A single parent 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
... [Show More] 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?
· “Boys who are cared for only by their moms are at highest risk for violent
behavior.”
· “There is quite a bit that you can do. Let’s talk about what you’re already doing
first.” Correct
· “Do you know all of your son’s friends, or is he left alone after school because
you work?”
· “Many young people die of gunshots every day in this country, so your son’s
behavior is unacceptable.”
Rationale: It is important to help parents to identify children at risk for violent behavior.
Unfortunately, this young person has already engaged in threatening and potentially
violent behavior, but there are parenting measures and therapies that this single parent can
use to help her son express his feelings of anger verbally rather than by acting out. The
nurse responds nontherapeutically in telling the mother that boys who are cared for only
by their mothers are at high risk for violence; this response could generate guilt in the
mother. Asking, “Do you know all of your son’s friends, or is he left alone after school
because you work?” is both inappropriate and premature. Telling the woman that her
son’s behavior is unacceptable is lecturing an upset parent, which is inappropriate.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques and
focus on the information in the question. Note that the client of the question (the mother)
is asking the nurse for assistance. The correct option is the only option that addresses the
mother’s concern and encourages verbalization. Review: therapeutic communication
techniques .
Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp.
27-31, 676-678). St. Louis: Mosby.
Cognitive Ability: Applying
12.ID: 9477084330
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?
· “Well, your health care provider is concerned that you will become physically
dependent on the first painkiller.”
· “Perhaps if I medicate you about a half-hour before you plan to start your daily
activities, the medicine will be more effective.” Correct
· “Your health care providerhealth care provider feels that your body is physically
ready to make the change in medication.”
· “I think you need to listen to your health care provider health care providerwhen it
comes to taking such strong medication.”
Rationale: The most supportive response is the one that addresses the client’s concern
and provides a plan that will help minimize the client’s pain. If this nursing measure does
not afford pain relief, then the nurse can report the client’s continued pain to the health
care provider. In stating, “Your health care provider feels that your body is physically
ready to make the change in medication,” the nurse is shifting attention from the client’s
feelings to the health care provider’s view. In telling the client that he or she needs to
listen to the health care provider, the nurse is nontherapeutically giving advice and
patronizing the client. Stating, “Well, your doctor is concerned that you will become
physically dependent on the first painkiller” is a defensive response, and the nurse’s
assertion about dependence may not be based on fact.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques and
focus on the subject, the client’s concern about pain relief. Eliminate the options that are
comparable or alike and focus on the health care provider, not the client. From the
remaining options, select the one that addresses the client’s concern. Review: therapeutic
communication techniques
13.ID: 9477081370
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?
· “Have you shared your feelings with your wife?” Correct
· “You seem to feel that a less prestigious job would be humiliating for you.”
· “How soon will you be able to find work? If this is permanent, you may need to
swallow your pride.”
· “Oh, I agree with you. Let her get another job if she needs that much money.”
Rationale: The therapeutic response is the one that helps determine whether the client is
sharing his feelings with his wife and providing her with the opportunity to join in the
decision-making process. Stating “You seem to feel that a less prestigious job would be
humiliating for you” is reflection to some degree; however, its focus is nontherapeutic
because the nurse is making a premature judgment of the client’s concerns. In stating,
“Oh, I agree with you. Let her get another job if she needs that much money,” the nurse is
using a nontherapeutic response of giving approval. “How soon will you be able to find
work? If this is permanent, you may need to swallow your pride” is a probing question
that the client is probably unable to answer and gives an unsolicited opinion, which is a
nontherapeutic communication.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques.
Note the words “shared your feelings” in the correct option. Remember to focus on the
client’s feelings. Review: therapeutic communication techniques .
References: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp.
27-31). St. Louis: Mosby.
14.ID: 9477081368
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?
· “Divorce is more difficult for children. Maybe you should focus on them for
now.”
· “You’ve been unfortunate, but you seem to be focusing on yourself and what you
have to do.”
· “You talk about how the divorces affected you. Tell me how your children are
dealing with the loss.” Correct
· “Oh, me too. I always pick the worst kind of men, so I know just how you feel.”
Rationale: When clients experience loss, they can become self absorbed. In responding,
“You talk about how the divorces affected you. Tell me how your children are dealing
with the loss,” the nurse is trying to refocus the client’s attention on her children and their
needs during this time. By stating, “Oh, me too. I always pick the worst kind of men, so I
know just how you feel,” the nurse personalizes and exaggerates the client’s problems,
using a nontherapeutic response. In stating, “Divorce is more difficult for children.
Maybe you should focus on them for now,” the nurse is being judgmental when he or she
should be refocusing the client’s energies. In stating, “You’ve been unfortunate, but you
seem to be focusing on yourself and what you have to do,” the nurse is responding with
empathy, but the choice of wording suggests that the nurse is judging and blaming the
client for not focusing on her children.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques.
Eliminate the option that is a nontherapeutic response and does not focus on the client’s
concern. To select from the remaining options, note that the correct option is the only
option that encourages the client to discuss the loss and its effect on her children. Review:
therapeutic communication techniques .
16.ID: 9477084377
The nurse is caring for a 39-year-old client who has experienced a mild brain attack
(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?
· “You are working to get better, but you’re worrying about things that aren’t going
to happen.”
· “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.”
· “You seem to be feeling very troubled.” Correct
· “You seem to be feeling very powerless right now, yet you’re getting better, so
why worry about what won’t happen?”
Rationale: The client has suffered two major losses and is expressing worry and concern
about his health and his children. The correct response conveys the nurse’s expression of
empathy and willingness to understand and help the client explore ways of coping with
difficulties. In stating, “You are working to get better and are doing so. But you are
worrying about things that aren’t going to happen,” the nurse is making a pat and clichéd
response that may or may not be true. In stating, “You seem to be feeling very powerless
right now, yet you’re getting better, so why worry about what won’t happen?” the nurse is
displaying empathy but also minimizing the client’s feelings with a false reassurance. In
stating “I am troubled that you are worried over the worst possible things that could
happen rather than worrying about the efforts needed to strengthen your family situation,”
the nurse is not focusing on the client’s concern, and the statement could be interpreted as
minimizing or belittling by the client.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques.
Select the option that focuses on the client’s feelings and encourages the client to express
his feelings. Review: therapeutic communication techniques .
References: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp.
27-31). St. Louis: Mosby.
17.ID: 9477089790
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?
· Displacement
· Delusions
· Psychosis
· Denial Correct
Rationale: Defense mechanisms protect us against anxiety. Denial is the defense
mechanism used to block out painful or anxiety-inducing events or feelings. In this case,
the client cannot deal with the upcoming cancer surgery and therefore denies that he or
she is ill. Psychosis and delusions are not defense mechanisms. Displacement is acting
out in anger or frustration with people who did not arouse the feelings.
Test-Taking Strategy: Focus on the subject, defense mechanisms. First, eliminate the
options that are not defense mechanisms. From the remaining options, focus on the data
in the question to find the correct option. Review: defense mechanisms .
18.ID: 9477081366
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?
· Talking with all family members, including the daughter, about the importance of
expressing their concerns and feelings to the dying client
· Teaching the client’s wife to write down her thoughts and feelings and to read
them to her husband
· Talking with both the client and his wife about the importance of expressing their
feelings and how to do it in healthy ways Correct
· Saying to the client, “It sounds to me like your wife is truly comfortable and
doesn’t want you to worry needlessly”
Rationale: The appropriate nursing intervention is to help the client and spouse describe
feelings that, left unspoken, might cause disruption and delay resolution. Teaching the
client’s wife to write down her thoughts and feelings and read them to her husband is
inappropriate without a prior determination of the wife’s feelings. In saying to the client,
“It sounds to me as if your wife is truly comfortable and doesn’t want you to worry
needlessly,” the nurse verbalizes a statement without a basis in fact, a nontherapeutic
technique. Talking with all family members is inappropriate and could violate client
confidentiality.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques.
Eliminate the option that does not address the client’s feelings and places the client’s
feelings on hold. Next, eliminate the options that are comparable or alike because they
both address an intervention with a family member before determining their feelings.
Review: therapeutic communication techniques .
References: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patientcentered collaborative care. (6th ed., p. 116). St. Louis: Saunders.
Stuart, G. (2009). Principles & practice of psychiatric nursing
19.ID: 9477092820
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?
· “You seem to be very angry about carrying out your responsibility to your
children.”
· “What would you expect your wife and children to do? They didn’t leave you.”
· “I wonder why you left your wife and children.”
· “Do you feel that child support is designed to help children, not punish spouses
who leave?” Correct
Rationale: The nurse employs the therapeutic communication technique of seeking
clarification to support the client in processing his feelings more specifically. In
maintaining a neutral, unbiased, and nonjudgmental stance, the nurse can establish a
trusting relationship with the client. In stating, “I wonder why you left your wife and
children,” the nurse changes the focus of the client’s concern and uses a “why” question
that implies criticism and could cause the client to become defensive. “What would you
expect your wife and children to do? They didn’t leave you” is sarcasm, which is
nontherapeutic and alienates the client. In stating, “You seem very angry about carrying
out your responsibility to your children,” the nurse is making an interpretation and
labeling the client’s feelings prematurely.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques.
Eliminate the option containing the word “why.” Next, eliminate the option that is
sarcastic and the option that labels the client’s feelings. Also note that the correct option
is the only option that focuses on the client’s concern and encourages the client to further
verbalize feelings. Review: therapeutic communication techniques .
Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp.
27-31, 94). St. Louis: Mosby. [Show Less]