took" her husband B. Purchasing a smaller car she is comfortable driving C. Placing a picture of her husband on the bedside stand D. Reporting that sleeping alone is so hard now E. Relating that "its better he went first"

A. Heard explaining to family that illness "took" her husband B. Purchasing a smaller car she is comfortable driving C. Placing a picture of her husband on the bedside stand D. Reporting that sleeping alone is so hard now Rationale: The tasks of mourning have been identified as accepting the reality of the loss; experiencing the pain of grief; adjusting to life without the lost one; and relocating and memorializing the loved one. It is not necessary to find a positive aspect to the loss in order to deal with the loss in a psychologically healthy manner. Therefore relating that "its better he went first" is incorrect.

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? A. "Mental illness is a result of environmental factors." B. "There are many possible physical causes of mental illness, and they include problems in the brain." C. "Today we know that all mental illness is genetically inherited." D. "Mental illness always has its roots in the family."

B. "There are many possible physical causes of mental illness, and they include problems in the brain." Rationale: Biologically based mental illnesses are caused by neurotransmitter dysfunction, abnormal brain structure, inherited genetic factors, or other biological causes. Biologically influenced illnesses include schizophrenia, bipolar disorder, major depression, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, autism, anorexia nervosa, and attention deficit-hyperactivity disorder. Stating that all mental illness is a result of genetic factors or that it is caused by environmental factors or family dynamics is incorrect and not associated with a biologically based disorder.

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. "Did you go through systematic desensitization with your doctor? I understand that it works well." B. "Your gardens are beautiful now. Would you like to stroll in them after our work?" C. "I know what you mean. I spent more than $2,000 on a dental implant and still wound up with false teeth." D. "It doesn't matter? Can you share your feelings with me?"

D. "It doesn't matter? Can you share your feelings with me?" Rationale: The client has made a depressive statement, and the nurse must further assess the statement to determine its meaning. By stating, "Your gardens are beautiful now. Would you like to stroll in them after our work?" the nurse uses distraction as a strategy and closes off the expression of feelings prematurely. By stating, "Did you go through systematic desensitization with your doctor? I understand that it works well," the nurse changes the subject (nontherapeutic) and closes off the client's expression of feelings. In the statement "I know what you mean. I spent more than $2,000 on a dental implant and still wound up with false teeth," the nurse again changes the subject (nontherapeutic) and provides a social response.

The slightly overweight mother of a morbidly obese 11-year-old girl says, "My family health care provider 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? A. "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." B. "Well, it seems very bleak to you, but your daughter is responsible for her eating and exercising, too." C. "What about her father? Isn't it partly his fault, too? I want to meet with you, him, and your daughter tomorrow." D. "It's all this fast food and TV-watching these days. If our kids aren't watching television, they're playing with their computers."

A. "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." Rationale: Self-blame is a negative stress response in which self-esteem is minimized, which will stop the client from acting to solve problems effectively. The use of a support system is the positive stress response recommended to help the client mobilize and stop the self-blame. By stating, "Well, it seems very bleak to you, but your daughter is responsible for her eating and exercising, too," the nurse offers reflection but prematurely interprets the client's feelings. "What about her father? Isn't it partly his fault, too? I want to meet with you, him, and your daughter tomorrow" is nontherapeutic because it is social and peremptory. "It's all this fast food and TV-watching these days. If our kids aren't watching television, they're playing with their computers" is nontherapeutic because it is a social response that does not assist the client in stopping self-blame.

A client comes to the mental health clinic after losing all of his personal belongings in a hurricane. The client tells the nurse that the loss of his possessions is his fault because he didn't prepare for the storm. The nurse determines that the client is coping ineffectively and develops goals with the client. Which goal requires revision because it is not realistic? A. The client will develop and use adaptive coping patterns. B. The client will express and share his feelings about this crisis. C. The client will stop blaming himself for the loss of his belongings. D. The client will identify effective coping skills.

C. The client will stop blaming himself for the loss of his belongings. Rationale: Expecting the client to stop blaming himself for the loss of belongings puts undue pressure on him by implying that the client was negligent and contributed to the loss of the belongings. The other options are realistic goals and represent positive movement toward improved self-esteem and problem-solving.

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? A. "Your doctor did all he could for your wife. You know, health care providers can only apply their best clinical judgment." B. "Let's focus not on what was not done but instead on what was done for your wife." C. Say nothing. Simply nod and say "Mm-hmm" noncommittally. D. "Sounds as if you're feeling angry and pretty helpless right now."

D. "Sounds as if you're feeling angry and pretty helpless right now." Rationale: Anger is not uncommon during the first month of grief and at times throughout the first year after the loss of a loved one. The nurse should not be surprised to hear the bereaved husband displace his anger onto the healthcare providers. The nurse's use of reflection will help him explore sadness and loss more easily. By saying nothing and simply saying "Mm-hmm" noncommittally, the nurse uses a response that may mislead the bereaved husband to think that the nurse agrees with his displaced anger. Although it may be a therapeutic response, it will not help the husband focus on his feelings. By stating, "Let's not focus on what was not done, but what was done for your wife," the nurse uses a social response of distraction and does not facilitate expression of the husband's feelings. "Your doctor did all he could for your wife. You know, health care providers can only apply their best clinical judgment" is defensive and lecturing.

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? A. "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." B. "I must begin by saying that I am uncomfortable meeting without your son here to talk for himself." C. "Why don't we all introduce ourselves and say what our relationship is to your son? I'll begin, because I'm the nurse who'll be seeing him after he comes home." D. "Let's start by introducing ourselves and talking about what is most troubling to each of you about having your son home."

A. "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." Rationale: Family therapy is a good idea when violence is part of a crisis or if the family requests help. By offering ways to cope and support the client, the nurse can relieve any hesitation on the part of the family about discussing their concerns. In stating, "I must begin by saying that I am uncomfortable meeting without your son here to talk for himself," the nurse uses a confrontational style of speaking that is not pertinent to the issues at hand. The family members have a right to their own counseling and to teaching on how to assess mood and suicidal ideation. At the appropriate time the nurse can request that the client be invited to attend the family therapy sessions. In stating, "Let's start by introducing ourselves and talking about what is most troubling to each of you about having your son home," the nurse uses an orientation and broad opening technique that may be helpful but is not the best of the options provided. By stating, "Why don't we all introduce ourselves and say what our relationship is to your son? I'll begin, because I'm the nurse who'll be seeing him after he comes home," the nurse uses a style that is introductory, but then the nurse changes the focus to herself, which is not therapeutic.

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? A. "It seems that you're blaming yourself for something that was beyond your control." B. "You should be thankful that you're a survivor. The victims and their families lost, not you." C. "I don't know what to say. It was a terrible fire. I'm so sorry this happened." D. "It seems to me that you're making this all about you when many people died in that fire."

A. "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. In stating, "I don't know what to say. It was a terrible fire. I'm so sorry this happened," the nurse is using a social response and the nontherapeutic communication technique of agreeing. In stating, "It seems to me that you're making this all about you when many people died in that fire," the nurse is using the nontherapeutic communication techniques of disapproval and judging. In stating, "You should be thankful that you're a survivor. The victims and their families lost, not you," the nurse is nontherapeutically lecturing the client.

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? A. "It sounds like you and your daughter were very close but she kept her sexual orientation from you." B. "You're good at talking with middle schoolers, but how about young adults?" C. "Are you prejudiced against lesbian and gay people?" D. "How did your wife happen to tell you about this? Did your daughter ask her to tell you?"

A. "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. In stating, "Are you prejudiced against lesbian and gay people?" the nurse changes the focus and insensitively addresses the client's feelings about sexual orientation. In stating, "You're good at talking with middle schoolers, but how about young adults?" the nurse confronts the client by probing and making a premature judgment that is nontherapeutic. In stating, "How did your wife happen to tell you about this? Did your daughter ask her to tell you?" the nurse changes the focus of the client's concerns, which is nontherapeutic.

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." B. "For it to be effective and produce deep relaxation, the technique requires your complete receptivity to its benefit and your need for it." C. "I could never master the technique myself, so I understand your frustration. Would you like me to explain its difficulty for you to the doctor?" D. "I want you to practice it as often as you can. Play soft, soothing music in the background when you practice your exercises."

A. "PMR requires training sessions. Let's check into classes that you can attend to learn the technique." Rationale: Progressive muscle relaxation, or PMR, a technique designed to help the client achieve relaxation by eliminating muscle contraction through systematic tensing and releasing of various muscles, requires the client to attend training for its use. The client learns to discriminate between sensations of tension and relaxation. In stating, "I want you to practice it as much as you can. Play soft, soothing music in the background when you practice your exercises," the nurse does not address the client's need for teaching and learning. "For it to be effective and produce deep relaxation, the technique requires your complete receptivity to its benefit and your need for it" is nontherapeutic because the nurse is offering incorrect information and implying that the client is unreceptive to learning. In stating, "I could never master the technique myself, so I understand your frustration. Would you like me to explain its difficulty for you to the doctor?" the nurse uses a nontherapeutic response that is social and does not support the client's need for mastery.

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? A. "Some people have added exercise to diet and medication therapy and gotten positive results. Do you think that this would work for you?" B. "I don't believe that you have been following your diet, because you haven't lost any weight." C. "Sounds fine to me. Let's meet again in 6 months." D. "Well, you've talked about diet in your terms, but perhaps I should test you on specific things."

A. "Some people have added exercise to diet and medication therapy and gotten positive results. Do you think that this would work for you?" Rationale: Although suggestion or overt giving of advice is sometimes nontherapeutic, these strategies are therapeutic when used in the working phase, because in this situation they will increase the client's perception of all available options in the treatment plan. Answering, "Sounds fine to me. Let's meet again in 6 months" stops the communication process. Stating to the client that he or she has not lost any weight implies disbelief and does not explore the reasons for the client's failure to lose weight. "Testing" challenges the client and is nontherapeutic.

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? A. "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?" B. "It's a shame. So many troubling things have been happening to you both because of the disease of alcoholism." C. "You're having a very difficult time, and the problem stems entirely from your husband's drinking." D. "You're codependent with your husband. Don't you see this? Are you willing to attend some group meetings to learn about ways to deal more effectively with your problem?"

A. "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?" Rationale: The therapeutic response reflects the information in the question and encourages the client to express her feelings. In saying, "You're having a very difficult time, and the problem stems entirely from your husband's drinking," the nurse is judgmental and places all blame on the husband. In stating, "It's a shame. So many troubling things have been happening to you both because of the disease of alcoholism," the nurse provides a closed-ended response. In saying, "You're codependent with your husband. Don't you see this? Are you willing to attend some group meetings to learn about ways to deal more effectively with your problem?" the nurse is nonempathetic and belittling.

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? A. "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." B. "Sounds as if you're exaggerating your situation and looking only at the half-full glass." C. "It seems that you measure your life and what you need to do against the behaviors of others." D. "Aren't you a little young to be thinking in such negative terms? You do still have plenty of time before your biological clock winds down."

A. "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: Reframing is a positive response in which the client redefines a situation to view both its positive and negative sides. The correct statement is the one that helps the client redefine the situation in this fashion and see how the situation could be used to the client's advantage. In stating, "Sounds as if you're exaggerating your situation and looking only at the half-full glass," the nurse gives advice and expresses an opinion, both of which are nontherapeutic. In stating, "It seems that you measure your life and what you need to do against the behaviors of others," the nurse uses the therapeutic response of reflection, but it does not teach the client reframing. "Aren't you a little young to be thinking in such negative terms? You do still have plenty of time before your biological clock winds down" is sarcastic and belittles the client; hence it is nontherapeutic.

The nurse is caring for a 39-year-old client who has experienced a cerebral vascular accident(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." B. "I am troubled that you are worried over the worst possible things that could happen rather than worrying about the efforts needed to strengthen your family situation." C. "You are working to get better, but you're worrying about things that aren't going to happen." D. "You seem to be feeling very powerless right now, yet you're getting better, so why worry about what won't happen?"

A. "You seem to be feeling very troubled." Rationale: The client has suffered two major losses and is expressing worry and concern about his health and his children. The correct response conveys the nurse's expression of empathy and willingness to understand and help the client explore ways of coping with difficulties. In stating, "You are working to get better and are doing so. But you are worrying about things that aren't going to happen," the nurse is making a pat and clichéd response that may or may not be true. In stating, "You seem to be feeling very powerless right now, yet you're getting better, so why worry about what won't happen?" the nurse is displaying empathy but also minimizing the client's feelings with a false reassurance. In stating "I am troubled that you are worried over the worst possible things that could happen rather than worrying about the efforts needed to strengthen your family situation," the nurse is not focusing on the client's concern, and the statement could be interpreted as minimizing or belittling by the client.

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. "You seem to be saying that you and your fiancé haven't been close, yet you found each another." B. "Can you share with me some of the strategies you've been using?" C. "It almost seems that you're saying that you will never be able to love your fiancé." D. "Do you want a normal sexual life? If you do, you will have one, I'm sure."

B. "Can you share with me some of the strategies you've been using?" Rationale: The question presents a client who may have posttraumatic stress disorder (PTSD) as a result of incest in childhood. The client's positive adaptive capacity is demonstrated by the ability to discuss the victimization and the attempt to reach out for a normal sexual relationship. The nurse should assist the client in focusing on her strengths and sources of support and using them to achieve optimal coping. In stating, "Do you want a normal sexual life"? If you do, you will have one, I'm sure," the nurse nontherapeutically employs platitudes and makes an insensitive, pat social response. In stating, "It almost seems that you are saying that you will never be able to love your fiancé," the nurse nontherapeutically reflects the negative cognitive thinking pattern rather than aiding cognitive restructuring or other coping strategies. In stating, "You seem to be saying that you and your fiancé haven't been close, yet you found each another," the nurse attempts to reflect the client's feelings and to offer another way of looking at the relationship. Because an assessment should be performed first, this is not the best response.

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. "Sounds as if you're lucky to have your wife's job to fall back on." B. "Can you tell me a little more about this?" C. "I would dig ditches if it contributed to my family's well-being." D. "I'm surprised that such a hardworking man is not able to find a job."

B. "Can you tell me a little more about this?" Rationale: In using the therapeutic communication of exploration, the nurse is trying to learn more about the situation and the client's coping style. In stating, "I would dig ditches if it would contribute to my family's well-being," the nurse uses the nontherapeutic communication of disapproval. In stating, "Sounds as if you're lucky to have your wife's job to fall back on," the nurse is using the nontherapeutic communication technique of making a judgment or offering an opinion. In stating, "I'm surprised that such a hardworking man is not able to find a job," the nurse is using the nontherapeutic techniques of sarcasm and giving an opinion.

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. "Oh, I agree with you. Let her get another job if she needs that much money." B. "Have you shared your feelings with your wife?" C. "You seem to feel that a less prestigious job would be humiliating for you." D. "How soon will you be able to find work? If this is permanent, you may need to swallow your pride."

B. "Have you shared your feelings with your wife?" Rationale: The therapeutic response is the one that helps determine whether the client is sharing his feelings with his wife and providing her with the opportunity to join in the decision-making process. Stating "You seem to feel that a less prestigious job would be humiliating for you" is reflection to some degree; however, its focus is nontherapeutic because the nurse is making a premature judgment of the client's concerns. In stating, "Oh, I agree with you. Let her get another job if she needs that much money," the nurse is using a nontherapeutic response of giving approval. "How soon will you be able to find work? If this is permanent, you may need to swallow your pride" is a probing question that the client is probably unable to answer and gives an unsolicited opinion, which is a nontherapeutic communication.

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. "Don't you just want to scream at someone when such bad things happen? Do you have to work to support your grandchildren?" B. "I am sorry you've had so many losses." C. "Your grandchildren sound as if they will give you a run for your money." D. "I lost my nephew in that nightclub fire, so I understand your sorrow."

B. "I am sorry you've had so many losses." Rationale: The correct option provides an empathetic response to the client. In stating, "I lost my nephew in that nightclub fire, so I understand your sorrow," the nurse changes the focus of the client's expression of feelings to her own loss, a nontherapeutic communication. "Your grandchildren sound as if they will give you a run for your money" and "Don't you just want to scream at someone when such bad things happen? Do you have to work to support your grandchildren?" are both social responses.

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 statement by the nurse would be therapeutic? A. "Before we talk about stress management, let's discuss your children." B. "Let's talk more about what has been helpful to you in the past." C. "Can you afford to pay for therapy sessions? I see that your benefits are pretty much maxed out, and I'd hate to ask you to take on any additional burden." D. "You have a lot of problems. How long does your wife have to live, and what is her relationship with your children?"

B. "Let's talk more about what has been helpful to you in the past." Rationale: The client is specifically asking the nurse to help him choose stress-management techniques and has already identified two that are not effective for him. Although the nurse will explore the client's stressors, the problem that is directly harming the client physically is his blood pressure, so the nurse focuses on this first and determines what stress-management strategies have been effective in the past. By stating, "Before we talk about stress management, let's discuss your children," the nurse changes the subject, a nontherapeutic communication. By stating, "You have a lot of problems. How long does your wife have to live, and what is her relationship to your children?" the nurse changes the subject and engages in probing, both of which are nontherapeutic actions. "Can you afford to pay for therapy sessions? I see that your benefits are pretty much maxed out, and I'd hate to ask you to take on any additional burden?" is an inappropriately timed and somewhat probing question that changes the subject.

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? A. "Of course you're angry. Who wouldn't be? Yet nothing is ever clear cut, is it?" B. "You not only lost your husband but also learned it was at the hands of someone you looked up to." C. "I wouldn't blame you if you never entered a church again. This is a terrible thing for the head of a church to do." D. "You're having stomach pain? You should get checked for an ulcer or other gastric problem."

B. "You not only lost your husband but also learned it was at the hands of someone you looked up to." Rationale: The therapeutic statement is the one that seeks clarification. By stating, "Of course you're angry. Who wouldn't be? Yet nothing is ever clear cut, is it?," the nurse agrees with the widow and then uses a social philosophic stance. This response is nontherapeutic. By stating, "You're having stomach pain? Sounds like you need to get checked for an ulcer or other gastric problem," the nurse changes the focus from the widow's expression of feelings to an expression of somatic distress. Sensations of somatic distress are common for a brief time during bereavement. However, if these symptoms were to persist, the nurse would then be correct to encourage the widow to get checked for physical problems. By stating, "I wouldn't blame you if you never entered a church again. This is a terrible thing for the head of a church to do." the nurse agrees with the widow and judges the perpetrator. This response is also nontherapeutic.

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? A. "Your children seem very distant. They hardly ever call?" B. "You seem to be identifying some issues in your life that are troubling, and you sound very down right now." C. "Are you thinking of hurting yourself just because you're alone?" D. "You're feeling pretty useless right now, but I wonder if you've taken enough time to grieve?"

B. "You seem to be identifying some issues in your life that are troubling, and you sound very down right now." Rationale: The therapeutic response is the one that reflects the client's losses and proceeds to focus on the client's depressive symptoms by making an observation and seeking clarification. After the nurse validates these observations, questions about suicidal ideation or plans would be appropriate. The nurse will attempt to reframe the situation with this client, helping her understand that major decisions should not be made until some time has passed and these issues have been effectively resolved. "Your children seem very distant. They hardly ever call?" is nontherapeutic because the nurse is making a premature judgment and offering opinions on the basis of few facts. (The client might describe her children as hardly calling even though they call weekly.) Asking, "Are you thinking of hurting yourself just because you're alone?" is nontherapeutic because the question is belittling and minimizes the client's feelings. The lethality assessment is appropriate only after the nurse has clarified the client's loss. In saying, "You're feeling pretty useless right now, but I wonder if you've taken enough time to grieve?" the nurse prematurely interprets that the client is feeling useless, but that may not be how she feels; it's important to let her tell the nurse if she can. It is not helpful at this point to tell the client that she hasn't grieved long enough.

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? A. "I'm sorry to hear that your loved ones are so ill. As a nurse, you should be able to assist them by using your professional expertise. Perhaps that's what your family expects from you." B. "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." C. "Shame on them for expecting so much from you. Perhaps we need to schedule a family meeting so I can help you set them straight." D. "Are you saying you are overly involved and will need to emotionally distance yourself to be therapeutic for your family?"

B. "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. Stating, "Are you saying you are overly involved and will need to emotionally distance yourself to be therapeutic for your family?" is paraphrasing, a therapeutic technique, but this response is premature and reflects unfounded assumptions. In stating, "Shame on them for expecting so much from you. Perhaps we need to schedule a family meeting so I can help you set them straight," the nurse expresses disapproval, a nontherapeutic communication technique, and then offers to "beat up" the family verbally in a family intervention. The statement "I'm sorry to hear that your loved ones are so ill. As a nurse, you should be able to assist them, using your professional expertise. Perhaps that's what your family expects from you," expresses sympathy but also lectures the client

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? A. "My parents would be devastated if they lost me and my sister, too. How can I be of service to you?" B. "Your loss touches me so. How truly devastated you both must be. Can you share what things you have been doing to grieve?" C. "Your feelings are appropriate for the extent of your loss and how your children's deaths happened." D. "Your loss is incalculable. Perhaps you could consider some ways in which to commemorate their lives for you and in your community."

B. "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. In stating, "My parents would be devastated if they lost me and my sister, too. How can I be of service to you?" the nurse nontherapeutically uses a social response that personalizes and shifts the focus from their feelings. In stating, "Your feelings are appropriate for the extent of your loss and how their deaths happened," the nurse lectures and moves away from the parents' expressed feelings to intellectualize. By stating, "Your loss is incalculable. Perhaps you could consider some ways in which to commemorate their lives for you and in your community," the nurse is empathetic and then begins to try to guide them toward creating a memorial. There may be a time when the nurse can help the parents reframe what has happened and think of ways to commemorate their children's lives, but they have not moved to that level of mourning yet, probably because of the nature of their children's deaths.

A client is going to receive instruction in biofeedback technique to lower his stress level. The client asks the nurse to describe this technique. What should the nurse tell the client? A. It involves learning to contract and relax muscles in a systematic way and may be combined with breathing exercises B. 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 C. It is the purposeful use of one's imagination to achieve relaxation and control D. It is a technique that trains the mind to elicit a relaxation response

B. 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 Rationale: Biofeedback is a therapeutic modality that enables an individual to monitor skin temperature, muscle activity, heart rate, blood pressure, brain waves, and other body functions and then control these physiologic responses to stressful or challenging events. Meditation trains the mind to elicit a relaxation response; the client focuses on an object or sound or concentrates on breathing. Guided imagery is the purposeful use of one's imagination to achieve relaxation and control. Progressive muscle relaxation involves learning to contract and relax muscles in a systematic way and may be combined with breathing exercises.

The wife of a victim of a gas explosion says, "It's not bad enough that I've been left alone to care for two children — now the company is denying our claim for compensation and we have to join a class action suit to get my husband's pension." Which statement by the nurse would be therapeutic? A. "Do you believe that a class action suit is the correct thing and that you are in the right?" B."You're saying that being left a widow with children is difficult enough, but now you've got to fight for your benefits." C. "Get a lawyer! That's what you all need to do." D. "Walk away. It's too much to even think about at your age, and how can you get caught up in all this with children and work, too?"

B."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. By stating, "Get a lawyer! That's what you all need to do," the nurse makes a social response, which is nontherapeutic. By stating, "Do you believe that a class action suit is the correct thing and that you are in the right?" the nurse engages in probing, which is premature and nontherapeutic. By stating, "Walk away. It's too much to even think about at your age, and how can you get caught up in all this with children and work, too?" the nurse gives a social opinion and expresses disapproval or disagreement.

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? A. "Oh, me too. I always pick the worst kind of men, so I know just how you feel." B. "Divorce is more difficult for children. Maybe you should focus on them for now." C. " Divorce is hard to go through. Tell me what difficulties you feel you will face raising your children." D. "You've been unfortunate, but you seem to be focusing on yourself and what you have to do."

C. " Divorce is hard to go through. Tell me what difficulties you feel you will face raising your children." Rationale: Stating "divorce is hard to go through", and asking what difficulties the client feels she will be experiencing, allows the client to discuss her feelings. By stating, "Oh, me too. I always pick the worst kind of men, so I know just how you feel," the nurse personalizes and exaggerates the client's problems, using a nontherapeutic response. In stating, "Divorce is more difficult for children. Maybe you should focus on them for now," the nurse is being judgmental when he or she should be refocusing the client's energies. In stating, "You've been unfortunate, but you seem to be focusing on yourself and what you have to do," the nurse is responding with empathy, but the choice of wording suggests that the nurse is judging and blaming the client for not focusing on her children.

A 74-year-old widower of 3 months says to the nurse, "When my wife died, I lost my love and my best friend. Everyone I cared about is dead. We both were only children, and we had no kids. I'm more than ready to go when the time comes." Which nursing response should the nurse make? A. "When my dad died, my mother said some of the things you're saying now, and she had three kids." B. "It must seem very lonely to you. I can't believe that you never had any children." C. "Are you thinking of ending your life because your time has come?" D. "Did you know that many people live happier lives without children?"

C. "Are you thinking of ending your life because your time has come?" Rationale: The client exhibits clinical manifestations of depression and alludes to suicidal ideation. Because dysfunctional grieving can manifest as suicidal ideation, the nurse must conduct a lethality assessment and ask the client whether he is thinking of ending his life. By stating, "Did you know that many people live happier lives without children?" the nurse gives a nontherapeutic response, changing the subject and focusing attention away from the client's expression of feelings. By stating, "It must seem very lonely to you. I can't believe that you never had any children," the nurse begins by reflecting, which is a therapeutic response, but changes the subject (a nontherapeutic response) and expresses disdain over the client's not having had children, which is insensitive and unprofessional. By stating, "When my dad died, my mother said some of the things you're saying now and she had three kids," the nurse changes the focus from the client's feelings to other content, which is nontherapeutic.

A young widow of 18 months says to the nurse, "I'm going to need a babysitter, because I'm going on a blind date at my brother and sister-in-law's house. They fixed me up, but I think it may be too soon." Which statement by the nurse would be therapeutic? A. "Nonsense. Your children need a new father, as your family knows. Your husband would want you to go on with life." B. "If it were me, I would be dating other men by now. After 6 months of mourning, most of society feels that it's okay." C. "By the end of a year, most people are able to renew their interest in other people and activities." D. "Hello? You go girl! You can see it's only natural, can't you?"

C. "By the end of a year, most people are able to renew their interest in other people and activities." Rationale: In this question, the widow is seeking confirmation from the nurse that resocialization is acceptable. Giving approval is as nontherapeutic as giving disapproval. Therefore the most therapeutic statement is "By the end of a year, most people are able to renew their interest in other people and activities." It is natural for the bereaved person to experience renewed interest in people and activities. Successful grieving will release the bereaved from one interpersonal relationship and provide the freedom to form new ones. In stating, "Hello? You go girl! You can see it's only natural, can't you?," the nurse offers a social response that is unprofessional and insensitively belittles the client's concern. In stating, "Nonsense. Your children need a new father, as your family knows. Your husband would want you to go on with life," the nurse gives a social response and is insensitive in assuming what her client's husband would want. By stating, "If it were me, I would be dating other men by now. After 6 months of mourning, most of society feels that it's okay," the nurse changes the focus from the client to herself and gives incorrect information, a nontherapeutic communication.

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? A. "Some women wish they had your problem. My mother keeps complaining that Dad is always messing around in the house, driving her nuts." B. "'When you can't beat 'em, join 'em' — that's what I always say. Why not play golf with him?" C. "Have you shared your feelings with your husband?" D. "Do other people call you a golf widow?"

C. "Have you shared your feelings with your husband?" Rationale: The correct option, encouraging the client to share her feelings with her husband, helps the client begin to problem-solve. Asking, "Do other people call you a golf widow?" is nontherapeutic probing. "When you can't beat 'em, join 'em — that's what I always say. Why not play golf with him?" is a nontherapeutic cliché. In stating, "Some women wish they had your problem. My mother keeps complaining that Dad is always messing around in the house, driving her nuts," the nurse offers a nontherapeutic social response that is focused on the nurse instead of on the client.

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? A. "You just felt like destroying your textbooks?" B. "Well, a picture paints a thousand words." C. "I am concerned about you. Are you being or have you ever been abused?" D. "Your parents and teachers are very concerned about your drawings."

C. "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. In stating, "Well, a picture paints a thousand words," the nurse is insensitive, sarcastic, and intrusive. In asking, "You just felt like destroying your textbooks?" the nurse is addressing the client's destructive behaviors, not the possibility of sexual abuse. By stating, "Your parents and teachers are very concerned about your drawings," the nurse is trying to assess the client's abuse-related symptoms, using indirect means rather than a straightforward expression of concern.

A client says to the nurse, "My health care provider wants me to start keeping a journal every day about what's happening in my job." Which response by the nurse is appropriate? A. "Yes, that is an excellent suggestion. You need to keep a meticulous diary of your day with all of the details." B. "Well, it has always helped me to write down daily happenings and relate them to my stress level." C. "Journal-keeping that identifies what seems to cause a strain in a person's life is a good way of improving one's health." D. "You can erase your stresses by identifying things that set off negative physical experiences."

C. "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. In stating, "You can erase your stresses by identifying things that set off negative physical experiences," the nurse discusses the issue of stress reduction but is misleading to the client: It may not be possible to actually "erase" stresses. In stating, "Well, it has always helped me to write down daily happenings and relate them to my stress level," the nurse provides a personal example for feedback, but its timing and use are nontherapeutic because the statement has a lecturing tone and focuses on the nurse. "Yes, that is an excellent suggestion. You need to keep a meticulous diary of your day with all of the details" is nontherapeutic because the statement gives approval. Additionally, journal-keeping needs to be effortless, with just a few key words used to remind the client of what took place and its effects on him or her. It is not meant to be a chore, which would only increase stress.

The nurse is caring for a bereaved man with acquired immunodeficiency syndrome (AIDS) who lost his twin brother in a rock-climbing accident a month ago. Which statement by the client should cause the nurse to be concerned? A. "I should have made him stay home. He was always clumsy." B. "You'd have thought that I would be the one to die first." C. "Lately I've been feeling that life isn't that great." D. "I miss him so much. We were close and talked almost daily."

C. "Lately I've been feeling that life isn't that great." Rationale: The nurse needs to be alert to statements by clients that might be indicative of suicidal ideation. On hearing such a statement, the nurse must conduct a lethality assessment to examine the meaning of the client's statement more closely. The client statement "Lately I've been feeling that life isn't that great" should alert the nurse that the client may be experiencing suicidal ideation. In the statement "You'd have thought that I would be the one to die first," the client is expressing anger and guilt, both normal components of bereavement. In the statement "I should have made him stay home. He was always clumsy," the client is expressing guilt. In the statement "I miss him so much. We were close and talked almost daily," the client is expressing normal sorrow and mourning.

The young nurse has just completed postmortem care of a 16-year-old client who died of cancer. The nurse says to the nurse manager, "I never get sick, and this client kept telling me that he couldn't remember not being ill. I feel terrible and so bad for him and about what he went through." Which statement by the nurse manager would be therapeutic? A. "Next time, take someone else in with you for postmortem care, OK?" B. "Your feelings are normal and will go away after a good night's sleep." C. "Let's go for coffee and talk about this some more, shall we? We're both due for our coffee breaks." D. "I should never have assigned you someone so close to your own age. I'll be more careful in the future."

C. "Let's go for coffee and talk about this some more, shall we? We're both due for our coffee breaks." Rationale: The young nurse is being appropriate in approaching the nurse manager to share these feelings. Strong emotional responses, positive or negative, may indicate countertransference, and the nurse who identifies this phenomenon is correct to encourage expression of feelings. The nurse manager responds empathetically and uses a coffee break to allow the nurse to further explore feelings. This is the therapeutic broad opening of offering self. By stating, "Next time take someone else in with you for postmortem care, OK?" the nurse manager suggests calling for assistance, which is therapeutic, but the nurse manager uses a nontherapeutic approach by not addressing the young nurse's feelings. By stating, "Your feelings are normal and will go away after a good night's sleep," the nurse manager correctly identifies the nurse's response but then dismisses and minimizes the young nurse's feelings. In stating, "I should never have assigned you someone so close to your own age. I'll be more careful in the future," the nurse manager personalizes the young nurse's comments and focuses on what the nurse manager can do to problem-solve. This is nontherapeutic and does not facilitate expression of the young nurse's feelings.

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? A. "You seem to have changed your feelings about your husband completely. This didn't happen overnight, so why are you here now?" B. "You sound disgusted with your husband. Is this an accurate assessment? Why not divorce him?" C. "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?" D. "Can you tell me how long you have felt like this and how much longer you plan to continue this way?"

C. "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?" Rationale: The client is telling the nurse that many things that have happened over time. These things did not occur at once, and it is important for the nurse to learn more from the couple and for the couple to hear each other. The correct option reflects this intervention. In stating, "Can you tell me how long you have felt like this and how much longer you plan to continue this way?," the nurse uses confrontation and sarcasm, both of which are nontherapeutic. Saying, "You sound as if you are disgusted with your husband. Is this an accurate assessment? Why not divorce him?" prematurely labels and judges the client's feelings. "You seem to have changed your feelings about your husband completely. This didn't happen overnight, so why are you here now?" is a 'why' question, and the way that the nurse is challenging the client is nontherapeutic in the initial phase of a relationship.

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? A. "Your health care provider feels that your body is physically ready to make the change in medication." B. "Well, your health care provider is concerned that you will become physically dependent on the first painkiller." C. "Perhaps if I medicate you about a half-hour before you plan to start your daily activities, the medicine will be more effective." D. "I think you need to listen to your health care provider when it comes to taking such strong medication."

C. "Perhaps if I medicate you about a half-hour before you plan to start your daily activities, the medicine will be more effective." Rationale: The most supportive response is the one that addresses the client's concern and provides a plan that will help minimize the client's pain. If this nursing measure does not afford pain relief, then the nurse can report the client's continued pain to the health care provider. In stating, "Your health care provider feels that your body is physically ready to make the change in medication," the nurse is shifting attention from the client's feelings to the health care provider's view. In telling the client that he or she needs to listen to the health care provider, the nurse is nontherapeutically giving advice and patronizing the client. Stating, "Well, your doctor is concerned that you will become physically dependent on the first painkiller" is a defensive response, and the nurse's assertion about dependence may not be based on fact.

A 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? A. "It sounds like you want to have your cake and eat it, too. If you can't have both things, which would you prefer — the thrills of one-night stands or the steady support of a loving relationship?" B. "So she's left you for cheating on her. If you can't be monogamous, I guess you'll have to be content with one-night stands." 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." D. "I'm confused. What is it that you've come to me for? It sounds like your lover refuses to share her lover with others, no matter how trivial the dalliances."

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. Also, in saying, "It sounds like you want to have your cake and eat it, too. If you can't have both things, which would you prefer — the thrills of one-night stands or the steady support of a loving relationship?" the nurse is nontherapeutic, using clichés and predeterminations before all necessary information has been gathered.

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? A. "I think your visits are perfectly normal. After all, you were married for a long time. You'll stop when the winter weather comes." B. "Perhaps you could reduce your visits to his grave to once a month and meet your daughter for coffee like you used to." C. "Sounds as if you have had difficulty letting your husband go from your life. What would happen if you visited his grave less frequently?" D. "You need to stop your visits immediately, or your daughter will have you examined for a mental disorder."

C. "Sounds as if you have had difficulty letting your husband go from your life. What would happen if you visited his grave less frequently?" Rationale: In the correct option, the nurse seeks information from the client about her feelings; this is a therapeutic action. Stating, "You need to stop your visits immediately, or your daughter will have you examined for a mental disorder," is a nontherapeutic response that gives advice and ridicules the client about a matter that is serious to the client. In stating, "Perhaps you could reduce your visits to his grave to once a month and meet your daughter for coffee like you used to," the nurse gives advice before making a complete assessment; to base a solution on inadequate information is inappropriate and premature. The client has been mourning for only 2 months and may need to make the visits to resolve her grief about her husband's death. By stating, "I think your visits are perfectly normal. After all, you were married for a long time. You'll stop when the winter weather comes," the nurse again makes a premature judgment on the basis of inadequate information, and the response is somewhat sarcastic, which is insensitive and nontherapeutic.

A single mother 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? A. "Boys who are cared for only by their moms are at highest risk for violent behavior." B. "Do you know all of your son's friends, or is he left alone after school because you work?" C. "There is quite a bit that you can do. Let's talk about what you're already doing first." D. "Many young people die of gunshots every day in this country, so your son's behavior is unacceptable."

C. "There is quite a bit that you can do. Let's talk about what you're already doing first." Rationale: It is important to help parents to identify children at risk for violent behavior. Unfortunately, this young person has already engaged in threatening and potentially violent behavior, but there are parenting measures and therapies that this single parent can use to help her son express his feelings of anger verbally rather than by acting out. The nurse responds nontherapeutically in telling the mother that boys who are cared for only by their mothers are at high risk for violence; this response could generate guilt in the mother. Asking, "Do you know all of your son's friends, or is he left alone after school because you work?" is both inappropriate and premature. Telling the woman that her son's behavior is unacceptable is lecturing an upset parent, which is inappropriate.

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 statement by the nurse would be therapeutic? A. "What's being planned for your son now?" B. "Sounds like you have to be your own health care provider these days — good for you! — but I'm sure your health care provider was following medical protocol." C. "You and your son are having a very trying time. What's happened since your son's diagnosis?" D. "These days only the squeaky wheel gets the grease in medicine. Your squeaking was excellent advocacy."

C. "You and your son are having a very trying time. What's happened since your son's diagnosis?" 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. In stating, "What's being planned for your son now?" the nurse does not acknowledge the parent's feelings. In stating, "These days only the squeaky wheel gets the grease in medicine. Your squeaking was excellent advocacy," the nurse nontherapeutically gives an unprofessional and social response. In stating, "Sounds like you have to be your own health care provider these days — good for you! — but I'm sure your health care provider was following medical protocol," the nurse is social and focuses on the client's frustration and anger with the healthcare system but then gives approval (nontherapeutic) and finally tries to defend the health care provider's actions, a move that will only divert the parents into anger and a potential regressive struggle.

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? A. "Would your family come in to see me so I can hear their version of the problems you cite?" B. "You tell me that you do everything. You don't say what happens when you stop doing everything. Does your wife understand that you are not able to work as you once did and that you need her help?" 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?" D. "Do the terms 'divorce' and 'leave the nest' mean anything to you or your family?"

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?" Rationale: In the correct option, the nurse acknowledges the client's concerns, encourages the client to express his feelings and concerns, and addresses the family. Also, the client views the situation solely from his viewpoint, so it would be most therapeutic to work with the entire family; however, it is important to obtain the client's permission to invite the family. In asking, "Do the terms 'divorce' and 'leave the nest' mean anything to you or your family?" the nurse uses humor and sarcasm in a nontherapeutic way. Although the nurse is correct in viewing this as potentially being a family problem as well as an individual one, asking, "Would your family come in to see me so I can hear their version of the problems you cite?" is nontherapeutic, with the potential to cause a negative response from the client. In saying, "You tell me that you do everything. You don't say what happens when you stop doing everything. Does your wife understand that you are not able to work as you once did and that you need her help?" the nurse seems accusatory, which is nontherapeutic.

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? A. "Maybe some others in this group want to talk about the assignment that we all agreed would be completed today." B. "Your deflection from your own problems here in this group is inappropriate. Let us remind you that you signed up for this group and agreed to participate in it." 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." D. "Why do I feel attacked by someone whom I'm trying to help? Could it be that you don't want to work in this group anymore?"

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." 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. In stating, "Maybe some others in this group want to talk about the assignment that we all agreed would be completed today," the nurse ignores the client and rudely pressures others in the group to do so, too. In stating, "Why do I feel attacked by someone whom I'm trying to help? Could it be that you don't want to work in this group anymore?" the nurse is passive-aggressive and defensive with the group. In stating, "Your deflection from your own problems here in this group is inappropriate. Let us remind you that you signed up for this group and agreed to participate in it," the nurse lectures the client and is very defensive.

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? A. "Maybe you could help the mother find a home for Rudy, and then your troubling thoughts would go away." B. "You've helped victims of some horrific fires lately, and yet you question your calling. Do you feel the need to resign?" C. "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." D. "Would you listen to yourself? You've seen firemen stress out before. What is your responsibility in all this?"

C. "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. With the suggestion "Maybe you could help the mother find a home for Rudy, and then your nightmares would go away," the nurse changes the subject, is insensitive, and is nontherapeutic. In saying, "Would you listen to yourself? You've seen firemen stress out before. What is your responsibility in all this?" the nurse nontherapeutically lectures and chastises the client. In stating, "You helped victims of some horrific fires lately, and yet you question your calling. Do you feel the need to resign?" the nurse reflects the fireman's positive contributions that he already knows and then asks him whether he is thinking of acting on his ruminations. Although the nurse clearly strives to determine the client's problems, it is nontherapeutically timed and the nurse has no basis for making this judgment.

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? A. "I am committed to keeping everything you say to me confidential, so it is troubling when you accuse me of talking to your family." B. "You sound concerned that I would tell your family something about you even though you know that what we talk about is confidential." C. "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." D. "Have you talked with your family? What have they said to you about the meetings?"

C. "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. In stating, "Have you talked with your family? What have they said to you about the meetings?" the nurse changes the focus and places responsibility on the family, which is nontherapeutic. In stating, "I am committed to keep everything you say to me confidential, so it is troubling when you accuse me of talking to your family," the nurse shifts the focus from the client's concerns to the feelings of the nurse. By stating, "You sound concerned that I would tell your family something about you even though you know that what we talk about is confidential," the nurse focuses on the client's concerns but does so in a challenging way.

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? A. Asking the emergency department health care provider to join the student in requesting that the family let the nursing staff care for their son B. Telling the student not to disturb the family until the end of shift C. 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 D. Calling their family priest immediately to come help them to let their son go

C. 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. Telling the student not to disturb the family until the end of shift does not provide support to the family. Asking the emergency department health care provider to join the student in requesting that the family let the nursing staff care for their son is inappropriate. This also represents a redundancy of tasks for personnel in a busy emergency department.

A young adult client who is dying says to the nurse, "I keep asking my wife what I can do for her and our daughter before I die, but she refuses to tell me." Based on the client's statement, what is the appropriate nursing intervention? A. Saying to the client, "It sounds to me like your wife is truly comfortable and doesn't want you to worry needlessly" B. Teaching the client's wife to write down her thoughts and feelings and to read them to her husband C. Talking with both the client and his wife about the importance of expressing their feelings and how to do it in healthy ways D. Talking with all family members, including the daughter, about the importance of expressing their concerns and feelings to the dying client

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. Teaching the client's wife to write down her thoughts and feelings and read them to her husband is inappropriate without a prior determination of the wife's feelings. In saying to the client, "It sounds to me as if your wife is truly comfortable and doesn't want you to worry needlessly," the nurse verbalizes a statement without a basis in fact, a nontherapeutic technique. Talking with all family members is inappropriate and could violate client confidentiality.

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? A. "I'd like to ask you a series of parenting questions to determine your fitness." B. "Lots of women do everything right but wind up having cesarean sections. Why worry when it won't change anything?" C. "What's been happening since you all came home? As I understand it, the baby is thriving." D. "Can you tell me more about the worrying? What's been happening since you brought your baby home?"

D. "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. In stating, "I would like to ask you a series of parenting questions to determine your fitness," the nurse insensitively uses the word "fitness," which is nontherapeutic. In stating, "What's been happening since you all came home? As I understand it, the baby is thriving," the nurse starts by asking the client to relate what has been happening but then nontherapeutically changes the subject. In stating,"Lots of women do everything right but wind up having cesarean sections. Why worry when it won't change anything?" the nurse starts by making an analogy to help the client differentiate guilt and reality but then asks a nontherapeutic clichéd question.

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? A. "You have many years to find a new relationship, but moving out of your parents' home is a first step to growing up." B. "When will your mother let you go? Seems to me that jobs have come easy to you but that you can't grow up and separate from your parents." C. "You made the Navy SEALs but can't live on your own like an adult and can't stick with anything." D. "Can you tell me more about your marriage and relationships? If you leave home, what do you fear will happen?"

D. "Can you tell me more about your marriage and relationships? If you leave home, what do you fear will happen?" Rationale: The client in the question admits his inability to maintain personal and work relationships and seems unable to leave home. The correct option focuses on the client's concerns. In stating, "You made the Navy SEALs but can't live on your own like an adult and can't stick with anything," the nurse starts by recognizing the client's achievement but then diminishes it by nontherapeutically and sarcastically accusing the client of not being able to stick with anything and being unable to grow up. In stating, "You have many years to find a new relationship, but moving out of your parents' home is a first step to growing up," the nurse uses labeling. In asking, "When will your mother let you go? Seems to me that jobs have come easy to you but that you can't grow up and separate from your parents," the nurse is premature in judging what is happening to this client. It is nontherapeutic to label the client's struggles as not growing up. The client may interpret this as ridicule.

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? A. "I wonder why you left your wife and children." B. "What would you expect your wife and children to do? They didn't leave you." C. "You seem to be very angry about carrying out your responsibility to your children." D. "Do you feel that child support is designed to help children, not punish spouses who leave?"

D. "Do you feel that child support is designed to help children, not punish spouses who leave?" Rationale: The nurse employs the therapeutic communication technique of seeking clarification to support the client in processing his feelings more specifically. In maintaining a neutral, unbiased, and nonjudgmental stance, the nurse can establish a trusting relationship with the client. In stating, "I wonder why you left your wife and children," the nurse changes the focus of the client's concern and uses a "why" question that implies criticism and could cause the client to become defensive. "What would you expect your wife and children to do? They didn't leave you" is sarcasm, which is nontherapeutic and alienates the client. In stating, "You seem very angry about carrying out your responsibility to your children," the nurse is making an interpretation and labeling the client's feelings prematurely.

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? A. "What makes you feel that you have the right to fly off the handle just because you feel ignored?" B. "So you're saying that you let your feelings build up and then you just explode?" C. "Have you tried standing in front of the television when your dad is watching it?" 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.'"

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. In stating, "So you're saying that you let your feelings build up and then you just explode?" the nurse is using the therapeutic communication of reflection, but the statement does not teach assertive behavior. In stating, "Have you tried standing in front of the television when your dad is watching television?" the nurse is using sarcastic humor, a nontherapeutic communication strategy. In stating, "What makes you feel that you have the right to fly off the handle just because you feel ignored?" the nurse challenges and belittles the client's feelings, which constitutes nontherapeutic communication.

A client says to the nurse, "I've started a journal because my health care provider suggested it, and I'm writing about the things that bother me each day. Sometimes I dictate my feelings and what happened during the day into a recorder and write them up before I go to bed — and, do you know, they seem silly to me then. Is this helping me?" Which response by the nurse would be appropriate? A. "Well, I wonder about the dictation, because the writing is what helps reduce stress." B. "I'm not certain that using a tape recorder will help you with the journal-keeping." C. "Well, it will take some time, but let's see how you're doing over a month. In the meantime, keep writing." D. "It seems that people who write in their journals and can share traumatic events improve their self-awareness." Correct

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. In stating, "I'm not certain that using a tape recorder will help you with the journal-keeping" or "Well, I wonder about the dictation, because the writing is what helps reduce stress," the nurse is off focus and concerned about the tape recorder even though the client is writing down thoughts at the end of the day. Perhaps the tape recorder is cause for concern, but because the client is keeping the journal as directed these are not the appropriate responses. In telling the client, "Well, it will take some time, but let's see how you're doing over a month. In the meantime, keep writing," the nurse gives advice, avoids the client's concerns, and is somewhat negative or uncertain about journaling.

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? A. "So you've started having sleeping problems but no other problems?" B. "Since you've lost your husband, have you experienced any other problems besides trouble sleeping?" C. "Perhaps you should join the grieving spouses group that meets on Monday nights." 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?"

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. In stating, "So you've started having sleeping problems but no other problems?" the nurse probes the client for other problems, which is a nontherapeutic response. By stating, "Perhaps you should join the grieving spouses group that meets on Monday nights," the nurse changes the focus of the client's concerns and is nontherapeutic in prematurely suggesting the group therapy. In asking, "Since you've lost your husband, have you experienced any other problems besides trouble sleeping?" the nurse nontherapeutically reminds the client of her loss and links the sleeplessness to the loss.

A dying client says to the nurse, "How do I tell my parents that I am dying of AIDS ?" Which statement by the nurse would be therapeutic? A. "Well, isn't it better that they learn from you than for them to learn on their own?" B. "I've worked with this illness for many years now, and there just doesn't seem to be an easy way to do this." C. "Are you saying that your parents don't know about your illness?" D. "Sounds as if you're thinking that it's time for you to tell your parents about your disease."

D. "Sounds as if you're thinking that it's time for you to tell your parents about your disease." Rationale: The client is asking the nurse to help him determine how and when to talk with his parents about his diagnosis. In the correct option, the nurse makes a statement that is open-ended and provides an opening for the client to talk about his thoughts, feelings, concerns, and fears more openly. This process may help the client decide when and how to tell his parents. In asking, "Well, isn't it better that they learn from you than to learn on their own?" the nurse makes a social response. "I've worked with this illness for many years now and there just doesn't seem to be an easy way to do this" validates the client's difficulties and is context free but also discourages the client rather than providing support. By stating, "Are you saying that your parents don't know about your illness?" the nurse engages in catastrophizing, which will only increase the client's anxiety level.

A health care provider (HCP) tells a client that she has cancer, that her illness is terminal, and that she has a 6-month prognosis. After the health care provider leaves the client's room, which therapeutic statement should the nurse make to the client? A. "Do you want me to get the phone so you can talk to your loved ones, or do you have questions for me about what's happening with you?" B. "Do you have any questions about what is happening with you? I can assure you that I will do everything I can to help minimize your pain." C. "I am so sorry about this. You are my favorite client, and I will take good care of you." D. "What did your HCP tell you about your condition? Can you tell me what you're thinking about?"

D. "What did your HCP 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. Open-ended statements such as "Can you tell me what you are thinking about?" are appropriate and encourage verbalization of feelings. In stating, "I am so sorry about this. You are my favorite client, and I will take good care of you," the nurse expresses sympathy but provides only a social response. By stating, "Do you have any questions about what is happening with you? I can assure you that I will do everything I can to help minimize your pain," the nurse begins with a therapeutic response but then gives a false reassurance. By stating, "Do you want me to get the phone so you can talk to your loved ones, or do you have questions for me about what's happening with you?," the nurse demonstrates discomfort and is seemingly reluctant to offer help. In this statement the nurse tells the client that the nurse would prefer that the client discuss feelings and concerns with loved ones.

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. "Did you really think that you wouldn't be frightened? You're fortunate if this is the first time you've ever been afraid." B. "My earlier work as a nurse involved trips through our local crack houses. Wait until you've had some experience working narcotics and then tell me how you feel." C. "You seem to be surprised that you were frightened by the violence. Have you talked with your co-workers about their experiences?" D. "You're saying that because you felt afraid in a violent situation, you may not be right for the job?"

D. "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. In stating, "Did you really think that you wouldn't be frightened? You're fortunate if this is the first time you've ever been afraid," the nurse nontherapeutically lectures the client and is somewhat dismissive. In stating, "You seem to be surprised that you were frightened by the violence. Have you talked with your co-workers about their experiences?" the nurse makes observations and offers the suggestion that the client talk with co-workers. Although this may be an option, it is not the best one, because the client has already sought out professional assistance. In stating, "My earlier work as a nurse involved trips through our local crack houses. Wait until you've had some experience working narcotics and then tell me how you feel," the nurse nontherapeutically changes the subject to a personal experience and belittles the client's feelings.

A client who is a health care provider says to the nurse, after receiving a diagnosis of terminal lung cancer, "All my life I took care of my clients, and now my family is taking care of me." Which statement is a therapeutic nursing response? A. "It is an honor for all of us to care for you. We want to help you." B. "You can look back on so many wonderful people you saved and cared for." C. "Well, you'd expect them to care for you, wouldn't you?" D. "Your family is caring for you now."

D. "Your family is caring for you now." Rationale: The client makes a statement that reflects powerlessness. In the correct option, the nurse uses the therapeutic communication technique of paraphrasing to enable the client to hear his own statement and express his feelings more completely, if he is able to express them.By stating, "Well, you'd expect them to care for you, wouldn't you?" the nurse uses sarcasm that implies that his care may be a responsibility his family feels burdened by. "It is an honor for all of us to care for you. We want to help you" and "You can look back on so many wonderful people you saved and cared for" are nontherapeutic platitudes that do not focus on the client's concern.

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? A. "Young people don't always obey their parents." B. "Everyone feels guilt or anger when they lose a loved one." C. "Does anyone in the family have a drinking or drug problem?" D. "Your sadness over losing your daughter is mixed with anger at her driving while intoxicated."

D. "Your sadness over losing your daughter is mixed with anger at her driving while intoxicated." Rationale: Anger, a component of the bereavement phenomenon, is a common emotion. In saying, "Young people don't always obey their parents," the nurse makes a closed-ended statement that is lecturing in tone. In stating, "Everyone feels guilt or anger when they lose a loved one," the nurse makes a preachy and nontherapeutic intellectualization statement. In stating, "Does anyone in the family have a drinking or drug problem?" the nurse changes the subject and takes the focus away from facilitation of the expression of feelings with an insensitive statement that may intensify the parents' anger.

The 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? A. Having the home care office secretary call the nurse's cell phone 20 minutes after starting the visit to expedite the nurse's departure B. Informing all home care nurses to schedule their visits to the couple as their last visit of the day C. Ordering a follow-up visit to the family pediatrician and mental health clinical specialist 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

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 Rationale: The young parents of a new baby are likely working hard to cope with anxiety and to deal with their fears of doing something wrong with the baby. Therefore the nurse should block out more time for the next visit and schedule another visit as soon as possible to assess how they are coping and gauge their level of anxiety. Ordering a follow-up visit to the family pediatrician and mental health clinical specialist is incorrect because it is premature without a total assessment of the parents' coping skills. Informing all home care nurses to schedule their visits to the couple as their last visit of the day and having the home care office secretary call the nurse's cell phone 20 minutes after starting the visit to expedite the nurse's departure are unprofessional. Additionally, the nurse needs to be assertive enough to set limits on the duration of the meetings.

A single mother whose only son died 2 months ago says to the nurse, "I've been bothered at work with thoughts of my son. Suddenly I'll think of something awful I said to him years ago or some punishment I gave him because he'd been bad." Which plan should the nurse include in caregiving? A. Seeking emergency certification for the psychiatric inpatient unit at the community hospital because of high lethality concerns and visiting the client daily. B. Calling the health care provider to report that the client is a high risk for suicide and increasing the frequency of visits with the client. C. Scheduling the client for an appointment with the psychiatrist, because this is a pathological manifestation. D. Explaining that bereaved persons often describe intrusive thoughts of negative experiences with the deceased and then increasing the frequency of nurse-client visits.

D. Explaining that bereaved persons often describe intrusive thoughts of negative experiences with the deceased and then increasing the frequency of nurse-client visits. Rationale: It is common for grieving people to experience intrusive reexperiences or compulsive reenactments of interactions, including negative ones, with deceased loved ones. Bad dreams and diminished ability to concentrate may also occur. Therefore, scheduling an appointment with the psychiatrist is unnecessary, as is seeking emergency certification for the psychiatric inpatient unit. These options indicate that the nurse is making a premature interpretation that the client is at high risk for suicide.

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. Which is most consistent with the client's behavior? A. Improvement B. Manipulation C. A desire to be accepted D. Attention-seeking

A. Improvement Rationale: The behavior exhibited by the client is appropriate and demonstrates improvement. No pattern of manipulation is exhibited. Acting out is attention-seeking behavior. All clients have the desire to be accepted.

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? A. "How do you feel the money decisions could best be handled in your household?" B. "You're making the most money, so the decisions should be left to you." C. "Have you told your husband to back off"? D. "You seem frustrated with your husband's habit of controlling financial decisions."

A. "How do you feel the money decisions could best be handled in your household?" Rationale: The therapeutic nursing response is the one that provides a broad opening or statement and is focused on the client's feelings. In this response, the nurse will be able to assess what the client believes concerning family financial decision-making. Asking, "Have you told your husband to 'back off'?" is improperly paraphrasing the client and assumes that the client's stance is correct. Stating, "You're making the most money, so decisions should be left to you," is inappropriate restating and provides an opinion; this response may be seen by the client as reassurance that her interpretation is being judged correct. When stating, "You seem to feel frustrated....," the nurse is sharing perceptions, which may appear to be challenging to the client when used in this context.

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? A. "You're saying that you feel useless without your hand?" B. "You'll never need to worry about work again, because your employer will cover all of your expenses and make a settlement that will support you for life." C. "Perhaps you need to focus on being happy that you survived." D."Don't worry about all of that at this point. You're going to be fine."

A. "You're saying that you feel useless without your hand?" Rationale: In the correct option, the nurse summarizes, refocuses, and seeks to reframe the client's thinking, an intervention that may help relieve some of the stress the client is experiencing. In stating, "Perhaps you need to focus on being happy that you survived," the nurse is nontherapeutic and preaching to the client, in addition to making a closed-ended statement. "Don't worry about all of that at this point. You're going to be fine" is false reassurance. "You'll never need to worry about work again, because your employer will cover all of your expenses and make a settlement that will support you for life" is nontherapeutic, social, and sarcastic.

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? A. Self-blame B. Wishful thinking C. Avoidance D. Reframing

C. Avoidance Rationale: The negative stress response of avoidance is when a client elects not to deal directly with negative feelings about a situation. Self-blame is focused on minimizing one's self-esteem rather than on seeking help. Reframing is a positive stress response in which the client redefines a situation to view both its positive and negative sides. Wishful thinking is a form of denial in which the client believes that everything will turn out fine.

The new nurse employee is developing a plan of care, with the registered nurse, for a client who recently received a diagnosis of acquired immunodeficiency syndrome (AIDS) and is experiencing difficulty adjusting to the illness. The registered nurse should suggest revision of which intervention for this client? A. Helping the client verbalize concerns related to fear B. Assisting the client with problem-solving and decision-making C. Discouraging social networking to prevent the spread of infection D. Monitoring the client for signs of self-harm

C. Discouraging social networking to prevent the spread of infection 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. The other options are appropriate interventions.

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? A. Sublimation B. Identification C. Projection D. Displacement

D. 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. Projection involves attributing an attitude, behavior, or impulse, such as that which occurs in blaming or scapegoating, to someone else. Sublimation is the act of rechanneling an impulse into a more socially acceptable object. Identification involves modeling behavior after someone else's.

The 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? A. "I won't ever be depressed again." B. "I need to take my medications." C. "I have learned ways to deal with stress." D. "I know that I can't do everything."

A. "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. Statements such as "I need to take my medications," "I know that I can't do everything," and "I have learned ways to deal with stress," indicate that the client has learned some coping skills, such as setting limits and taking medications.

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 (4.5 kg) this month." Which initial nursing statement should the nurse make to the client? A. "Seems as if you feel lost without your wife and maybe a bit ignored by your children." B. "I'm calling the doctor immediately to obtain a homemaker for you!" C. "Meals-on-Wheels can help you minimize the frustration you are having cooking. Are you a member of the local senior center?" D. "First things first. What are you doing eating bacon and eggs? That's not a good meal for you."

A. "Seems as if you feel lost without your wife and maybe a bit ignored by your children." Rationale: The client is exhibiting grief over the recent loss of his wife; feelings of insecurity, inexperience, and helplessness; weight loss (a vegetative sign of depression); evidence of poor nutritional habits; isolation; and a lack of safety in activities of daily living. The initial nursing statement should seek clarification of the client's feelings so that the nurse can estimate the extent of mood alteration. In stating, "I'm calling the doctor immediately to obtain a homemaker for you!" the nurse is responding too abruptly. Although the stated intervention may be a part of mutual planning, the client may not need or qualify for such support at this time; more data should be gathered. In stating, "First things first. What are you doing eating bacon and eggs? That's not a good meal for you," the nurse begins by ordering data from the client but veers off into expressing disapproval of the one meal that the client has cited, which may not be representative of his dietary habits. The nurse jumps to conclusions on the basis of inadequate information, and being judgmental is nontherapeutic. Saying, "Meals-on-Wheels can help you minimize your frustration. Are you a member of the local senior center?" jumps prematurely to referral to community resources that may be helpful. However, it is too early to address resources; a complete assessment of the client's stated complaints should be obtained first.

The nurse is reading the medical record of a client who has a diagnosis of moderate anxiety and notes that the health care provider has documented that the client exhibits eustress. Based on this information, which finding would the nurse expect to encounter while assessing the client? A. The client complains of feeling anxious. B. The client engages in purposeful movement. C. The client complains of fatigue. D. The client complains of feeling drained.

B. 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. Distress, the opposite of eustress, is destructive to health. On the basis of this description, fatigue, feeling drained, and feelings of anxiety are incorrect options because they are all examples of distress.

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? A. "Your food is not poisoned." B. "There is no poison in the food. Here, I'll taste the food for you." C. "It must be frightening to you. Has something made you feel that your food is poisoned?" D. "Why do you think the food is poisoned?"

C. "It must be frightening to you. Has something made you feel that your food is poisoned?" Rationale: The correct option acknowledges the client's feelings and encourages verbalization of the client's concerns. In stating, "Your food is not poisoned," the nurse is defensive and therefore nontherapeutic. In asking, "Why do you think the food is poisoned?" the nurse places the client on the defensive, which is not therapeutic. In stating, "There is no poison in the food. Here, I'll taste the food for you," the nurse supports the client's delusion.

The nurse is teaching assertiveness training to a client with anger-management issues. Which client statement indicates the client is able to assertively confront someone? A. "I can tell the person that the behavior has become intolerable for me and that the behavior must be changed immediately." B. "I will emphasize how much I like the person but insist that the other person make the changes I need." C. "I could demonstrate that I understand how the other person feels but state that I still expect the other person to make the changes I need." D. "I can ask for private time to talk and point out the facts without being accusatory, then determine areas of mutual misunderstanding and request the changes I need."

D. "I can ask for private time to talk and point out the facts without being accusatory, then determine areas of mutual misunderstanding and request the changes I need." Rationale: The formula for confrontational assertion is to "ask for private time to talk and point out facts without being accusatory, then determine areas of mutual misunderstanding and request the changes that I need." The incorrect options identify aggressive rather than assertive approaches.

The nurse coordinates the use of hospice care to visit a dying client who will be going home with his family. Which is a function of hospice services that the nurse should tell the family? A. Helping the family stop the client's efforts to go out at night with his friends B. Helping the client focus completely on his physical health C. Working with the client to sustain hope by talking of recent research breakthroughs regarding his illness D. Providing bereavement support to the family after the client's death

D. Providing bereavement support to the family after the client's death 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. Helping the family stop the client's efforts to go out at night with his friends and helping the client focus completely on his physical health are both incorrect because they are not holistic approaches. Working with the client to sustain hope by talking of recent research is inappropriate in that it falsely reassures the dying client rather than allowing him to seek resolution.

A client who has been referred for group therapy asks the nurse about the therapy. The nurse tells the client that this type of therapy is focused on which purpose? A. Social skills training B. Cognitive behavioral therapy C. Social functioning in groups D. The development of interpersonal skills

D. The development of interpersonal skills Rationale: Group therapy is especially effective in helping clients develop interpersonal skills. Group therapy is also used to solve everyday problems, to express feelings and emotions, to ask questions, and to share experiences. It does not provide social skills training and is not focused on social function or cognitive behavioral therapy.

The nurse 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? A. Problem-solving B. Use of social supports C. Reframing D. Locus of control

A. Problem-solving Rationale: In avoidance, the client elects not to deal with a situation, which allows negative feelings and situations to build up and become chronic. Problem-solving is the positive stress response of figuring out how to deal with a situation. Reframing and use of social supports are positive stress responses to self-blame and wishful thinking. Locus of control is not a positive stress response; instead, it refers to one's sense of control (internal or external).

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? A. "Because you seem to be blaming yourself unnecessarily, perhaps we can talk about your illness and what you can expect after surgery." B. "Sounds like you feel that you're being punished for your drinking, yet you've been sober, so perhaps you're being rewarded by having a cancer that's curable." C. "You feel that you're being punished even though you've been sober for 25 years. Your doctor must have told you that the cancer is unrelated to alcohol." D. "You started drinking at 12 years of age — is that why you feel that the cancer is retribution?"

A. "Because you seem to be blaming yourself unnecessarily, perhaps we can talk about your illness and what you can expect after surgery." Rationale: The client in this question is expressing guilt and anxiety regarding his cancer diagnosis and impending surgery. Because he is anxious, the most therapeutic approach is to avoid trying to convince him that he is blameless in his cancer diagnosis and to move to health teaching and anticipatory guidance that may help reduce his anxiety and relieve his guilt. In asking, "You started drinking at 12 years of age — is that why you feel that the cancer is retribution?" the nurse focuses on his early onset of alcoholism and the need to convince him that he's faultless. In stating, "Sounds like you feel that you're being punished for your drinking, yet you've been sober, so perhaps you're being rewarded by having a cancer that's curable," the nurse starts by trying to convince the client that he is blameless for the cancer and then tries to restructure but does not use logic. In stating, "You feel that you're being punished even though you've been sober 25 years. Your doctor must have told you that the cancer is unrelated to alcohol," the nurse reflects his guilt back to him.

In planning the care of a client dying of cancer, the nurse seeks to have the client verbalize acceptance of his impending death. Which statement indicates to the nurse that this goal has been met? A. "I'll be ready to die once my daughter gets married." B. "I want to go to my family reunion; then I'll be ready to die." C. "I just want to live to see my grandchildren graduate from college." D. "I'd like to have my family here when I die."

D. "I'd like to have my family here when I die." Rationale: Acceptance is often characterized by plans for death. Often the client wants loved ones near. Therefore the statement "I'd like to have my family here when I die" indicates acceptance of impending death. The incorrect options reflect the bargaining stage of coping, in which the client tries to negotiate with his or her God or with fate.

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? A. "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?" B. "Can your husband help you with the baby and your chores? Is he on paternity leave? C. "You have a beautiful new baby, and caring for her will help you feel better. Your hormones will be back in balance soon." D. "You seem to be experiencing postpartum depression. I suggest that you have someone take your baby for a while until your hormones level off."

A. "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. In asking, "Can your husband help you with the baby and your chores? Is he on paternity leave?" the nurse changes the focus and moves away from the client's expression of feelings. In stating, "You have a beautiful new baby, and caring for her will help you feel better. Your hormones will be back in balance soon," the nurse gives false reassurance. In stating, "You seem to be experiencing postpartum depression. I suggest that you have someone take your baby for a while until your hormones level off," the nurse nontherapeutically intellectualizes and makes a premature diagnosis.

The nurse developing a plan of care for a client whose spouse recently died, determines the client has a problem with dysfunctional grieving. Which priority intervention does the nurse incorporate into the plan? A. Monitoring the client's sleep pattern B. Obtaining a health care provider's prescription for an antidepressant C. Assisting the client in resolving the grief through emotional, cognitive, and behavioral means D. Assessing the client's risk for violence toward self and others

D. Assessing the client's risk for violence toward self and others Rationale: The priority intervention for a client with dysfunctional grieving is assessing the client's risk for violence toward self and others. Although the nurse will assist the client in resolving the grief and will monitor the client's sleep pattern, these are not priorities in the list of options given. Obtaining a health care provider's prescription for an antidepressant is not a priority.

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? A. "It seems that your parents expect you to follow their rules when you live under their roof." B. "Well, if you directly discussed your concerns with them, I guess it's a case of 'When in Rome, do as the Romans do.'" C. "You tell me you live rent free, yet you expect the same privileges as an adult who supports the household?" D. "Well, I guess you could move out and live on your own if you wanted to."

A. "It seems that your parents expect you to follow their rules when you live under their roof." Rationale: The therapeutic nursing response uses reflection, in which the nurse directs the content of the client's message back for the client to review from a new perspective. This technique also includes an element of focusing on the crux of the issue — in this case, that it is his parents' home and they set the rules for living in their home, just as he someday will in his. Telling the client to move out is giving advice or suggestions to the client prematurely. Although this technique can be useful in the working phase, it is usually nontherapeutic when the nurse needs to promote client understanding and self-exploration. Stating, "You tell me you live rent free, yet you expect the same privileges as an adult who supports the household?" is judgmental and poorly timed in that it humiliates the client unnecessarily. The client has acknowledged that he pays no rent, so there is no helpful purpose in reemphasizing this fact. Stating, "Well, if you directly discussed your concerns with them, I guess it's a case of 'When in Rome, do as the Romans do.'" is nontherapeutic in that it offers a cliché and expresses hopelessness and powerlessness, two emotions that the client is no doubt already experiencing.

The nurse is caring for a 15-year-old girl who has been hospitalized. The client tells the nurse that she had her hair styled just like her young math teacher, whom she admires. Which defense mechanism should the nurse recognize that the client is using? A. Identification B. Intellectualization C. Projection D. Regression

A. Identification Rationale: Identification is the process by which a person tries to become like someone he or she admires by taking on the beliefs, mannerisms, or tastes of that person. Projection is attributing one's thoughts or impulses to another person. Regression is retreating to a behavior characteristic of an earlier level of development. Intellectualization is excessive reasoning or logic used to avoid experiencing disturbed feelings.

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 (136 kg) 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? A. Wishful thinking B. Daydreaming C. Problem- solving D. Blaming

A. Wishful thinking Rationale: Wishful thinking, a negative stress response, involves the belief that everything will work out and resolve itself. Blaming involves placing the reason for a particular occurrence on another person or object. Daydreaming is thinking but not necessarily verbalizing. Problem-solving involves the use of a systematic plan to work through problems.

The nurse reviews the nursing care plan of a client being seen in the mental health clinic and notes that the client is experiencing dysfunctional grieving after losing his spouse. Which is the appropriate outcome for the treatment plan for this client? A. The client verbalizes an absolute need to spend time with friends. B. The client reports that he is trying to use coping strategies. C. The client plans to attend a community grief group. D. The client verbalizes the relationship between significant loss and depression.

C. The client plans to attend a community grief group. Rationale: The question is focused on an appropriate outcome for a client with dysfunctional grieving. The correct option is the only one that deals with grief in an appropriate way. The other options are not related to resolution of grief related to dysfunctional grieving. The phrases "trying to use coping strategies," "an absolute need," and "depression" indicate inappropriate outcomes.

A client who is experiencing suicidal thoughts says to the nurse, "Life is just not worth it anymore." What is the appropriate initial response? A. "Tell me what you mean by that." B. "You have a lot to live for." C. "You should feel grateful for everything you have." D. "A good night's sleep will help you feel better."

A. "Tell me what you mean by that." Rationale: The statement in the correct option provides the client an opportunity to tell the nurse more about what he or she is thinking. By stating, "You have a lot to live for," or "You should feel grateful for everything you have," the nurse avoids the client's feelings and halts the communication process. Stating, "A good night's sleep will help you feel better," changes the subject and may block communication.

The mental health home care nurse says to the client, "Do you feel ready to try attending a group session at the clinic?" The client shakes his head. Which nursing statement would be therapeutic? A. "You seem to be saying no. Would you tell me more about your reluctance?" B. "OK, but I hope you will let me know when you feel ready to attend a group session at the clinic." C. "No? Why not?" D. "Perhaps a group session would be too overwhelming for you right now. How about just seeing me?"

A. "You seem to be saying no. Would you tell me more about your reluctance?" Rationale: The therapeutic nursing statement is seeking clarification. In this statement, the nurse is asking the client to put his ideas into words and explain what he means or feels. This encourages the client to express his reluctance and to try to work out any reservations about attending the group session. In responding, "No? Why not?" the nurse is using a confrontational style, which could lead to a regressive struggle. The nurse expresses doubt and uses a laissez-faire style regarding attending a group session at the clinic when the nurse states "....let me know when you feel ready to attend." In stating, "Perhaps a group session would be too overwhelming for you right now. How about just seeing me?" the nurse prematurely guesses the reasons for the client's refusal, and this is not appropriate.

The parents of an adopted child schedule an appointment at a psychiatric clinic, and when they arrive the nurse conducts an initial assessment. One of the parents says to the nurse, "We need to speak to a psychiatrist about our adopted daughter. Could you please get one for us?" Which intervention by the nurse would be therapeutic? A. "Do you feel that I am incompetent to talk with you? Everyone who comes here sees me first." B. "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." C. "That is not the procedure here. If you can't work with the system, you're free to go elsewhere." D. "I'd like to accommodate you both, but he is busy right now and you will have to talk to me."

B. "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." Rationale: The therapeutic intervention is the one that explains the clinic's procedure to the parents and moves on from there. "I'd like to accommodate you both, but he is busy right now and you will have to talk to me" is abrupt, which is dismissive and nontherapeutic. In stating, "Do you feel that I am incompetent to talk with you? Everyone who comes here sees me first," the nurse personalizes the client's request for the psychiatrist and is nontherapeutic. By stating the policy in a baiting, snide style, the nurse creates a barrier and will meet resistance from the clients. In stating, "That is not the procedure here. If you can't work with the system, you're free to go elsewhere," the nurse is nontherapeutic, making the policy known in a pedantic style of communication. The patronizing style of the communication is nontherapeutic and will serve as a barrier when the nurse tries to elicit data.

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 antibiotic until the pills are gone?" Which response by the nurse is appropriate? A. "Doctors always tell clients to take all of their medicine." B. "It's because insurance companies pay for the medications and want to make sure that the client is healed." C. "Completing the prescription ensures that the infection will be resolved." D. "Medication is always prescribed for 1 month. Do you have a month's supply?"

C. "Completing the prescription ensures that the infection will be resolved." Rationale: The client has an anxiety disorder and is anxious about her treatment plan. The appropriate response is the one that educates the client about the purpose and use of antiinfective agents. In stating, "Doctors always tell clients to take all of their medicine," or "Because insurance companies pay for the medications and want to make sure that the client is healed," the nurse provides inaccurate information. Antiinfectives are not usually prescribed for 1 month. The usual course of treatment for an antiinfective medication is 10 to 14 days.

As the nurse prepares to interview a client being admitted to the mental health unit, the client says, "I asked my family to bring me in here to talk to someone, but now I don't know where to begin." Which response by the nurse would be most helpful? A. "Why not just start talking and see where it takes you?" B. "Don't worry. Everyone who comes in here for the first time feels reluctant to talk." C. "Perhaps you can start by sharing some of your most recent concerns." D. "If I were you, I'd begin with what you were doing this morning."

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. Sharing concerns is a good place to start the conversation, because it will allow the client to express feelings. The response "Why not just start talking and see where it takes you?" is too general and does not provide the client with a focus on self. Telling the client not to worry is nontherapeutic and avoids addressing the client's concerns.

A client who is an alcoholic, and 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. "Okay, what's going on with you? You had to be coerced into treatment, but now you seem to want the full monty." B. "The best time to add individual therapy seems to be after 2 to 5 years of sobriety. Individuals vary, though, and it may be that you are asking because you feel ready to work on your issues." C. "Are you feeling that you're vulnerable to a slip? If not, why complicate treatment further?" D. "What do you think? What is the individual therapy all about?"

B. "The best time to add individual therapy seems to be after 2 to 5 years of sobriety. Individuals vary, though, and it may be that you are asking because you feel ready to work on your issues." 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. In asking, "Are you feeling like you are still very vulnerable to a slip? If not, why complicate treatment further?" the nurse is challenging the client. In asking, "Okay, what's going on with you? You had to be coerced into treatment, but now you seem to want the full monty," the nurse questions and is aggressive to the client, using an accusatory style of expressing doubt.

During a nursing interview, a client says, "My daughter was murdered in her apartment, and her estranged husband called to tell me. I can't stop myself from wondering whether he killed her, but the police have ruled him out as a suspect." Which response by the nurse would be therapeutic? A. "Sounds like it." B. "It feels terrible to lose a daughter." C. "Have you shared your concerns with the police?" D. "I agree. What do you want to bet he did it?"

B. "It feels terrible to lose a daughter." Rationale: The correct option is the only one that therapeutically addresses the issue of the client's statement. In stating, "Sounds like it" or "I agree. What do you want to bet he did it?" the nurse agrees with the client. In stating, "It feels terrible to lose a daughter," the nurse reflects the client's feelings.

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." Which defense mechanism should the nurse recognize that the client is using? A. Delusions B. Displacement C. Denial D. Psychosis

C. 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.

The client says to a nurse, "Do you know that after 24 years of marriage I still serve my husband breakfast in bed? After all I do for him, he still doesn't treat me well. He should treat me better." Which nursing response is appropriate? A. "It seems that you feel that your husband could treat you well just as you treat him." B. "Ask your husband to do the things you'd like. If he doesn't, tell him you're leaving him." C. "You know, you could work and make money serving food to people." D. "I agree. If you can do all that for your husband, he should treat you better."

A. "It seems that you feel that your husband could treat you well just as you treat him." Rationale: In the correct response, the nurse uses the therapeutic communication of seeking clarification. In stating, "You know, you could work and make money serving food to people," the nurse uses a social response that is tinged with sarcasm. In stating, "I agree. If you can do all that for your husband, he should treat you better," the nurse uses the nontherapeutic technique of agreeing and giving an opinion. In stating, "Ask your husband to do the things you'd like. If he doesn't comply, tell him you're leaving him," the nurse is giving advice.

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? A. "Your poor son. How troubled he must have been. It's a shame he couldn't talk to you and get some help." B. "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." C. "Your son had an autopsy because he committed suicide, but the coroner didn't have to tell you that he was ill." D. "You didn't know that he had AIDS? How did he see the family health care provider without your knowing?"

B. "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. "You didn't know he had AIDS? How did he see the family health care provider without your knowing?" is a redundant question that simply places emphasis on the client's not having the child's confidence. It is also nontherapeutic, because the nurse is changing the subject. "Your poor son. How troubled he must have been. It's a shame he couldn't talk to you and get some help" is nontherapeutic because it is social and fosters a sense of guilt. In stating, "Your son had an autopsy because he committed suicide, but the coroner didn't have to tell you that he was ill," the nurse makes a social statement that changes the focus and moves away from the client's grief.

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? A. "Why not write down the pros and cons of taking work leave all at once and any other options and then decide with your husband and family which would be most helpful?" B. "Your husband has managed to be active up to now, so he could live longer than predicted, but his actual lifespan remains unclear." C. "Only you and your husband can determine how you should best allocate your work leave." D. "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."

D. "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. By stating, "Only you and your husband can determine how you should best allocate your work leave," the nurse avoids any discussion with the family member. By stating, "Your husband has managed to be active up to now, so he could live longer than predicted, but his lifespan remains unclear," the nurse begins to discuss physiological issues but is so vague that in the end the statement offers no support. By stating, "Why not write down the pros and cons of taking work leave all at once and any other options, and then decide with your husband and family which would be most helpful?" the nurse makes suggestions but leaves the family member with little to use for decision-making.