Psychiatric Mental Health Nursing 4th Edition by Frisch Noreen Cavan Frisch Lawrence E. Test Bank

Psychiatric Mental Health Nursing  4th Edition by Frisch Noreen Cavan Frisch Lawrence E.  Test Bank
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CHAPTER 6 TOOLS OF PSYCHIATRIC MENTAL HEALTH NURSING: COMMUNICATION, NURSING PROCESS, AND THE NURSE-CLIENT RELATIONSHIP

TRUE/FALSE

1. One of the major differences between therapeutic communication and social conversation is that social conversation is more purposeful.

ANS: F PTS: 1

2. Defense mechanisms are consciously selected responses used by individuals to protect themselves from stress.

ANS: F PTS: 1

3. It has been estimated that nonverbal communication comprises more than half of all messages communicated.

ANS: T PTS: 1

4. How close you stand from a person when communicating with him or her sends a message to that person.

ANS: T PTS: 1

5. Personal space ranges from 18 inches to about 4 feet.

ANS: T PTS: 1

COMPLETION

1. The therapeutic communication technique usually considered to be the most important is ____________________.

ANS: listening

PTS: 1

2. The communication technique of ____________________ is being used when the nurse asks, Are you saying you are disappointed?

ANS: clarification

PTS: 1

3. When the client incorporates the qualities or attributes of another, the client is using the defense mechanism of ____________________.

ANS: introjection

PTS: 1

4. When the nurse walked into a clients room, the client shouted, Get out of here, you hate me, you hate me! I know you dont like me! This is an example of the defense mechanism of ____________________.

ANS: projection

PTS: 1

5. After a session with the provider, the client was furious about an interpretation. Instead of confronting the provider, the client arrived back on the ward and yelled at the nurse, with whom the client had a good relationship. The nurse correctly recognizes this behavior as the defense mechanism of ____________________.

ANS: displacement

PTS: 1

6. A driving instructor runs through a red light while answering his cell phone. When pulled over by a police officer, he explains to the officer that he was distracted by the vehicle behind him for being too close for the speed limit. He was concerned that it would have hit him if he had applied his brakes when the light turned yellow. This is an example of the defense mechanism of ____________________.

ANS: rationalization

PTS: 1

7. An elderly woman is admitted to a hospice for terminal care of metastatic cancer. The woman is very open about the fact that she is dying and is actively preparing for her death by revising her will and writing good-bye letters to all of her friends and family. When a nurse refers to her condition as cancer, the woman corrects the nurse, saying, I dont have cancer. I had a tumor that was removed, but I dont have cancer. The nurse correctly recognizes this as the defense mechanism of ____________________.

ANS: denial

PTS: 1

MULTIPLE CHOICE

1. A psychiatric nurse begins the initial meeting with a new client by requiring the client to sign a written explanation of all the rules the client must follow while under psychiatric care. By the end of the meeting, the client has stopped talking and displays a closed, guarded affect and nonverbal behavior. This is MOST likely because the nurse failed to first:
a. convey that the nurse is kind as well as willing and competent to provide psychiatric nursing care
b. thoroughly assess the clients knowledge of his or her diagnosis
c. present a written care plan and have the client sign that the client understands and agrees with the care plan
d. administer medication to reduce the clients level of anxiety prior to the meeting

ANS: A
The clients behavior indicates that trust between the client and nurse has not developed. A critical aspect in beginning any relationship is to identify the roles of both parties. This will facilitate the development of trust and rapport. Beginning with the rules that the client must follow indicates that the nurse is not caring and implies that the relationship is not mutual but one-sided.

PTS: 1 DIF: Analysis REF: Part 3: The Nurse-Client Relationship

2. A psychiatric nurse has worked with a client throughout the clients 6-week, short-term outpatient psychiatric treatment and is guiding the client to formulate follow-up independent self-care plans. The nurse gently teases the client about a momentary lapse into an old maladaptive behavior. The client responds by smiling and saying, Youre right! See? I am so much better now! The old me would have stormed out of here cursing if you had said that the first day we met. The clients response indicates that the nurses primary purpose in this use of humor with this client succeeded because it promotes the clients:
a. acceptance of a lifelong problem
b. insight and control of symptoms
c. awareness of the need for long-term treatment
d. conscious use of defense mechanisms

ANS: B
The client demonstrated control by not storming out of the office. He demonstrated insight when he was able to identify his previous method of dealing with a stressful situation.

PTS: 1 DIF: Analysis REF: Evaluating Communication

3. When working with a client, you notice that he always tends to stand within 10 to 18 inches of others. The clients peers and the staff complain that this closeness is uncomfortable. The client follows you around the unit. After assessing this client, your MOST likely conclusion will be that this client:
a. has developed a bad habit
b. is lonely and needs friends
c. needs to work on boundary issues
d. would benefit from behavior modification

ANS: C
Clients who maintain a personal space of only 12 to 10 inches of the nurse are demonstrating dependency. These clients may need to develop boundaries and a stronger sense of self to establish the social skills necessary to initiate communication with others. When appropriate in the nurse-client relationship, the nurse will use observations to let the client know how the clients verbal messages come across to others.

PTS: 1 DIF: Analysis
REF: Part 1: Communication| Nonverbal Communication| Physical Space

4. The nurse is helping a client to verbalize emotions. The response that BEST indicates that the nurses communication was effective is when the client:
a. stares blankly and states, You dont like me, do you?
b. pats the nurse on the hand and states, You are so kind and understanding!
c. frowns and states, I guess I did say that, but thats not what I meant.
d. looks concerned and states, You sound like youre coming down with a cold!

ANS: C
The nurses communication is effective because the client indicates an emotion by both his verbal and nonverbal communication. His nonverbal communication is the frown on his face. His verbal response is his acknowledgment that the verbal message he sent was not the message he wanted to send.

PTS: 1 DIF: Application REF: Evaluating Communication

5. During group therapy, the psychiatric nurse notices that when Client A complains to Client B about Client Bs loud singing late at night, Client B leans back in his chair, turns away from Client A, and folds his arms across his chest without responding verbally to Client A. In turn, Client A smiles and winks at a third client in the group. The nurse would BEST assist these clients to understand more clearly how feedback contributes to communication by:
a. remaining silent and allowing the group communication process to continue naturally without intervention
b. asking other group members to interpret both Client As and Client Bs nonverbal behaviors
c. commenting on these behaviors and asking both Client A and Client B to clarify their nonverbal behaviors
d. ending the group session at that point so that both Client A and Client B can spend time reflecting on the interaction

ANS: C
Both Client A and Client B are sending nonverbal messages. The nurse provides feedback by commenting on the behavior and asking the two clients to clarify the messages that they were intending to send by their nonverbal communication.

PTS: 1 DIF: Application REF: Part 1: Communication| Feedback

6. A student nurse observes a group of clients and experienced psychiatric nurses interacting and performing a variety of tasks with each other throughout the day. The student notices that the nurses physically position themselves at different distances from the clients during these encounters. The student correctly ascertains that the nurses appropriately determine the therapeutic distance between themselves and a client based on:
a. psychiatric diagnosis
b. physical attractiveness
c. socioeconomic status
d. time of day

ANS: A
Nurses understand that a clients psychiatric diagnosis plays a role in the determining of the amount of physical space that the client can tolerate when communicating with the nurse. For example, a client diagnosed with paranoid schizophrenia may feel the nurse is being invasive when the distance between the nurse and client is too short. On the other hand, a passive-dependent client may need to be closer to the nurse because the nurse represents a source of comfort and security.

PTS: 1 DIF: Analysis
REF: Part 1: Communication| Nonverbal Communication| Physical Space

7. You are a staff nurse working on a psychiatric unit. Your head nurse reports that a newly admitted client is withdrawn. You knock, announce yourself, and obtain the clients permission to enter the clients room. You sit about 5 feet away from the client. The client moves to the corner of the room farthest from you without ever looking up. As a psychiatric nurse, you understand that the MOST likely reason that the client moved was because the client:
a. doesnt like you and is deliberately snubbing you
b. is intolerant of physical closeness to others
c. prefers to talk to you in a group setting rather than one-on-one
d. would like to speak, but needs a better view of you

ANS: B
The most likely reason the client moved is that the client is intolerant of physical closeness. An individuals personal space ranges from 18 inches to about 4 feet. The client moving farther away from the nurse indicates that the client needs more space between him- or herself and the nurse.

PTS: 1 DIF: Analysis
REF: Part 1: Communication| Nonverbal Communication| Physical Space

8. Kinetic communication cues include:
a. words
b. tone of voice
c. facial expression while talking
d. nervous coughing while speaking

ANS: C
Kinetic communication cures include facial expression while talking. Kinetics or action refers to movement, expressions, gestures, and posture that accompany interactions and influence communication. Words, tone of voice and nervous coughing are not kinetic communication cues.

PTS: 1 DIF: Knowledge
REF: Part 1: Communication| Physical Space and Interaction| Actions of Kinetics

9. Paralinguistic communication cues include:
a. words
b. tone of voice
c. facial expression while talking
d. patting the listeners hand while talking

ANS: B
Paralinguistic communication cues include tone of voice. Words are an example of verbal cues. Facial expression while talking is an example of a kinetic or action cue, and patting a listeners hand is an example of the nonverbal communication of touch.

PTS: 1 DIF: Knowledge
REF: Part 1: Communication| Physical Space and Interaction| Paralinguistic Cues

10. You are a psychiatric nurse practitioner. The mother of one of your clients dies, and you attend the funeral. When you approach the client at the gravesite, the MOST appropriate nonverbal therapeutic communication technique that would convey your sympathy and therapeutic support would be to:
a. gently squeeze the clients hand while patting the client on the shoulder or upper back with your other hand
b. adopt a long, sorrowful facial expression, and wipe tears from your eyes
c. attempt to speak in a choked voice, and then cough nervously or cry audibly
d. stand off to the side with hands clasped in front of you, and continuously gaze at the client throughout the service

ANS: A
A gentle squeeze of the clients hand while patting the client on the shoulder or upper back with your other hand would be the most appropriate nonverbal method for the nurse to communicate support and sympathy for a client at a funeral. Touch can convey warmth, positive regard, support during silence, and reassurance that the nurse is fully present and caring.

PTS: 1 DIF: Application
REF: Part 1: Communication| Physical Space and Interaction| Touch

11. A student nurse shared in postconference that she was ineffective in communicating with her client. She described their interaction of sitting in silence for 10 minutes. At the end, when walking out of the room, the clients hand lightly brushed her arm. An analysis of the situation suggests that the student nurse did NOT:
a. use silence as an effective tool of communication
b. accept touch as an effective means of connecting or reaching out
c. handle her anxiety effectively while sitting in silence with her client
d. effectively use the time because the client never spoke to her

ANS: B
The student felt that her communication with the client was ineffective because the client did not speak. However, the student failed to understand the importance of being present for the client. The clients use of touch was an example of the client demonstrating warmth and positive regard for the student. However, the student did not recognize that even though the client did not talk, the client nonverbally communicated with the student.

PTS: 1 DIF: Analysis
REF: Part 1: Communication| Physical Space and Interaction| Touch

12. In a team meeting, it is noted that a client uses defense mechanisms to avoid dealing with certain topics. The nurse can BEST use this knowledge to:
a. guide the nurse-client interactions
b. analyze the clients psyche
c. assist the client in changing behavior
d. explain the clients problems

ANS: A
Defense mechanisms are unconscious responses used by persons to protect themselves from internal conflicts and external stress. When a nurse concludes that the client is using a defense mechanism to avoid dealing with certain subjects, the nurse can use this knowledge to guide interactions, knowing that the defense mechanism indicates the presence of psychologically significant material.

PTS: 1 DIF: Application REF: Part 1: Communication| Defense Mechanisms

13. A client has been working on relationship issues with a psychiatric nurse. The client usually changes the subject or reverts to cracking jokes when discussing a sensitive, emotionally charged subject. Today, the client remains focused on the subject. Which of the following therapeutic communication techniques would MOST appropriately encourage the client to continue to explore new ideas or issues in more depth?
a. Lets review your progress so far and see what else seems to be an important issue to focus on today.
b. Have you considered talking with your psychiatrist about increasing the dosage of your medication?
c. Its not like you to stay on topic. Usually you are pretty good at keeping the tone lighthearted or avoiding heavy topics.
d. That sounds really important to you. Tell me more about this.

ANS: D
To have the client discuss an issue in more depth, the nurse would acknowledge that the topic is important to the client. The most effective way to achieve this is for the nurse to use the therapeutic communication technique of focusing. The other options avoid dealing with the clients feelings about the emotionally charged topic that is currently being discussed.

PTS: 1 DIF: Application
REF: Part 1: Communication| Verbal Communication| Focusing

14. You are a psychiatric nurse working with a client who feels a strong need to be in control at all times. Which of the following therapeutic communication techniques would MOST appropriately encourage this client to consider a new treatment approach?
a. Youve come to me for expert advice, yet you reject the treatment option that I suggest.
b. Would it help you to talk with people who have tried those treatments themselves?
c. Lets go back over these treatment options to be sure you have your facts straight.
d. This chapter out of a textbook that I edited is the best source of information about these treatment options.

ANS: B
The best response by the nurse would be to say, Would it help you to talk with people who have tried those treatments themselves? The nurse is using the technique of suggestion, which is used to encourage a client to consider a specific option or asking the client to consider an alternate means of coping with a particular situation.

PTS: 1 DIF: Application
REF: Part 1: Communication| Verbal Communication| Suggesting

15. During a psychiatric unit meeting, a client from Asia is making a statement that no one seems to understand. Which action would indicate that the nurse was using therapeutic communication principles?
a. Insist that the client from Asia be quiet until the meeting is over.
b. Assess the nonverbal quality of this clients communication.
c. Ask the other clients what they think the client from India is saying.
d. Make an interpretation, and act on it in responding to this client.

ANS: B
The nurse would be using therapeutic communication when assessing the nonverbal quality of the clients communication. The other options are nontherapeutic and can be barriers to communication.

PTS: 1 DIF: Application
REF: Part 1: Communication| Nonverbal Communication

16. In a process recording, the nurse records:
a. a verbatim account of what both the nurse and the client say during a conversation
b. nonverbal communications of both the nurse and the client
c. specific communication techniques used
d. the nurses evaluation of whether or not the communication was therapeutic
e. all of the above

ANS: E
A process recording is a verbatim account of the communication, with the nurses interpretation of the specific communication technique used and an evaluation of whether or not the communication was therapeutic. Process recordings include the verbal and nonverbal communication that occurred during the interaction.

PTS: 1 DIF: Comprehension REF: Evaluating Communication

17. In nursing rounds, the charge nurse shares with the group that a client, who was admitted last night, is a 59-year-old male with hypertension. This is his first psychiatric hospitalization. The behaviors on admission were suspiciousness and agitation. The information shared may be considered a part of the nursing:
a. evaluation
b. assessment
c. goals
d. intervention

ANS: B
Assessment in psychiatric nursing involves information obtained on admission. This would include both subjective data obtained by the client and objective data that the nurse has obtained. Information is obtained from the interview and the client history and physical examination.

PTS: 1 DIF: Comprehension
REF: Part 2: Nursing Process| Steps of the Nursing Process| Assessment

18. Upon admission, a clients temperature measured 99.4 degrees Fahrenheit, pulse rate was 90 beats per minute, respirations were 24 per minute, and blood pressure was 190/100. What type of measurements do these represent?
a. subjective data
b. client outcomes
c. nursing diagnosis
d. objective data

ANS: D
Vital signs are an example of objective data secured by the nurse. Subjective data would be information provided by the clients statements. The nursing diagnosis is an analysis of the assessed data, and outcomes are the desired goals to achieve as a result of treatment.

PTS: 1 DIF: Comprehension
REF: Part 2: Nursing Process| Steps of the Nursing Process| Assessment

19. What is the highest-priority safety determination of the psychiatric nursing assessment?
a. past medical history
b. potential for suicide or violence
c. level of mental functioning
d. developmental history

ANS: B
The highest priority assessment of safety is to determine the clients potential for suicide or violence. While information regarding past medical history, level of mental functioning, and developmental history may be obtained, they are indicators of an immediate safety issue.

PTS: 1 DIF: Comprehension
REF: Part 2: Nursing Process| Steps of the Nursing Process| Assessment

20. A psychiatric nurse can make a nursing diagnosis and address it in the nursing care plan as a nursing concern when which of the following criteria are met?
a. The nursing diagnosis is probable or potential, but not yet substantiated by either objective or subjective assessment data.
b. The nursing diagnosis must be substantiated by objective assessment data.
c. The nursing diagnosis is substantiated by either objective or subjective assessment data.
d. The client does not have to agree that it is an area of nursing concern nor desire nursing treatment for it.

ANS: C
A nursing diagnosis must be substantiated by either objective or subjective assessment data to become a component of the nursing care plan. The assessed data and nursing diagnosis will then be used by the nurse to determine expected outcomes and a plan for interventions.

PTS: 1 DIF: Comprehension
REF: Part 2: Nursing Process| Steps of the Nursing Process| Nursing Diagnosis

21. An elderly client is admitted for acute psychiatric inpatient treatment of multiple psychiatric disorders. The client also carries several nonpsychiatric medical disorders. Which method of documenting the nursing process for this client would BEST promote critical thinking about the complex interrelationships among the multiple medical and nursing diagnoses?
a. traditional columnar nursing care plan
b. diagrammatic concept map
c. verbatim process recording
d. stages of the nurse-client relationship

ANS: B
Diagrammatic concept maps are the best method to promote critical thinking about complex interrelationships among multiple medical and nursing diagnoses. The concept map permits the nurse to think through all data and the relationships among areas of nursing concerns. This thinking-throughassists nurses to develop priorities of care in situations where the nurse concludes that one diagnosis or issue is a focal point of all of the diagnoses or issues observed.

PTS: 1 DIF: Comprehension
REF: Part 2: Nursing Process| Documentation of the Nursing Process| Concept Maps

22. An otherwise healthy, young adult client is admitted for short-term outpatient psychiatric treatment of a single psychiatric condition. The method of documenting the nursing process for this client that would BEST compare observed outcomes with anticipated outcomes for a single nursing diagnosis is the:
a. traditional columnar nursing care plan
b. diagrammatic concept map
c. verbatim process recording
d. stages of the nurse-client relationship

ANS: A
Nurses have used nursing care plans as tools to document activities described in the nursing process. Traditional care plans have a column format. These plans provide a means to record assessment data, provide a list of nursing diagnoses drawn from the data, record anticipated outcomes of nursing interventions, and present a plan of care that is a statement of nursing interventions to be used. Finally, the nursing care plan provides documentation of the observed outcome, which can be compared to the anticipated outcome. This last item is generally placed in the final column known as the evaluation.

PTS: 1 DIF: Comprehension
REF: Part 2: Nursing Process| Documentation of the Nursing Process| Nursing Care Plan

23. Autonomous psychiatric nursing role actions include which of the following?
a. inviting a client to sit in the dayroom with other clients
b. secluding or restraining a combative client
c. leading a treatment team meeting
d. administering medications

ANS: A
Autonomous psychiatric nursing role actions include inviting a client to sit in the dayroom with other clients. These actions are the ones that the nurse can implement independently. Secluding or restraining a combative client or administering medications are dependent nursing actions because there must be an order from the physician. Leading a treatment team meeting is an interdependent action because it involves other health providers. Both dependent and interdependent actions require the nurse to implement collaborative nursing role actions.

PTS: 1 DIF: Comprehension
REF: Part 2: Nursing Process| Steps of the Nursing Process| Planning

24. Collaborative psychiatric nursing role actions include which of the following?
a. inviting a client to sit in the dayroom with other clients
b. secluding or restraining a combative client
c. formulating and recording nursing diagnoses statements
d. matching clients with appropriate roommates

ANS: B
Collaborative psychiatric role actions include secluding or restraining a combative client because it involves the need for a physicians order. The other options are all actions that the nurse can take autonomously.

PTS: 1 DIF: Comprehension
REF: Part 2: Nursing Process| Steps of the Nursing Process| Collaborative Nursing Interventions

25. You are a psychiatric nurse who has just admitted a client for acute inpatient psychiatric treatment. Which projected outcome(s) is appropriate for the nurse-client relationship orientation phase?
a. The client will learn and practice new adaptive methods of interacting and coping.
b. The client will develop insight and understanding of how current maladaptive methods of interacting and coping contribute to the clients problem.
c. The client will demonstrate congruent verbal and nonverbal behaviors indicating establishment of trust and feeling of nonjudgmental acceptance.
d. The client will consistently demonstrate congruent verbal and nonverbal behaviors indicating readiness to independently resume preepisodic social role functions.

ANS: C
The most appropriate outcome for the orientation phase of the nurse-client relationship would focus on establishing rapport and trust. Learning adaptive methods of interacting and developing insight will not occur until the working phase of the nurse-client relationship. Demonstrating a readiness for independence and a summary of the clients progress and goals achieved will occur during the termination phase of the relationship.

PTS: 1 DIF: Application REF: Part 3: The Nurse-Client Relationship

26. You are a psychiatric nurse. You have collaborated with a client to establish a mutually agreeable plan of care. Which projected outcome is appropriate for the nurse-client relationship working phase?
a. The client will identify and agree to work on a priority issue during treatment.
b. The client will develop insight and understanding of how current maladaptive methods of interacting and coping contribute to the clients problem.
c. The client will demonstrate congruent verbal and nonverbal behaviors indicating establishment of trust and feeling of nonjudgmental acceptance.
d. The client will consistently demonstrate congruent verbal and nonverbal behaviors indicating readiness to independently resume preepisodic social role functions.

ANS: B
The most appropriate outcome for the nurse-client working phase would be that the client will develop insight and understanding of how current maladaptive methods of interacting and coping contribute to the clients problem. The client identifying and agreeing to work on a priority issue during treatment, and demonstrating congruent verbal and nonverbal behaviors indicating establishment of trust and feeling of nonjudgmental acceptance are outcomes that occur during the orientation phase of the nurse-client relationship. The client consistently demonstrating congruent verbal and nonverbal behaviors indicating readiness to independently resume preepisodic social role functions is an outcome that would occur during the termination phase of the relationship.

PTS: 1 DIF: Analysis REF: Part 3: The Nurse-Client Relationship

27. You are a psychiatric nurse. You and your client agree that psychiatric nursing care is no longer indicated for the client. Which projected outcome is appropriate for the nurse-client relationship termination phase?
a. The client will identify and agree to work on a priority issue during treatment.
b. The client will develop insight and understanding of how current maladaptive methods of interacting and coping contribute to the clients problem.
c. The client will demonstrate congruent verbal and nonverbal behaviors indicating establishment of trust and feeling of nonjudgmental acceptance.
d. The client will consistently demonstrate congruent verbal and nonverbal behaviors indicating readiness to independently resume preepisodic social role functions.

ANS: D
The most appropriate outcome for the termination phase of the nurse-client relationship would focus on the clients behaviors indicating readiness to independently resume preepisodic social role functions. It is during the termination phase that the nurse and client evaluate progress and determine that the client is ready to move on and to establish new patterns of interacting without the nurse.

PTS: 1 DIF: Analysis REF: Part 3: The Nurse-Client Relationship

28. Which of the following statements by a client would indicate that the termination phase of the nurse-client relationship is resolved?
a. I wish that the nurse would continue to remain in contact with me.
b. I feel so sad all the time about leaving the nurse.
c. I didnt always agree with the nurse, but she gave good nursing care.
d. Im glad that we have become good friends.

ANS: C
The clients statement, I didnt always agree with the nurse, but she gave good nursing care, would indicate that the termination phase of the nurse-client relationship is resolved. The other options would not indicate resolution of the termination phase. Termination is part of a professional relationship, because there is no expectation that the nurse and client will become friends or continue a relationship beyond the time when the client needs the nurses assistance.

PTS: 1 DIF: Analysis REF: Part 3: The Nurse-Client Relationship

29. During the nurses discussion with the client, the clients statements show a beginning awareness of her difficulty. This may be indicative of which phase in the nurse-client relationship?
a. termination phase
b. orientation phase
c. work phase
d. introduction phase

ANS: C
The clients awareness of her difficulty indicates that she is developing insight. Insight occurs during the working phase of the nurse-client relationship.

PTS: 1 DIF: Analysis REF: Part 3: The Nurse-Client Relationship

30. The nurse admits a client who is a university student. The student immediately announces that she has been studying for final examinations in several courses. The student is pacing and expresses concern that this time in the hospital away from studies will cause a drop in grades and the parents will be angry if As are not attained in each course. Which statement represents the MOST appropriate nursing diagnosis for this client?
a. Panic Disorder with Suicidal Ideation, secondary to panic disorder
b. Violence Directed toward Others, related to confusion and impaired impulse control as evidenced by depression
c. Traumatic Experience, related to feelings of unreality as evidenced by unmet needs
d. Ineffective Individual Coping, related to fear of failure as evidenced by inability to meet role expectations

ANS: D
The most appropriate diagnosis is Ineffective Individual Coping. The client is experiencing stress over the possibility of not meeting role expectations. This stress causes anxiety as demonstrated by her pacing. The anxiety is beginning to interfere with her ability to cope effectively. Because previous coping strategies are ineffective, new coping strategies must be developed to address this challenging situation and reduce the anxiety it has caused.

PTS: 1 DIF: Analysis
REF: Part 2: Nursing Process| Steps of the Nursing Process| Nursing Diagnosis

31. You are working with a client who becomes upset one day and tells you, Ive decided just to give up on finishing the nursing program; its too much. The BEST response from the nurse would be:
a. It is probably too much for you to handle right now.
b. You think its too much for you?
c. I am sure you are capable of finishing the nursing program.
d. You dont need to make a decision about that right now.

ANS: B
The best response to the clients statement is to say, You think its too much for you? In this situation, the nurse is using the therapeutic communication technique of restating, Restating is a technique whereby the nurse repeats the main message the client has expressed. Restating, also called paraphrasing, permits the nurse to verify understanding of the clients message and also permits the client to reflect on the statement and emotion expressed. The other options are nontherapeutic and may create barriers to further communication with the client.

PTS: 1 DIF: Application
REF: Part 1: Communication| Verbal Communication| Restating

32. You are working with a client who is in a doctoral program in graduate school and is thinking of dropping out of school. You use therapeutic communication techniques. Which of the following client behaviors would be the BEST indication that your interventions were helpful?
a. discusses the intense fear experienced while in graduate school
b. discusses preparatory plans to ace working on the doctorate
c. states that since being hospitalized, things are going better
d. decides to withdraw from graduate school

ANS: A
The nurses interventions have been helpful if the evaluation of the clients communication determines that the client is able to discuss fears experienced while in graduate school. The other options would not indicate that the client has addressed factors causing the emotional state.

PTS: 1 DIF: Analysis REF: Evaluating Communication

33. One of your assigned clients speaks about family members, indicating that the members are highly educated with advanced doctorate and medical degrees. The client states, I can never measure up to them. The nurses BEST reply would be:
a. You are just as smart as your family.
b. Maybe you are just more sensitive than they are.
c. What are some of the things that you have accomplished?
d. What would someone have to do to measure up?

ANS: D
The best reply by the nurse would be to ask, What would someone have to do to measure up? The nurse would be using the therapeutic communication technique of focusing. Focusing is when the nurse directs the conversation to focus on a topic of particular importance to the client. Here, the nurse asks questions about one theme that has emerged during the interaction with the client.

PTS: 1 DIF: Application
REF: Part 1: Communication| Verbal Communication| Focusing

34. Clients may protect themselves psychologically by the extraordinary use of defense mechanisms. This need for protection is MOST frequently associated with which of the following conditions?
a. affection
b. anxiety
c. frustration
d. conflict

ANS: B
Defense mechanisms are unconscious responses used by persons to protect themselves from internal conflicts and external stress, which create anxiety. When the defense mechanism is used, the clients anxiety is reduced.

PTS: 1 DIF: Comprehension
REF: Part 1: Communication| Defense Mechanisms

35. Which of the following comments is an example of directing a conversation to explore a topic in depth?
a. Are you saying that you want to move out of your apartment?
b. Have you ever considered attending a weekly self-help group?
c. Lets go back to the situation where you felt uncomfortable in class.
d. Hmmm, I see.

ANS: C
The best example would be for the nurse to say, Lets go back to the situation where you felt uncomfortable in class. The nurse would be using the therapeutic communication technique of focusing. Focusing is when the nurse directs the conversation to focus on a topic of particular importance to the client. Here, the nurse asks questions about one theme that has emerged during the interaction with the client.

PTS: 1 DIF: Analysis
REF: Part 1: Communication| Verbal Communication| Focusing

36. A new psychiatric nurse is concerned about maintaining appropriate boundaries in relationships with clients. Which of the following BEST reflects an appropriate outcome for the nurse-client relationship? The nurse will:
a. set rigid boundaries with all clients
b. establish a close friendly relationship with all clients
c. share personal beliefs with selected clients
d. establish a warm, caring relationship with clients

ANS: D
The outcome reflective of appropriate boundaries would focus on the nurses ability to establish a warm, caring relationship with the client. Setting rigid boundaries, developing a close friendship, or sharing personal beliefs are not professional behaviors and would violate boundary issues.

PTS: 1 DIF: Application REF: Part 3: The Nurse-Client Relationship

37. The nurse is writing a process recording of an interaction with a client. The nurse records the exchange that follows. Client: My brother is such a mean person. He never has anything nice to say about me, and is always complaining that I cant do anything right. He says Im a loser. Nurse: I know what you mean. My sister is always trying to tell me how to run my life, and it really gets me upset. Sometimes I could just scream. Analysis of the preceding exchange indicates that the nurses part in the interaction is:
a. an effective use of active listening skills to build the relationship
b. an offer of self as a positive role model for interactions
c. incorporating reflection as a therapeutic communication technique
d. an inappropriate use of self-disclosure

ANS: D
The nurses discussion of her own sister is an inappropriate use of self-disclosure. The nurse has neglected to explore further the clients feelings regarding comments made to the client by her brother. The focus of the conversation should have remained on the client.

PTS: 1 DIF: Analysis REF: Evaluating Communication

38. When working with a client who describes his father as saying to him, Youre dumb, and Youre just a loser, which of the following statements would be a therapeutic response to the clients comments?
a. A loser? In what way are you a loser?
b. How dont you do things right?
c. What would you rather he tell you?
d. You sound like you are really upset by what he says.

ANS: D
The most therapeutic response by the nurse would be to say, You sound like you are really upset by what he says. In this situation the nurse is using reflection as a therapeutic communication technique. The nurse is reflecting on the clients statement that the father called him dumb and a loser. Reflection is powerful tool to bring out important aspects of the clients feelings and to put them in the context when and where they occur.

PTS: 1 DIF: Application
REF: Part 1: Communication| Verbal Communication| Reflection

39. Many nursing diagnoses in the human response patterns:
a. evaluate the quality of care
b. determine whether the client is in danger
c. rely on the clients subjective evidence
d. evaluate the nurse-client communication process

ANS: C
Many nursing diagnoses in the human response patterns rely on the clients subjective evidence. This type of data cannot be directly assessed by the nurse through direct observation or any physical technique. Subjective data are statements made by the client regarding issues related to health and illness. For example, a client may state that he or she feels unable to cope with life or is having severe pain.

PTS: 1 DIF: Comprehension
REF: Part 2: Nursing Process| Steps of the Nursing Process| Nursing Diagnosis

40. During an individual session with a client, the nurse states, You say you are upset about the number of fights your son has been involved in, but you smile as you say so and you brag about your son being known as a tough guy. Which therapeutic communication technique is the nurse using?
a. confrontation c. reflection
b. informing d. focusing

ANS: A
The nurse is using confrontation. Confrontation is communication that points out inconsistencies between feelings, thoughts, and actions. Used correctly, confrontation encourages the client to explore maladaptive behavior. To use confrontation as a therapeutic tool, the nurse must use a friendly but firm approach and recognize that a client may deny or become angry with the suggestion that something in his or her life is inconsistent.

PTS: 1 DIF: Application
REF: Part 1: Communication| Verbal Communication| Confrontation

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