NUR415 Module Exam 3

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. "Are you thinking of ending your life because your time has come?" b. "Did you know that many people live happier lives without children?" c. "It must seem very lonely to you. I can't believe that you never had any children." d. "When my dad died, my mother said some of the things you're saying now, and she had three kids."

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

A female victim of incest says to the nurse, "I've had tons of therapy but still can't let my fiancé get too close. He knows I've been sexually abused by my dad and older brother, but I'm wondering whether I'll ever be able to lead a normal sexual life." Which statement by the nurse would be therapeutic? a. "Can you share with me some of the strategies you've been using?" b. "Do you want a normal sexual life? If you do, you will have one, I'm sure." c. "It almost seems that you're saying that you will never be able to love your fiancé." d. "You seem to be saying that you and your fiancé haven't been close, yet you found each another."

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

A client who was formerly a workaholic has lost his job and is being supported financially by his wife. The client says to the nurse, "I know that my wife is disappointed in me, but I can't seem to get a job doing what I've done for 25 years. Why should I take a low-level job when she's able to support us financially?" Which response by the nurse would be therapeutic? a. "Can you tell me a little more about this?" b. "I would dig ditches if it contributed to my family's well-being." c. "Sounds as if you're lucky to have your wife's job to fall back on." d. "I'm surprised that such a hardworking man is not able to find a job."

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

An older adult client who is dying says to the nurse, "My son is 40 years old, but he works in a very poorly paying job and is always borrowing money from me. I don't know how he's going to manage without me." Which response by the nurse would be therapeutic? a. "Could you share your feelings with your son just as you have with me?" b. "Sounds as if your son will never grow up and learn to take care of himself." c. "Goodness. At 22, I supported myself and never asked my mother for anything." d. "I wonder why you're so worried about your adult son when you need to concentrate on you?"

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

A client who was employed as a corporate manager before being laid off says to the nurse, "My wife thinks that I should work in a menial job to maintain our lifestyles until I find another job as a corporate manager, but I don't feel I should have to humiliate myself like that." Which nursing response would be therapeutic? a. "Have you shared your feelings with your wife?" b. "You seem to feel that a less prestigious job would be humiliating for you." c. "Oh, I agree with you. Let her get another job if she needs that much money." d. "How soon will you be able to find work? If this is permanent, you may need to swallow your pride."

a. "Have you shared your feelings with your wife?"

A 61-year-old client whose two sons and daughter-in-law died in a nightclub fire says to the nurse, "We were going to retire early, but now we are the only ones who can care for our two grandchildren." Which response by the nurse would be therapeutic? a. "I am sorry you've had so many losses." b. "I lost my nephew in that nightclub fire, so I understand your sorrow." c. "Your grandchildren sound as if they will give you a run for your money." d. "Don't you just want to scream at someone when such bad things happen? Do you have to work to support your grandchildren?"

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

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

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

The nurse is talking to a client whose spouse died 10 months ago. Which statement by the client indicates successful mourning? a. "I'm planning a trip to England next fall to tour the mansions and their gardens." b. "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." 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."

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

A dying client with agoraphobia says to the nurse, "I've been unable to leave this house without tremendous effort for so long, and now it doesn't matter." Which statement by the nurse would be therapeutic? a. "It doesn't matter? Can you share your feelings with me?" b. "Your gardens are beautiful now. Would you like to stroll in them after our work?" c. "Did you go through systematic desensitization with your doctor? I understand that it works well." d. "I know what you mean. I spent more than $2,000 on a dental implant and still wound up with false teeth."

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

The wife of a dying man is ignoring his rapid physiological decline and imminent death. She continues with her usual activities, exhibits inability to remember what others have just told her, and misses important appointments. Which therapeutic statement should the nurse make to the wife? a. "It isn't unusual for family to suffer from anticipatory grief when a loved one is dying." 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. "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."

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

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. "Lately I've been feeling that life isn't that great." b. "You'd have thought that I would be the one to die first." c. "I should have made him stay home. He was always clumsy." d. "I miss him so much. We were close and talked almost daily."

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

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. "Let's talk more about what has been helpful to you in the past." b. "Before we talk about stress management, let's discuss your children." c. "You have a lot of problems. How long does your wife have to live, and what is her relationship with your children?" d. "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."

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

A client says to the nurse, "My doctor tells me that I need to start progressive muscle relaxation(PMR) to ease my stress, but I just can't get the hang of it." Which response by the nurse would be most helpful? a. "PMR requires training sessions. Let's check into classes that you can attend to learn the technique." b. "I want you to practice it as often as you can. Play soft, soothing music in the background when you practice your exercises." c. "For it to be effective and produce deep relaxation, the technique requires your complete receptivity to its benefit and your need for it." d. "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?"

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

A university professor meeting with the mental health nurse for his weekly therapy session says, "I have a very intelligent student who keeps disrupting my classroom by bragging, and all I want to do is say, 'OK, you're great and you know it all! Now shut up!' But I just don't want to be rude." Which statement by the nurse is therapeutic? a. "Sounds like you feel pretty helpless, yet you are the professor here." b. "Just say, 'Gee where did you earn your doctorate?' and move on with your lecture." c. "Just smile and say nothing. Go on with your lecture and then talk with the student after class." d. "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?"

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

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. "You seem to be feeling regret." Correct b. "Don't blame yourself. Some people just turn out bad no matter what." c. "All we can do is give our children love and do our very best. The rest is up to them." d. "Do I hear you saying that you feel that your son's behavior was caused by his upbringing?"

a. "You seem to be feeling regret."

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. "You are working to get better, but you're worrying about things that aren't going to happen." c. "You seem to be feeling very powerless right now, yet you're getting better, so why worry about what won't happen?" d. "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."

a. "You seem to be feeling very troubled."

A 25-year-old client says to the nurse, "I got my degree in criminal justice. I graduated first in my class from the police academy and had just started as a patrolman when my partner and I responded to a domestic violence call in the most rural part of our patrol area. Someone started shooting at us, and I'm terrified. Maybe I'm not right for this job." Which statement by the nurse would be therapeutic? a. "You're saying that because you felt afraid in a violent situation, you may not be right for the job?" b. "Did you really think that you wouldn't be frightened? You're fortunate if this is the first time you've ever been afraid." c. "You seem to be surprised that you were frightened by the violence. Have you talked with your co-workers about their experiences?" d. "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."

a. "You're saying that because you felt afraid in a violent situation, you may not be right for the job?"

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. "Perhaps you need to focus on being happy that you survived." c. "Don't worry about all of that at this point. You're going to be fine." d. "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."

a. "You're saying that you feel useless without your hand?"

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. "Your family is caring for you now." b. "Well, you'd expect them to care for you, wouldn't you?" c. "It is an honor for all of us to care for you. We want to help you." d. "You can look back on so many wonderful people you saved and cared for."

a. "Your family is caring for you now."

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

a. Denial

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 plans to attend a community grief group. b. The client reports that he is trying to use coping strategies. c. The client verbalizes an absolute need to spend time with friends. d. The client verbalizes the relationship between significant loss and depression.

a. The client plans to attend a community grief group.

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. Relating that "its better he went first" b. Reporting that sleeping alone is so hard now c. Purchasing a smaller car she is comfortable driving d. Placing a picture of her husband on the bedside stand e. Heard explaining to family that illness "took" her husband

b, c, d, e

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. "I am so sorry about this. You are my favorite client, and I will take good care of you." b. "What did your HCP tell you about your condition? Can you tell me what you're thinking about?" c. "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." d. "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. ""What did your HCP tell you about your condition? Can you tell me what you're thinking about?"

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. "You started drinking at 12 years of age — is that why you feel that the cancer is retribution?" b. "Because you seem to be blaming yourself unnecessarily, perhaps we can talk about your illness and what you can expect after surgery." c. "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." d. "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."

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

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. "Hello? You go girl! You can see it's only natural, can't you?" b. "By the end of a year, most people are able to renew their interest in other people and activities." c. "Nonsense. Your children need a new father, as your family knows. Your husband would want you to go on with life." d. "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."

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

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. "Can you tell me more about the worrying and blaming you are experiencing?" c. "I wonder whether you think you're responsible for making everything turn out right." d. "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."

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

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 made the Navy SEALs but can't live on your own like an adult and can't stick with anything." b. "Can you tell me more about your marriage and relationships? If you leave home, what do you fear will happen?" c. "You have many years to find a new relationship, but moving out of your parents' home is a first step to growing up." d. "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."

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

A client with an anxiety disorder who has been prescribed an antibiotic for otitis media asks the nurse, "Why'd the doctor tell me not to discontinue the 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. "Completing the prescription ensures that the infection will be resolved." c. "Medication is always prescribed for 1 month. Do you have a month's supply?" d. "It's because insurance companies pay for the medications and want to make sure that the client is healed."

b. "Completing the prescription ensures that the infection will be resolved."

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

b. "Have you shared your feelings with your husband?"

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

b. "It feels terrible to lose a daughter."

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

b. "It seems that you're blaming yourself for something that was beyond your control."

During a mental health intake interview, a young adult client who lives with his family rent free says, "I'm tired of not being able to offer my friends a beer just because my folks don't believe in taking a drink socially." Which nursing response would be therapeutic? a. "Well, I guess you could move out and live on your own if you wanted to." b. "It seems that your parents expect you to follow their rules when you live under their roof." c. "You tell me you live rent free, yet you expect the same privileges as an adult who supports the household?" d. "Well, if you directly discussed your concerns with them, I guess it's a case of 'When in Rome, do as the Romans do.'"

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

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. "I'm calling the doctor immediately to obtain a homemaker for you!" b. "Seems as if you feel lost without your wife and maybe a bit ignored by your children." c. "First things first. What are you doing eating bacon and eggs? That's not a good meal for you." d. "Meals-on-Wheels can help you minimize the frustration you are having cooking. Are you a member of the local senior center?"

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

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

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

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. "Sounds as if you're thinking that it's time for you to tell your parents about your disease." c. "I've worked with this illness for many years now, and there just doesn't seem to be an easy way to do this." d. "Are you saying that your parents don't know about your illness?"

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

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. "You have a lot to live for." b. "Tell me what you mean by that." Correct c. "A good night's sleep will help you feel better." d. "You should feel grateful for everything you have."

b. "Tell me what you mean by that."

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. "There is quite a bit that you can do. Let's talk about what you're already doing first." c. "Do you know all of your son's friends, or is he left alone after school because you work?" d. "Many young people die of gunshots every day in this country, so your son's behavior is unacceptable."

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

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. "You and your son are having a very trying time. What's happened since your son's diagnosis?" c. "These days only the squeaky wheel gets the grease in medicine. Your squeaking was excellent advocacy." d. "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."

b. "You and your son are having a very trying time. What's happened since your son's diagnosis?"

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. "You're having stomach pain? You should get checked for an ulcer or other gastric problem." d. "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."

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

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. "No? Why not?" b. "You seem to be saying no. Would you tell me more about your reluctance?" c. "OK, but I hope you will let me know when you feel ready to attend a group session at the clinic." d. "Perhaps a group session would be too overwhelming for you right now. How about just seeing me?"

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

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. Assessing the client's risk for violence toward self and others c. Obtaining a health care provider's prescription for an antidepressant d. Assisting the client in resolving the grief through emotional, cognitive, and behavioral means.

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

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. Avoidance c. Reframing d. Wishful thinking

b. Avoidance

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. Manipulation b. Improvement c. Attention-seeking d. A desire to be accepted

b. Improvement

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 client focus completely on his physical health b. Providing bereavement support to the family after the client's death c. Helping the family stop the client's efforts to go out at night with his friends d. Working with the client to sustain hope by talking of recent research breakthroughs regarding his illness

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

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. "Only you and your husband can determine how you should best allocate your work leave." 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. "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. "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?"

c. "Are there other options for you in taking work leave? Perhaps you could simply reduce your work hours at first so that you can extend your compassionate leave."

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 your husband help you with the baby and your chores? Is he on paternity leave? b. "You have a beautiful new baby, and caring for her will help you feel better. Your hormones will be back in balance soon." c. "Can you share with me more specifically how you feel that you're hanging on by a thread? Are you having thoughts of hurting yourself?" 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."

c. "Can you share with me more specifically how you feel that you're hanging on by a thread? Are you having thoughts of hurting yourself?"

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. "What's been happening since you all came home? As I understand it, the baby is thriving." c. "Can you tell me more about the worrying? What's been happening since you brought your baby home?" d. "Lots of women do everything right but wind up having cesarean sections. Why worry when it won't change anything?"

c. "Can you tell me more about the worrying? What's been happening since you brought your baby home?"

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

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

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 need to take my medications." b. "I know that I can't do everything." c. "I won't ever be depressed again." d. "I have learned ways to deal with stress."

c. "I won't ever be depressed again."

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. "You know, you could work and make money serving food to people." b. "I agree. If you can do all that for your husband, he should treat you better." c. "It seems that you feel that your husband could treat you well just as you treat him." d. "Ask your husband to do the things you'd like. If he doesn't, tell him you're leaving him."

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

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."

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. "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." d. "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."

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. "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." b. "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." d. "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?"

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."

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. "You're having a very difficult time, and the problem stems entirely from your husband's drinking." b. "It's a shame. So many troubling things have been happening to you both because of the disease of alcoholism." c. "The lack of money has stopped you from saving your husband? It sounds like you need to help yourself right now. What do you think?" 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?"

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

A client 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. "Do the terms 'divorce' and 'leave the nest' mean anything to you or your family?" b. "Would your family come in to see me so I can hear their version of the problems you cite?" 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. "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?"

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. "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." d. "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."

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. "Get a lawyer! That's what you all need to do." b. "Do you believe that a class action suit is the correct thing and that you are in the right?" c. "You're saying that being left a widow with children is difficult enough, but now you've got to fight for your benefits." 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?"

c. "You're saying that being left a widow with children is difficult enough, but now you've got to fight for your benefits."

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 feelings are appropriate for the extent of your loss and how your children's deaths happened." c. "Your loss touches me so. How truly devastated you both must be. Can you share what things you have been doing to grieve?" d. "Your loss is incalculable. Perhaps you could consider some ways in which to commemorate their lives for you and in your community."

c. "Your loss touches me so. How truly devastated you both must be. Can you share what things you have been doing to grieve?"

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. Projection b. Sublimation c. Displacement d. Identification

c. Displacement

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. Projection b. Regression c. Identification d. Intellectualization

c. Identification

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. Reframing b. Locus of control c. Problem-solving d. Use of social supports

c. Problem-solving

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. Teaching the client's wife to write down her thoughts and feelings and to read them to her husband b. Saying to the client, "It sounds to me like your wife is truly comfortable and doesn't want you to worry needlessly" 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

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. "You've been unfortunate, but you seem to be focusing on yourself and what you have to do." d. "Divorce is hard to go through. Tell me what difficulties you feel you will face raising your children."

d. "Divorce is hard to go through. Tell me what difficulties you feel you will face raising your children."

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?"

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

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

d. "I am concerned about you. Are you being or have you ever been abused?"

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 must begin by saying that I am uncomfortable meeting without your son here to talk for himself." b. "Let's start by introducing ourselves and talking about what is most troubling to each of you about having your son home." 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. "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."

d. "I am going to begin by talking in general terms about your son's return home and some of the things that might happen. I can suggest measures that might be helpful, and then you can ask questions."

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 will emphasize how much I like the person but insist that the other person make the changes I need." b. "I can tell the person that the behavior has become intolerable for me and that the behavior must be changed immediately." 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."

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. "Why do you think the food is poisoned?" c. "There is no poison in the food. Here, I'll taste the food for you." d. "It must be frightening to you. Has something made you feel that your food is poisoned?"

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

A client says to the nurse, "I've started a journal 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. "I'm not certain that using a tape recorder will help you with the journal-keeping." b. "Well, I wonder about the dictation, because the writing is what helps reduce stress." 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."

d. "It seems that people who write in their journals and can share traumatic events improve their self-awareness."

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

d. "It sounds like you and your daughter were very close but she kept her sexual orientation from you."

A client who is an attorney says to the clinic nurse, "I'm worried about my wife. She's been so distant and disorganized since our son died of leukemia 4 months ago. She never suggests that we go out or take our other children anywhere. Is this normal, or do I need to get her to a doctor?" Which statement by the nurse would be therapeutic? a. "Absolutely. It sounds as if she may be experiencing a severe depression." 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. "The reluctance to resume activities and overprotect your other children is a normal part of bereavement and will subside in 2 months." d. "It's normal, but by the end of a year you can expect that your wife is improving and able to redirect her energy. Have you expressed your concerns to her?"

d. "It's normal, but by the end of a year you can expect that your wife is improving and able to redirect her energy. Have you expressed your concerns to her?"

A client says to the nurse, "My 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. "You can erase your stresses by identifying things that set off negative physical experiences." b. "Well, it has always helped me to write down daily happenings and relate them to my stress level." c. "Yes, that is an excellent suggestion. You need to keep a meticulous diary of your day with all of the details." d. "Journal-keeping that identifies what seems to cause a strain in a person's life is a good way of improving one's health."

d. "Journal-keeping that identifies what seems to cause a strain in a person's life is a good way of improving one's health."

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 sound disgusted with your husband. Is this an accurate assessment? Why not divorce him?" b. "Can you tell me how long you have felt like this and how much longer you plan to continue this way?" c. "You seem to have changed your feelings about your husband completely. This didn't happen overnight, so why are you here now?" d. "Many things have happened to you and your husband. Sounds as if you've both been struggling for some time. Would you like to have him come in with you to talk with me about all of this?"

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

A 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. "Perhaps you should join the grieving spouses group that meets on Monday nights." c. "Since you've lost your husband, have you experienced any other problems besides trouble sleeping?" 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?"

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. "I think you need to listen to your health care provider when it comes to taking such strong medication." c. "Well, your health care provider is concerned that you will become physically dependent on the first painkiller." d. "Perhaps if I medicate you about a half-hour before you plan to start your daily activities, the medicine will be more effective."

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

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

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

A client whose husband died 2 months ago says to the nurse, "After church, I visit my husband's grave and talk to him. It comforts me, but my daughter thinks I'm morbid and crazy and is upset with me because I don't want to meet her for coffee after church like I used to." Which statement by the nurse would betherapeutic? a. "You need to stop your visits immediately, or your daughter will have you examined for a mental disorder." 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. "I think your visits are perfectly normal. After all, you were married for a long time. You'll stop when the winter weather comes." d. "Sounds as if you have had difficulty letting your husband go from your life. What would happen if you visited his grave less frequently?"

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

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

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

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. "What do you think? What is the individual therapy all about?" b. "Are you feeling that you're vulnerable to a slip? If not, why complicate treatment further?" c. "Okay, what's going on with you? You had to be coerced into treatment, but now you seem to want the full monty." d. "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."

d. "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."

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. "I'd like to accommodate you both, but he is busy right now and you will have to talk to me." b. "Do you feel that I am incompetent to talk with you? Everyone who comes here sees me first." c. "That is not the procedure here. If you can't work with the system, you're free to go elsewhere." d. "The doctors here feel that clients are best served when I conduct the initial assessment, after which the psychiatrist will see you with complete information."

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

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

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

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. "Sounds as if you're exaggerating your situation and looking only at the half-full glass." b. "It seems that you measure your life and what you need to do against the behaviors of others." c. "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." d. "You can't seem to meet someone that you care about? You can still find enjoyment in friendships, work, books, and other things as well."

d. "You can't seem to meet someone that you care about? You can still find enjoyment in friendships, work, books, and other things as well."

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. "Are you thinking of hurting yourself just because you're alone?" c. "You're feeling pretty useless right now, but I wonder if you've taken enough time to grieve?" d. "You seem to be identifying some issues in your life that are troubling, and you sound very down right now."

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

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. "Would you listen to yourself? You've seen firemen stress out before. What is your responsibility in all this?" c. "You've helped victims of some horrific fires lately, and yet you question your calling. Do you feel the need to resign?" d. "You're questioning your job because you're upset about the little girl you tried to save. Work stress can be treated and help you cope better. It is so important for you to seek treatment."

d. "You're questioning your job because you're upset about the little girl you tried to save. Work stress can be treated and help you cope better. It is so important for you to seek treatment."

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. "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." c. "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." d. "You're seeking help appropriately, and there are many things you can do to get comfortable behind the wheel again. You've returned to driving, but remember, you're still grieving. It's normal to still feel this way."

d. "You're seeking help appropriately, and there are many things you can do to get comfortable behind the wheel again. You've returned to driving, but remember, you're still grieving. It's normal to still feel this way."

A 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. "Are you saying you are overly involved and will need to emotionally distance yourself to be therapeutic for your family?" b. "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." c. "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." d. "You've seen your loved ones dealing with some troubling events recently. Sounds as if you feel that your family expects more from you than from others in the family because you're a nurse."

d. "You've seen your loved ones dealing with some troubling events recently. Sounds as if you feel that your family expects more from you than from others in the family because you're a nurse."

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. "Well, it seems very bleak to you, but your daughter is responsible for her eating and exercising, too." b. "What about her father? Isn't it partly his fault, too? I want to meet with you, him, and your daughter tomorrow." c. "It's all this fast food and TV-watching these days. If our kids aren't watching television, they're playing with their computers." d. "Your daughter has a serious problem, but there are many successful programs that you can join with her to lose weight and improve your overall lifestyle."

d. "Your daughter has a serious problem, but there are many successful programs that you can join with her to lose weight and improve your overall lifestyle."

A 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. "Have you talked with your family? What have they said to you about the meetings?" b. "I am committed to keeping everything you say to me confidential, so it is troubling when you accuse me of talking to your family." c. "You sound concerned that I would tell your family something about you even though you know that what we talk about is confidential." d. "Your family is learning about depression and how best to help you so that they can be supportive of you. We do not talk about you or anything confidential about you."

d. "Your family is learning about depression and how best to help you so that they can be supportive of you. We do not talk about you or anything confidential about you."

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."

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. "You didn't know that he had AIDS? How did he see the family health care provider without your knowing?" b. "Your poor son. How troubled he must have been. It's a shame he couldn't talk to you and get some help." c. "Your son had an autopsy because he committed suicide, but the coroner didn't have to tell you that he was ill." d. "Your son was keeping a very troubling diagnosis to himself. I am so sorry. No matter how close and loving children are to their parents, some children just aren't able to confide in their parents."

d. "Your son was keeping a very troubling diagnosis to himself. I am so sorry. No matter how close and loving children are to their parents, some children just aren't able to confide in their parents."

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

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. Monitoring the client for signs of self-harm b. Helping the client verbalize concerns related to fear c. Assisting the client with problem-solving and decision-making d. Discouraging social networking to prevent the spread of infection

d. Discouraging social networking to prevent the spread of infection

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. Scheduling the client for an appointment with the psychiatrist, because this is a pathological manifestation. 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. Seeking emergency certification for the psychiatric inpatient unit at the community hospital because of high lethality concerns and visiting the client daily. 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

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 is a technique that trains the mind to elicit a relaxation response b. It is the purposeful use of one's imagination to achieve relaxation and control c. It involves learning to contract and relax muscles in a systematic way and may be combined with breathing exercises d. It is a therapeutic modality that enables an individual to monitor skin temperature, muscle activity, heart rate, blood pressure, and other bodily functions, then learn to control these physiologic responses to stressful or challenging events

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

A nursing student is assigned to work in the emergency department to assist victims after a tornado. The student says to the nurse in charge, "I don't know how to help these parents. Their son was just decapitated by a flying piece of glass, and they won't leave him. They did mention that they are Catholic." Which intervention does the nurse suggest for inclusion in a plan of immediate care for the family? a. Telling the student not to disturb the family until the end of shift b. Calling their family priest immediately to come help them to let their son go c. Asking the emergency department health care provider to join the student in requesting that the family let the nursing staff care for their son d. Joining the family and, after they have been able to be with their son for some time, helping them relinquish their son's body to the nurses

d. Joining the family and, after they have been able to be with their son for some time, helping them relinquish their son's body to the nurses

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 fatigue. b. The client complains of feeling drained. c. The client complains of feeling anxious. d. The client engages in purposeful movement.

d. The client engages in purposeful movement.

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 identify effective coping skills. b. The client will develop and use adaptive coping patterns. c. The client will express and share his feelings about this crisis. d. The client will stop blaming himself for the loss of his belongings.

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

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

d. The development of interpersonal skills

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. Blaming b. Daydreaming c. Problem- solving d. Wishful thinking

d. Wishful thinking