Psychosocial

Therapeutic Communication

100

A nurse recognizes that a helping relationship is established with a client if the communication A. is equally reciprocal between the nurse and the client. B. encourages the client to express his thoughts and feelings. C. has no time limits. D. occurs spontaneously throughout the nurse-client relationship

B. encourages the client to express his thoughts and feelings. Therapeutic communication facilitates a helping relationship that maximizes the client’s ability to openly express his thoughts and feelings. The communication is not reciprocal but client-focused. Therapeutic communication is limited to the boundaries of the therapeutic relationship. Therapeutic communication is planned by a health care professional. ATI

200

A nurse is bathing an older adult client and says to him, “Turn to your side now, honey.” The nurse believes she is demonstrating warmth and caring by calling the client “honey.” However, the client finds the term offensive. What has caused this miscommunication to occur? A. The connotative meaning of the word is different to the client and the nurse. B. The client was unable to hear the nurse’s message. C. The nurse’s verbal communication was not congruent with her nonverbal communication. D. It is not the appropriate time for performing the client’s bath.

A. The connotative meaning of the word is different to the client and the nurse. The nurse believes that the word “honey” communicates warmth and caring. The client interprets the word as being derogatory and perhaps unprofessional. The client did not have any difficulty hearing the message. There is no indication that verbal and nonverbal communication is not congruent, or that it is an inappropriate time for performing the bath. ATI

300

3. Which of the following are behaviors of active listening? (Select all that apply.) a. Maintaining an open posture b. Writing down what the client says so that details are not forgotten c. Establishing and maintaining eye contact d. Nodding in agreement with the client throughout the conversation e. Responding positively when giving feedback

A. Maintaining an open posture C. Establishing and maintaining eye contact E. Responding positively when giving feedback Having an open posture and leaning forward, establishing and maintaining eye contact, and responding positively when giving feedback are ways the nurse can demonstrate active listening. Writing down everything the client says will interfere with the nurse’s ability to maintain eye contact and an open posture. Nodding in agreement throughout the conversation may be interpreted as agreement with what the client is saying when it was only intended to indicate attending to what was being said. ATI

400

The speech therapist reports to the nurse that the client has expressive aphasia. Which nursing intervention is best for communicating with the client at this time? A. Speak using a low tone of voice B. Have the client point to key phrases printed on a clipboard C. Complete the sentence if the client becomes frustrated D. Encourage the client to practice verbalizing key words

B. Have the client point to key phrases printed on a clipboard Expressive aphasia means that the client can understand what is said but cannot respond using spoken language. An appropriate alternative is to use some nonverbal method by which the client can communicate, such as a written or printed list of key words that he can point to. Encouraging the client to practice key words is likely to cause frustration because his loss of language is not from a lack of effort or practice. Despite the client's inability to respond verbally, it is still appropriate for the nurse to speak to the client but should be done in a normal tone of voice, allowing the client ample time to complete his thoughts. Completing the client's sentences for him serves no therapeutic benefit. (Timby, Carmack, & Rupert, 2009)

500

What approach is best when managing the care of a client with dementia who insists on carrying a purse at all times? A. Ask the client where the purse can be stored B. Ensure that the client is never without the purse C. Inform the client that the purse may become lost E. Find out why the client feels the need for a purse

B. Ensure that the client is never without the purse The purse may be a symbol of security for the client. Therefore, it is best to accommodate the client's idiosyncrasy. Trying to alter the client's behavior may increase her confusion and lead to aggressive behavior. The client may not have the cognitive ability to offer a reason, choose a storage place, or understand the concept of loss. (Timby, Carmack, & Rupert, 2009)

Coping

100

A nurse is caring for a client whose partner passed away 4 months ago and who has been recently diagnosed with diabetes mellitus. He is tearful and states, “How could you possibly understand what I am going through?” Which of the following would be an appropriate response by the nurse? A. “It takes time to get over the loss of a loved one.” B. “You are right; I cannot really understand. Perhaps you’d like to tell me more about what you’re feeling.” C. “Why don’t you try something to take your mind off your troubles, like watching a funny movie.” D. “I might not share your exact situation, but I do know what people go through when they deal with a loss.”

B. "You are right; I cannot really understand. Perhaps you'd like to tell me more about what you are feeling." By stating that she is not in his situation, the nurse is using the therapeutic communication technique of validation, whereby she shows sensitivity to the meaning behind his behavior. She is also creating a supportive and nonjudgmental environment, and inviting him to express his frustrations. Telling the client it will take more time to heal belittles the client’s feelings and gives false reassurance. Telling the client to try a distraction dismisses the client’s feelings and gives common advice instead of expert advice. Saying she knows what clients feel is presumptive and inappropriate. ATI

200

Diagnostic tests confirm that the client's adrenal glands are producing excessive amounts of adrenocortical hormones. When the nurse explains the disorder to the slient's spouse, it is accurate to stress that the client is also likely to experience which effect? A. Anxiety and occasional panic attacks B. Depression and suicidal tendencies C. Impulsiveness and poor self-control D. Forgetfulness and memory changes

B. Depression and suicidal tendencies Depression is common among clients with Cushing's syndrome because of the severity of physical changes or excess cortisol from increased adrenal glucocorticoid production; this places the clients at increase risk for suicide. The other emotional symptoms are not necessarily associated with Cushing's syndrome, although they may occur randomly in some clients for other psychophysioligic reasons. (Timby, Carmack, & Rupert, 2009)

300

When interacting with a client experiencing an anxiety attack, which technique by the nurse is most likely used to help reduce the client's anxiety level? A. Stand less than an arm's length away B. State that everything is going to be OK C. Instruct the client to take shallow breathes D. Explain all actions and procedures

D. Most people experience increased anxiety during situations in which they have no prior experiences. to a client who is already anxious, this unfamiliarity adds to the anxiety. Providing examinations and instructions help to diminish the client's insecurity, thereby decreasing the anxiety. Standing within an arm's length invades a client's personal space and heightens anxiety. Instructing the client to take shallow breaths will not decrease the anxiety, and may result in hyperventilation. A more appropriate instruction would be to tell the client to take slow, deep breaths with air going in through the nose and out of the mouth. Telling the client that everything is going to be OK is meaningless reassurance, and this action should be avoided. (Timby, Carmack, & Rupert, 2009)

400

Which of the following types of stress is being experienced by a middle adult client who is stressed by the concerns of caring for young adults still in the home and her aging parents? A. Developmental B. Situational C. Social D. Cultural

A. Developmental Developmental stress is related to the stages of life. Situational stress is an unexpected, sudden stressor, such as a job loss. Social and cultural stresses are widespread problems, such as poverty that affect a community as a whole. ATI

500

Once a nurse has counseled a client about her situational role changes and she has accepted them, what is the next step in her recovery? A. Adaptation B. Resentment C. Tension D. Apprehension

A. Adaptation A client who has accepted role changes will demonstrate adaptation. Resentment, tension, and apprehension are not behaviors or emotions consistent with acceptance. ATI

Self-Concept

100

A nurse in an ambulatory care clinic is caring for a client who had a mastectomy 6 months ago. The client tells the nurse that she has not had much desire for sexual relations since her surgery, stating, “My body is so different now.” Which of the following is an appropriate response by the nurse? A. “Really, you look just fine to me. There’s no need to feel undesirable.” B. “I’m interested in finding out more about how your body feels to you.” C. “Consider an afternoon at a spa. A facial will make you feel more attractive.” D. “It’s still too soon to expect to feel normal. Give it a little more time.”

B. "I'm interested in finding out more about how your body feels to you." Showing interest in the client is applying the therapeutic communication technique of offering self; asking more about how the client feels is applying the therapeutic communication technique of encouraging a description of perception. Telling the client she looks fine is using the nontherapeutic communication technique of giving an opinion; assuming she feels undesirable is using the nontherapeutic communication technique of interpreting. Suggesting a facial is using the nontherapeutic communication technique of giving advice. Telling her it is too soon to feel normal and to give it more time is belittling the client’s feelings and giving false reassurance. ATI

200

Which action by the nurse can best determine if an older client's inappropriate responses to several questions are due to miscommunication or impaired cognition? A. Ask the client to repeat the question before answering it B. Ask questions that require only a "yes" or "no" response C. Ask the client's next of kin for answers to the questions Ask question to which the client is sure to know the answers

A. Ask the client to repeat the question before answering it. Asking a client to repeat the question helps to rule out a hearing deficit or possible dementia. A client has a 50% chance of being right when responding only with a "yes" or "no". Asking the next of kin is appropriate if the client is not a reliable historian. Asking questions only the client can answer does not provide comprehensive objective data. (Timby, Carmack, & Rupert, 2009)

300

Which of the following factors positively affect self-concept? (Select all that apply.) A. Diabetes mellitus B. Parental approval C. Success at school D. Receiving a promotion at work E. Excessive use of alcohol

B. Parental approval C. Success at school D. Receiving a promotion at work. Parental approval, success at school, and receiving a promotion at work all have a positive impact on the individual’s self-concept, as these situations promote good feelings about self-concept. A chronic illness usually has a negative impact on self-concept, as the client is required to adapt to the changes. Excessive use of alcohol is a symptom of a poor self-concept. ATI

400

Which nursing intervention is most appropriate to include in the care plan of an anxious client who is blind or has both eyes patched? A. Touch client before speaking? B. Explain what you plan to do beforehand C. Shut the door to his room to decrease noise D. Leave the room lights on at all times

B. Explain what you plan to do beforehand Anxiety occurs because a person feels threatened by an unexpected or unfamiliar situation. Hearing an explanation beforehand prepares a person for what is about to take place. The nurse should always speak prior to touching to a blind client. Shutting the door increases a client's feeling of isolation and fear that help will be unavailable. Having adequate lights helps partially slighted clients, not those who cannot see. (Timby, Carmack, & Rupert, 2009)

500

Which question best assesses the client's long-term memory? A. What is your current age? B. What is today's date? C. What is your date of birth? D. What occurred last January?

C. What is your date of birth? Asking the client to identify the date of birth is a standard technique for assessing long-term memory. To evaluate the client's response, the nurse should know the answer to the question. Asking the client's current age and today's date helps in the assessment of short-term memory and orientation. Asking what occurred last January is to vague a question for a valid assessment. (Timby, Carmack, & Rupert, 2009)

Cultural/Spiritual

100

The belief that one’s culture is superior to others is called A. ethnocentrism. B. socialization. C. repatterning. D. acculturation.

A. ethnocentrism Ethnocentrism is the belief that one’s own culture is superior to others. Socialization refers to a person’s upbringing within a culture that results in becoming a practicing member of the culture. Repatterning refers to helping clients shift their beliefs to make them compatible with health promotion. Acculturation refers to the degree to which a client adopts the behaviors of a new dominant culture. ATI

200

Which of the following is appropriate when using an interpreter to communicate with a client and his family? (Select all that apply.) A. Talk to the interpreter about the family while the family is in the room. B. Ask the family one question at a time. C. Look at the interpreter when asking the family questions. D. Use lay terms if possible. E. Do not interrupt the interpreter and the family as they talk.

B. Ask the family one question at a time. D. Use lay terms if possible. E. Do not interrupt the interpreter and the family as they talk. Asking the family one question at a time, using lay terms, and not interrupting will promote communication between the family and the nurse/interpreter. Talking to the interpreter about the family while the family is in the room and looking at the interpreter instead of the family would hinder communication between the family and the nurse/interpreter. ATI

300

A client is observed crying as he reads from his devotional book. What intervention is appropriate? A. Contact the hospital’s spiritual services. B. Ask him what is making him cry. C. Provide quiet times for these moments. D. Turn on the television for a distraction.

C. Provide quiet times for these moments. Providing privacy and time for the reading of religious materials supports the client’s spiritual health. Contacting the hospital’s spiritual services presumes there is a problem. Asking the client about the crying or providing a distraction could be interpreted as discounting or being disrespectful of the client’s beliefs. ATI

400

When providing care for an Asian client diagnosed with mental illness, which barriers should be considered before beginning treatment? Select all that apply. A. Language B. Literacy C. Somatization of mental health symptoms D. Food preferences E. Client's tendency to give limited information F. Financial status

A. Language B. Literacy C. Somatization of mental health symptoms E. Client's tendency to give limited information For many clients, regardless of their cultural background, mental illness is an embarrassment and a social stigma. For these reasons, many ethnic and cultural groups are less likely to seek treatment for their mental illness, and when they do, they have a greater likelihood of not completing treatment. Barriers that the nurse needs to assess when providing care for various cultural groups include language, literacy levels, and attributing symptoms of the mental disorders as vague physical symptoms such as headache, stomach ache, and vague muscle aches. The nurse also needs to assess the client's willingness to give oral personal information about symptoms. Food preferences and financial status may be barriers, but are not considered as relevant as the other choices. (Timby, Carmack, & Rupert, 2009)

500

A 68 year old Mexican immigrated to the United States 3 months ago. The client comes to the Emergency Department with complaints of severe pain in the shoulder, elbow, and knee. The physician diagnoses bursitis. On the basis of the nurse's knowledge of the client's culture and beliefs, which statement regarding the health seeking behavior is probably most accurate? A. Home remedies have been unsuccessful, and the client's condition threatens the role expectations. B. The power to cure comes from physicians and is based on advances in medical technology C. The client has lost faith in prayer, supernatural forces, and the curadero D. The client's condition is the result of the mal de ojo (evil eye)

A. Home remedies have been unsuccessful, and the client's condition threatens the role expectations Many Mexican American clients will not go to the hospital or physician until all attempts at treating the illness with home remedies have been exhausted. Because Mexican American men are traditionally expected to be strong, the client's illness may be perceived as interfering with his ability to provide for his family. Some believe that medical technology assists the physician in curing illnesses; however, since the client has been in the United States for a short time, it is unlikely he would be aware of these medical advances in this country. A curandero is a folk healer. There is no evidence in this question to validate that the client no longer believes in curanderos. Some believe that illness is caused by "evil eye," which would be treated by spiritual ceremonies, candles, and prayer. (Timby, Carmack, & Rupert, 2009)

Grief/Loss

100

In which stage of grief, per Kübler-Ross, is a client who is terminally ill displaying when she states that she is going to a clinic for acupuncture? A. Anger B. Depression C. Bargaining D. Acceptance

C. Bargaining A client who tries alternative treatments is attempting to negotiate a way to lengthen life or find cures. Lashing out at people or things occurs during the anger stage. Being withdrawn and sad occurs during the depression stage. Recognizing the end is near with thoughts for the future occurs during the acceptance stage. ATI

200

Which of the following is a sign of impending death? A. Elevated blood pressure B. Warm extremities C. Tense muscles D. Labored breathing

D. Labored breathing Labored breathing, such as dyspnea, apnea, and Cheyne-Stokes respirations, are common when a client approaches death. ATI

300

The client's disease fails to respond to medical treatment. The nurse is present in the room when the physician tells the client that the condition is terminal. Which nursing action is most helpful in assisting the client to deal with impending death? A. Providing literature on death and dying B. Allowing privacy to reflect on the news C. Encouraging communication regarding feelings D. Suggesting a second opinion by another physician

C. Encouraging communication regarding feelings Discussing feelings with another person facilitates grieving. The client should not be left alone immediately after hearing this information. It is important to remain with the client until the information has been processed. The client would also benefit from talking with other supportive individuals, such as a spouse, family member, friend, or clergyman. Reading literature on the subject and thinking in private help some people, but most believe it is more effective to verbalize thoughts and feelings. If the client requests a second opinion, the request should not be denied; however, it would be inappropriate for the nurse to initiate the suggestion. Doing so is considered a form of false reassurance and could prolong the client's denial. (Timby, Carmack, & Rupert, 2009)

400

The client is rushed to surgery where his arm is amputated above the elbow. Postoperatively, the client screams obscenities at the nurse when he realizes that his forearm is missing. Which nursing action is most appropriate at this time? A. Leave until the client works through his anger B. Stay quietly with the client at his bedside C. Tell the client to get control of himself D. Call the physician and request a sedative

B. Stay quietly with the client at his bedside Staying with a grief-stricken client provides emotional support and may help the patient feel he can depend on the nurse to be available and respond to his future needs. Leaving an uncomfortable situation is one method health professionals use to cope with their own feelings of inadequacy; however, the client would probably interpret the desertion as a sign that the nurse is not a caring individual. Allowing the client to release his rage can be therapeutic as long as it does not endanger him or others. Feeling angry is one of the early steps in the grieving process. Calling the physician is inappropriate because it does not address the real problem of anger related to the missing limb. (Timby, Carmack, & Rupert, 2009)

500

A 48 year old client experiences an exacerbation of multiple sclerosis after being asymptomatic for 6 months. How can the nurse best help the client deal with personal fears at this time? A. Encourage the client to verbalize feelings B. Provide a detailed explanation of the disease process C. Tell the client about physical assessment findings D. Explain that the disease may become periodically acute

A. Encourage the client to verbalize feelings Multiple sclerosis is a progressive, debilitating disease affecting the myelin sheath of the peripheral nerves. The cause is unknown and onset affects clients usually between the ages of 20 and 40. Being able to verbalize feelings of fear and frustration about a debilitating disease can be extremely therapeutic for the client. Sharing possibly irrational fears with a caring individual may help put them in a more realistic light. Giving accurate information, identifying assessment findings, and validating that the present health experience is common are appropriate nursing measures once the client verbalizes fears. (Timby, Carmack, & Rupert, 2009)