Therapeutic Communication
A client with depression who has attempted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." The nurse would make which therapeutic response to the client?
1) "I don't see you as a failure."
2) "You have everything to live for."
3) "Feeling like this is all part of being ill."
4) "You've been feeling like a failure for a while?"
4) "You've been feeling like a failure for a while?"
A client with a history of depression and several suicide attempts is admitted to the mental health unit reporting severe suicidal thoughts. The nurse would focus the initial data collection on which information?
1) past treatment regimen
2) food intake for past 24 hours
3) client's interaction with peers
4) presence of existing suicidal thoughts
4) presence of existing suicidal thoughts
The nurse has been caring for a client with a diagnosis of depression. The client says to the nurse, "I wish you would just be my friend." Which would be the appropriate response by the nurse?
1) "I am your friend."
2) "Our relationship is a therapeutic and a helping one."
3) "I can't be your friend. I'm the nurse and you're the client."
4) "You have plenty of friends. You don't need me to be your friend, too."
2) "Our relationship is a therapeutic and a helping one."
The nurse informs a client with an eating disorder about group meetings with Overeaters Anonymous. Which statement by the client indicates a need for further teaching about this self-help group?
1) "The leader of this self-help group is the nurse or psychiatrist."
2) "The members of this self-help group provide support to each other."
3) "This self-help group is designed to serve people who have a common problem."
4) "In this self-help group, people who have a similar problem are able to help others."
1) "The leader of this self-help group is the nurse or psychiatrist."
A client tells the nurse that they are feeling out of control. The nurse observes that the client is pacing back and forth. Which approach by the nurse is appropriate to maintain a safe environment?
1) Continue to monitor the client.
2) Isolate the client in a seclusion room.
3) Move the client to a quiet room and talk about their feelings.
4) Administer the prescribed antianxiety medication immediately.
3) Move the client to a quiet room and talk about their feelings.
A client who has just received a diagnosis of asthma says to the nurse, "This condition is just another nail in my coffin." Which response by the nurse is therapeutic?
1) "Do you think that having asthma will kill you?"
2) "You seem very distressed over learning you have asthma."
3) "I'm not going to work with you if you can't view this as a challenge rather than a 'nail in your coffin.'"
4) "Asthma is a very treatable condition. It is important to properly administer your medications. Let's practice with your inhalant."
2) "You seem very distressed over learning you have asthma."
A client with severe depression who was admitted to the mental health unit 2 days ago suddenly begins smiling and reporting that the crisis is over. The client says to the nurse, "I'm finally cured." The nurse interprets this behavior as a cue to modify the treatment plan by taking which action?
1) Suggesting a reduction of medication
2) Allowing increased "in-room" activities
3) Increasing the level of suicide precautions
4) Allowing the client off-unit privileges as needed (PRN)
3) Increasing the level of suicide precautions
A nurse is establishing a therapeutic relationship with a client who has been admitted to the mental health unit. During the orientation phase of the therapeutic relationship, which of the following actions should the nurse prioritize?
A. Explore the client’s feelings and begin to address concerns.
B. Set goals collaboratively with the client.
C. Establish trust and formulate a contract for intervention.
D. Review progress made toward the client’s goals.
C. Establish trust and formulate a contract for intervention.
The nurse is assisting in conducting a group therapy session. One of the clients there, who shared with the group at a previous session that they isolate themself when they feel depressed, suddenly gets up to leave. Which nursing action is appropriate?
1) Tell the client that it is not safe to leave.
2) Encourage the client to stay, and ask the client what they are feeling.
3) Tell the client that if they leave, they cannot return to this therapy group.
4) Lock the door so that the client cannot leave at this potentially vulnerable time.
2) Encourage the client to stay, and ask the client what they are feeling.
The nurse in the mental health clinic hears a client yelling and threatening to hurt their sibling. The nurse reports this episode to the mental health therapist. Which would the nurse anticipate the therapist to do? Select all that apply.
1) Identify the specific person being threatened.
2) Tell the client that this behavior is not appropriate.
3) Take appropriate action to protect the identified victim.
4) Threaten the client that the police are going to be called.
5) Have the client sign a document promising not to harm their sibling.
6) Assess and predict the client's danger of violence toward another.
1) Identify the specific person being threatened.
3) Take appropriate action to protect the identified victim.
6) Assess and predict the client's danger of violence toward another.
A client states to the nurse, "I haven't slept at all the last couple of nights." The nurse would make which therapeutic response to the client?
1) "Go on...."
2) "Why aren't you sleeping?"
3) "The last couple of nights?"
4) "Tell me about your difficulty sleeping."
4) "Tell me about your difficulty sleeping."
The nurse is monitoring a client with a diagnosis of depression. Which behavior observed by the nurse indicates that suicide precautions would be instituted for this client?
1)The client refuses to attend group therapy.
2) The client asks to meet with a lawyer to take care of unfinished business.
3) The client has an argument with their significant other during visiting hours.
4) The client swears at their roommate because the roommate takes too much time in the bathroom.
2) The client asks to meet with a lawyer to take care of unfinished business.
During the termination phase of the nurse–client relationship, the clinic nurse observes that the client continuously demonstrates bursts of anger. Which interpretation would the nurse make of this behavior?
1) The client needs to be admitted to the hospital.
2) The client needs to be referred to the psychiatrist as soon as possible.
3) The client requires further treatment and is not ready to be discharged.
4) The client is displaying typical behaviors that can occur during termination.
4) The client is displaying typical behaviors that can occur during termination.
The nurse is providing care to a female client who has been given the diagnoses of schizophrenia and chronic obstructive pulmonary disease (COPD). The client is experiencing visual and auditory hallucinations, is short of breath with cyanosis of nail beds, and has cool moist skin. According to Maslow’s theory, toward what should the nurse’s first intervention be directed?
1. Cool, moist skin
2. Shortness of breath and cyanosis
3. Auditory hallucinations
4. Visual hallucinations
2. Shortness of breath and cyanosis
An adolescent female with anger management issues is found destroying items in her room. What is the nurse's most appropriate response?
1) "Stop! Why are you destroying these things?"
2) "You need to stop that behavior. Destroying property is not allowed."
3) "Why do you feel you have the right to destroy those things?"
4) "You are very disappointing to me right now."
2) "You need to stop that behavior. Destroying property is not allowed."
A client is being encouraged to attend music therapy as part of the individual plan of care. The client refuses to attend and states that they "cannot sing." Which response by the nurse is therapeutic?
1) "You must go. You have no choice."
2) "Life is short! Enjoy it while you can."
3) "Why don't you really want to attend?"
4) "Perhaps you could just enjoy the music without singing."
4) "Perhaps you could just enjoy the music without singing."
A client with a history of depression and several suicide attempts is admitted to the mental health unit reporting severe suicidal thoughts. The nurse would focus the initial data collection on which information?
1) The past treatment regimen
2) Food intake for the past 24 hours
3) The client's interaction with peers
4) The presence of existing suicidal thoughts
4) The presence of existing suicidal thoughts
A nurse has been assigned to care for a patient who reminds the nurse of a close family member. The nurse notices feelings of over-identification with the patient and struggles to maintain professional boundaries. Which term best describes this situation?
A. Transference
B. Countertransference
C. Professional detachment
D. Emotional projection
B. Countertransference
Which statement best reflects the primary psychosocial conflict for a 2-year-old child, according to Erikson?
A. "I want to do it myself!"
B. "I’m not as good as the other kids."
C. "I don’t know what I want to be when I grow up."
D. "I feel bad for not following the rules."
A. "I want to do it myself!"
A mental health nurse is assigned to care for a client who has been admitted with major depressive disorder. During one of their conversations, the client states, "You're the only person who truly understands me. I wish we could be friends outside of this hospital." Which of the following is the most appropriate response by the nurse?
A. "I feel the same way, but we need to keep this professional for now."
B. "I'm glad you're comfortable talking to me, but our relationship must remain professional."
C. "It’s inappropriate to think about our relationship outside of this environment."
D. "I can’t be your friend, but I’ll take care of you while you’re here."
B. "I'm glad you're comfortable talking to me, but our relationship must remain professional."
The nurse is caring for a client who says, "I don't want you to touch me. I'll take care of myself!" The nurse would make which therapeutic response to the client?
1) "If you didn't want our care, why did you come here?"
2) "Why are you being so difficult? I only want to help you."
3) "Sounds as if you're feeling pretty troubled by all of this. Let's work together so that you can do everything for yourself as you request."
4) "I will respect your feelings. I'll just leave this cup for you to collect your urine in. After breakfast, I will take more blood from you."
3) "Sounds as if you're feeling pretty troubled by all of this. Let's work together so that you can do everything for yourself as you request."
The nurse receives a telephone call from a client who states that they want to kill themself and that they have a bottle of sleeping pills in front of them. Which would be the best response by the nurse?
1) Keep the client talking and allow the client to vent their feelings.
2) Use therapeutic communications, especially the reflection of feelings.
3) Keep the client talking, and signal to another staff member to call the police.
4) Insist that the client give you their name and address so that you can get the police there immediately.
3) Keep the client talking, and signal to another staff member to call the police.
A nurse is caring for a patient who begins to exhibit behaviors and attitudes toward the nurse that resemble the feelings the patient has toward their mother. The nurse recognizes this as an example of:
A. Countertransference
B. Transference
C. Projection
D. Displacement
B. Transference
A nurse is caring for a 7-year-old child who is hospitalized for a surgical procedure. According to Erikson's stages of psychosocial development, which of the following interventions would best support the child in meeting their developmental needs?
A) Encourage the parents to stay with the child to promote trust.
B) Allow the child to make choices, such as selecting a meal from the menu.
C) Provide opportunities for the child to engage in age-appropriate activities and tasks.
D) Offer praise for attempts at independence, such as self-feeding or dressing.
C) Provide opportunities for the child to engage in age-appropriate activities and tasks.
A nurse is caring for a 40-year-old client of Asian descent who has been diagnosed with major depressive disorder. The client states, “I feel ashamed to admit my struggles and don’t want my family to know.” What is the most appropriate response by the nurse?
A. “You should tell your family so they can support you in your treatment.”
B. “In many Asian cultures, mental health issues may carry a stigma. How can I help you feel more comfortable seeking treatment?”
C. “It’s important to remember that depression is a medical illness and not something to feel ashamed of.”
D. “Why are you ashamed to share your struggles with your family?”
B. “In many Asian cultures, mental health issues may carry a stigma. How can I help you feel more comfortable seeking treatment?”