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The nurse is evaluating a client's ability to engage in adaptive coping strategies. Which client statement supports the nurse's belief that the client is successfully managing the stress of a recent divorce?
A. “Loving someone is no guarantee that they will love you back.”
B. “I know now that we were never really meant to be together.”
C. “It's not my fault I loved someone who was incapable of being faithful.”
D. “I'm a lovable person who has control over my own happiness.”
Answer: C
Rationale: In most situations, the sense of control an individual feels over a particular stressor determines how they think about or perceive it. Reframing is a way of restructuring our thinking about a stressful event into one that is less disturbing and over which we can have some control such as the belief that one is lovable and in control. The remaining options state feelings that deflect the hurt felt or that provide a rationale for the divorce.
A college student who is very anxious about auditioning for the school's famous chorale comes to the health center for assistance. During the interview, the student reveals using various coping strategies. Which strategy would the nurse recognize as being maladaptive?
A. Arranging for private voice lessons
B. Practicing the songs used in the audition
C. Repeatedly telling friends it's okay to fail
D. Singing with a group of friends who are also auditioning
Answer: C
Rationale: Maladaptive and dysfunctional strategies usually do not result in a positive outcome. The individual who does not attempt to reduce the anxiety or solve the problem is considered to have dysfunctional coping in response to the stressor and the emotional response. In this scenario, the student does not attempt to reduce the anxiety of auditioning but rather decides that failing will be acceptable. The other options demonstrate some positive action directed toward preparing for the audition and so reducing anxiety.
A client recently diagnosed with a terminal illness appears to be denying the finality of the condition. The client's adult child expresses concern. Which response by the nurse would be most effective in explaining the therapeutic value of denial?
A. “Denial allows your parent time to prepare for their death.”
B. “Denial is a natural response to bad news and is expected.”
C. “The first stage of the healthy grief process is denial.”
D. “Your parent will soon move into the anger stage of the process.”
Answer: A
Rationale: The first stage of grief is shock, disbelief, and denial that the event is happening. Denial allows an adjustment period in which to gather coping strategies for the grieving work ahead. While the remaining options are true, none explain the positive purpose of denial associated with the grief process.
A client being treated for chronic stress and moderate anxiety questions the usefulness of relaxation techniques. Which response by the nurse would be most effective?
A. “Relaxation techniques are universally taught to clients with diagnoses like yours.”
B. “Each time you successfully use the techniques, you increase your chances of being able to manage those feelings.”
C. “These techniques don't produce the side effects often associated with antidepressant and antianxiety medications.”
D. “These techniques are easy to learn and can be used as often as you need them.”
Answer: B
Rationale: Relaxation techniques can momentarily allow a reprieve from stress. The escape provides a temporary defense withdrawal from the anxiety, giving the individual renewed energy. Each success the individual has in dealing with an anxiety-producing situation provides a foundation for helping to manage or control the anxiety the next time. While the other options are true, none adequately explain their usefulness in managing stress and anxiety.
A young adult student recently failed a major exam. While talking with the student, the nurse determines that the student is using reframing to cope with the resulting anxiety based on which student statement?
A. “That course is taught again next semester; if I fail, I'll take it over then.”
B. “I've decided to transfer to another section that's taught by an easier teacher.”
C. “That exam wasn't really that important. I'll do better on the next one.”
D. “I've arranged to join a study group so I'll do better on the next exam.”
Answer: D
Rationale: Reframing is a way of restructuring our thinking about a stressful event into one that is less disturbing and over which we can have some control such as deciding on a plan to improve on their next exam grade. Reframing does not involve minimization, transference, or denial of the problem.
When working with a client who is grieving, which nursing action best demonstrates an understanding of the grieving process and the most effective means of facilitating the client's ability to bring about closure and display hope for the future?
A. Using open-ended questioning techniques when communicating with the client who is currently in the grieving process
B. Devoting time each meeting to discussing the feelings the client has described in daily journal entries
C. Sharing with the grieving client that the client's grief is demonstrated in very specific and personal ways that are unique to the person alone
D. Assuring the client that while the grieving process has identifiable stages, there is no specific timetable for moving through these stages
Answer: B
Rationale: Interventions that assist individuals with the grieving process should encourage openness and honesty about their feelings, while encouraging expressions of hope for the future and reinvestment in life interests. Journaling, that encourages the expression of grief-related feelings, has proven to be an effective intervention in this process and can help bring closure. Open-ended questioning focuses on effective information gathering especially related to the assessment of the grieving client. It is true that the grieving process is an experience that is unique to each individual and not bound by specific timetables; sharing this information with the client does not facilitate the expression of feelings so necessary to the successful management of acute grief.
The nurse suspects a client is demonstrating signs of dysfunctional grief. Which question would the nurse most likely use to help confirm this suspicion?
A. “How would you define grief?”
B. “What gives your life meaning?”
C. “Have you ever thought about hurting yourself?”
D. “When did you first notice the feelings of grief?”
Answer: B
Rationale: Dysfunctional grief is a failure to complete the grieving process and cope successfully with a loss. If the person experiences a prolonged and intensified reaction, life may become meaningless and a mere existence centered on longing for that which is lost. While the assessment should attempt to identify when the symptoms began and how the client views their condition, this information will not necessarily support a diagnosis of dysfunctional grief. Assessing for suicidal ideations is appropriate for clients experiencing a variety of mental health disorders.
The nurse determines that a client understands the concept of being mentally healthy based on which client statement?
A. “I try to eliminate stress from my life.”
B. “If I'm physically healthy, I'll be mentally healthy.”
C. “Mental health is dependent on one's early childhood experience.”
D. “I make every effort to balance work, play, and my relationships.”
Answer: D
Rationale: Mental health involves the components of emotional, psychological, and social well-being; the balance between the individual’s cognitive, behavioral, and emotional states; and the individual’s ability to handle stress and adversity, relate to others, emote (express) their feelings, and make healthy choices. It is not possible or even desirable to eliminate stress from one's life. One can be mentally healthy but be considered physically unhealthy. While being cared for and supported effectively during childhood can have an impact on mental health, there are other factors that must be considered.
A nurse manager is conducting an in-service program for a group of staff members on mental health and mental illness. The nurse manager determines that the teaching was successful when the group makes which statement(s) about mental illness? Select all that apply.
A. “There are universally accepted behaviors and thoughts that contribute to the definition of mental illness.”
B. “The definition of mental illness is based on one's inability to regulate emotions and behaviors.”
C. “Mental illness can be and is often defined differently based on specific views, beliefs, and behaviors.”
D. “Impaired developmental processes are the foundation upon which the definition of mental illness is based.”
E. “Mental illness can be described by problems involving the same areas as mental health.”
Answer: C, E
Rationale: Defining mental illness or disorders is complicated because there are various views and interpretations. A currently accepted definition states that it is a “clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biologic, or developmental processes underlying mental functioning.” Causes and descriptions of mental disorders are many and varied. However, by comparison with the indicators of mental health, a state of mental illness might be characterized by disarray in these same areas of the persona. The remaining options address specific but limited areas that are considered and fail to state the basic truth concerning its varied nature.
A nurse assisting a client in dealing with the grief associated with the death of a loved one. Which intervention would the nurse do first?
A. Use open-ended questions to explore the client's feelings about grief and encourage communication.
B. Engage in self-reflection regarding personal beliefs and values associated with death and dying
C. Help the client identify the members of the client's support system and the importance of their assistance.
D. Assist the client in creating a letter to the deceased in order to facilitate closure for the relationship.
Answer: B
Rationale: To deal effectively with the client experiencing grief, the nurse must face the reality of their own mortality and the concept of death. While all the remaining options are appropriate interventions, the process must begin with the nurse working toward an understanding of their personal grief beliefs and the ability to provide unbiased support to the client.
When considering the various aspects of stress, which client statement would the nurse interpret as accurately describing eustress?
A. “I often feel stressed by the end of a very hectic shift.”
B. “When I'm really stressed, I usually get a severe headache.”
C. “I generally do my best work when I feel some stress.”
D. “When you become a nurse, you become familiar with stress.”
Answer: C
Rationale: Eustress is positive and motivating, as shown by one's confidence in the ability to master a challenge or stressor as reflected by the statement of doing one’s best work when feeling some stress. Stress results when a threat or challenge to one's well-being requires the person to adjust or adapt to the environment. Distress in response to a threat or challenge is actually harmful to one's health. This is a negative stress and demands an exhausting type of energy.
While gathering information from a client who has experienced a loss, the client states, “I’ve been doing okay, but I still have periods of grief from time to time, especially around the time of our anniversary, knowing that we’ll never get to celebrate our 50th.” The nurse interprets this statement as reflecting which condition?
A. Dysfunctional grief
B. Chronic sorrow
C. Unresolved grief
D. Conventional grief
Answer: B
Rationale: A person’s response to a loss is uniquely personal and is dependent on the person’s level of development, past experiences with loss and grief as well as past and present coping strategies. The client’s statement reflects chronic sorrow, which is seen in a situation where the grief resurfaces at times, but never fully goes away. Dysfunctional grief is a failure to complete the grieving process and cope successfully with a loss. If the person experiences a prolonged and intensified reaction, life may become meaningless and a mere existence centered on longing for that which is lost. Unresolved grief describes situations when the grief process is incomplete, and life is burdened with maladaptive symptoms continuing months after the loss has occurred. Conventional grief is primarily associated with the grief that is experienced following a loss.
A client is observed pacing back and forth in the room. When the nurse attempts to gather more information from the client about the behavior, the client responds, “I don't know why but I'm really feeling uneasy.” This response most likely reflects which situation?
A. Stress
B. Anxiety
C. Distress
Answer: B
Rationale: Anxiety is defined as a feeling of apprehension, uneasiness, or uncertainty that occurs in response to a real or perceived threat whose source is not known. It is an automatic and unconscious biologic response to a stressor that cannot be controlled by our conscious minds. Stress, on the other hand, is the condition that results when a threat or challenge to one's well-being requires the person to adjust or adapt to the environment. Distress is negative stress in response to a threat or challenge that exhausts and drains energy from the individual. Grief is defined as the emotional process of coping with a loss.
A nurse is gathering data about a person's cultural identity. The nurse would collect information about which area(s)? Select all that apply.
A. Whether children are named to honor family elders
B. What language is spoken at family gatherings
C. Whether family members develop acute depression when individuals experience a severe loss
D. Whether the family prefers to live in a geographic locale where other people from a similar culture reside
E. Use of the Internet to help research employment opportunities
Answer: A, B, D
Rationale: Cultural identity may include a common language, family customs, country of origin, religious and political beliefs, sexual orientation, gender, and an established culture within the geographic locale where the group resides. Depression, as a response to a loss, is a human response and not dependent on culture. Using cross-cultural resources is not associated with cultural values or beliefs.
A student who has been ill and unable to properly prepare for an exam scheduled in 3 days is experiencing an elevated stress level. The student demonstrates palliative coping by which action?
A. Studies for the exam but accepts the fact that this is only one grade.
B. Asks the instructor for a week's postponement of the exam.
C. Decides that studying is useless and anticipates a failing grade.
D. Joins a study group that meets daily until the day of the exam.
Answer: B
Rationale: If the solution temporarily relieves the anxiety but the problem still exists and must be dealt with again at a later time, the strategy is termed palliative coping. While postponing the exam doesn't eliminate the stress entirely, doing so allows the student to prepare more effectively. Studying is an adaptive strategy but as described, it may not bring about successful management of the stress but rather exacerbate the existing degree of stress. Accepting that one poor grade is not necessarily catastrophic is a realistic and healthy way to manage stress. Assuming the grade will be a failing one is a dysfunctional strategy and likely to also increase the stress already being experienced.
Which client statement supports the nurse's suspicions that a client being treated for chronic depression is experiencing severe emotional distress produced by external circumstances?
A. “My professional life is ruined because my boss never recognizes my worth and value.”
B. “My doctor told me that I have to manage my stress or risk having a heart attack.”
C. “I have been depressed ever since I was diagnosed with leukemia.”
D. “I'm never comfortable when I know that I have to fly for my work.”
Answer: A
Rationale: It is important to recognize that many times people view external circumstances as the cause of their stress such as in the case of the client's perception of the boss's viewpoint. The remaining options demonstrate internal or self-perceptions and viewpoints.
A client is telling the nurse about a recent stressful experience. Which client statement would the nurse interpret as indicating the client experienced the fight-or-flight response?
A. “When I feel stressed, I get this surge of energy.”
B. “I find it difficult to make decisions when I'm stressed.”
C. “I can't remember a time when I didn't feel stressed.”
D. “I can't seem to relax even after the stress is gone.”
Answer: A
Rationale: The fight-or-flight response is a reaction to an immediate threat (acute stress) in which there is a surge of adrenalin into the bloodstream. It is referred to in this way because it provides the energy or instant strength to either fight or run away from an acute danger or threat. This type of response can occur in situations where there is a sense of imminent danger and the response is usually reversed to a relaxation mode once the danger is past. Poor concentration is characteristic of a moderate level of anxiety. Chronic stress occurs when the situation is ongoing or continuous.
A nurse is gathering data about a client. Which question would be most appropriate to use to assess a client's current state of mental health?
A. “Do you feel that your life has value in spite of its stressors?”
B. “Do you feel equally comfortable with both your family and strangers?”
C. “How pleased are you with both yourself and your life?”
D. “What was happier; your childhood or your present life?”
answer: C
Rationale: Mental health involves the components of emotional, psychological, and social well-being; the balance between the individual’s cognitive, behavioral, and emotional states; and the individual’s ability to handle stress and adversity, relate to others, emote (express) their feelings, and make healthy choices. Mental health is affected by the individual’s ability to realize their own abilities; to work productively (examples of work can include, but are not limited to, attending school, holding a job, or tending a family); contribute to their community or family; and to enjoy life. How persons feel about themselves and those around them has an influence on how they cope with life and meet the expectations it creates. The remaining options each focus on only one specific aspect of what creates mental health.
A nurse is interviewing a client with a history of anxiety. The nurse determines that the client is able to implement an adaptive coping strategy based on which statement(s)? Select all that apply.
A. “I know that I can find another job; I’ve done it before.”
B. “Being able to laugh instead of cry is an invaluable skill.”
C. “If I can get through this, I’ll manage to do better next time.”
D. “If I don’t think about my problems, they will go away.”
E. “I’m better at managing stress since I meditate daily.”
Answer: A, B, E
Rationale: Examples of adaptive coping include positive self-talk, humor, and meditation. Denial is a maladaptive coping strategy. Bargaining and denial are observed during the grieving process.
The parents of a 10-year-old client recently died in an automobile accident. When helping to develop the child's plan of care to address the child's mental health, which information would the nurse need to integrate into this plan? Select all that apply.
A. Uses magical thinking primarily to cope with unfamiliar events
B. Responds best to concrete explanations of new concepts
C. Can differentiate between temporary and permanent loss
D. Perceives permanent loss as a threat to personal identity
E. Is egocentric and focused on personal needs
Answer: B, C
Rationale: The school-age child may feel guilty and responsible for the loss. A 10-year-old child generally understands the permanence of death as compared to situations of temporary loss. This age group also responds to concrete, simple, and logical explanations of death such as in the death of a pet. The toddler is egocentric and self-focused while the preschooler employs magical thinking as a coping mechanism. Although adolescents understand the concept of death as finality, it is difficult for this age group to fit death or loss into their search for an identity.
After collecting data about a client, the nurse determines that the client is demonstrating mental health and wellness based on which data? Select all that apply.
A. Has been happily married for 35 years
B. Identifies having a sense of humor as being a personal strength
C. Always views challenges with a sense of hope
D. Is free of any chronic illnesses
E. Has achieved financial security
Answer: A, B, C
Rationale: Mental health can be viewed as a state of well-being in which the individual realizes their own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community. Our ability to act independently directed by inner values and strengths, to face life with assurance and hope, and seek a meaningful balance between work,
A nurse is reinforcing teaching with a client about managing stress effectively. Which aspect(s) will the nurse emphasize as most important for the client’s ability to accomplish this goal? Select all that apply.
A. Using humor to accept stress
B. Practicing stress reduction techniques
C. Being flexible when handling daily stress
D. Recognizing personal stress-producing triggers
E. Learning to adapt to the situation
Answer: C, E
Rationale: Stress and anxiety are unavoidable issues that confront people daily, making it necessary for people to be flexible and adaptive. Although using humor, practicing stress reduction techniques, and recognizing personal stress is important, being flexible and adaptable are most important to allow an individual to effectively implement the appropriate options.
A client is diagnosed with chronic anxiety. When planning the care for this client, which area(s) would the nurse focus on to assist the client in managing the symptoms? Select all that apply.
A. Good sleep hygiene techniques
B. Energy conservation strategies
C. Identification of a dependable support system
D. Effective ways to minimize social interactions
E. Strategies to strengthen the ability to concentrate
Answer: A, B, C, E
Rationale: When anxiety persists over a long period, the chronic feeling is demonstrated by a sense of apprehension and overreaction to all unanticipated environmental stimuli. This state may be shown through chronic fatigue, insomnia, poor concentration, or impairment in work and social functioning. Minimizing social interactions would not be advisable since there is a tendency to withdraw as a means of coping.
A nurse is reviewing the medical records of several clients. The nurse would be alert to the possibility of a mental illness based on which behavior(s)? Select all that apply.
A. Refuses to drink water because all water has been poisoned
B. Is hesitant to part with clothing that belonged to a recently deceased spouse
C. Is consistently late for work due to poor time management skills
D. Eats alone to mask how much is really being eaten
E. Becomes nauseous at the thought of entering an elevator
Answer: A, D, E
Rationale: In mental illness, the individual demonstrates a change in one or more of the following: emotions (sometimes referred to as mood), thinking, or behavior; these changes are accompanied by problems relating to others in personal, work, or social relationships or an inability to perform activities of daily living (ADLs). In the individual with mental illness, interpersonal relationships are often stressed or ineffective as mental distress impacts the emotional stability and coping efforts of the individual. Thinking is often distorted as misconceptions and thinking errors take the place of rational and realistic processing. The distress experienced in the mind sets in motion the behavioral patterns characteristic of the various mental disorders. The remaining options represent behaviors that are either nonsignificant or based on poor but not impaired thought processes. The normal grieving process could account for an individual's hesitancy to part with the belongings of a recently deceased loved one. While poor time management skills can affect an individual's life, their root is not based on a distorted thought process.
A nurse is providing care to several clients. Which individual(s) would the nurse identify as being at risk for an unresolved grieving process? Select all that apply.
A. Female client whose child committed suicide
B. Young male client whose abusive, paternal parent drowned
C. Female client whose child has been diagnosed with terminal cancer
D. Sole survivor of a multiple automobile accident
E. Male client who accidently shot and killed a close friend
Answer: A, B, D, E
Rationale: Factors that may contribute to unresolved grief include a socially unaccepted death like a suicide, when the individual has ambivalent feelings about the one who died, survivor guilt, and feelings of responsibility for someone's death. Anticipatory grief may be seen in individuals and families who are expecting a major loss in the near future such as from a terminal condition.