Module 3 Exam
1.ID: 9477081360
The mother of a 3-year-old child tells the nurse that her child hit her doll after the mother
scolded her for picking the neighbors’ flowers. Which defense mechanism used by the
child does the nurse identify in the mother’s report?
· Displacement Correct
· Sublimation
· Identification
· Projection
Rationale: The defense mechanism of displacement involves the discharge of intense
feelings for one person onto a substitute person or object that is less threatening to satisfy
an impulse. Projection involves attributing an attitude, behavior, or impulse, such as that
which occurs in blaming or scapegoating, to someone else. Sublimation is the act of
rechanneling an impulse into a more socially acceptable object. Identification involves
modeling behavior after someone else's.
2.ID: 9477084316
A client says to the nurse, “I’ve been following my diet and taking my medication. What
else do you want to talk about today?” Which response would be most helpful during the
working phase of the therapeutic alliance?
· “Some people have added exercise to diet and medication therapy and gotten
positive results. Do you think that this would work for you?” Correct
· “Sounds fine to me. Let’s meet again in 6 months.”
· “Well, you’ve talked about diet in your terms, but perhaps I should test you on
specific things.”
· “I don’t believe that you have been following your diet, because you haven’t lost
any weight.”
Rationale: Although suggestion or overt giving of advice is sometimes nontherapeutic,
these strategies are therapeutic when used in the working phase, because in this situation
they will increase the client’s perception of all available options in the treatment plan.
Answering, “Sounds fine to me. Let’s meet again in 6 months” stops the communication
process. Stating to the client that he or she has not lost any weight implies disbelief and
does not explore the reasons for the client’s failure to lose weight. “Testing” challenges
the client and is nontherapeutic.
Test-Taking Strategy: Note the strategic word “most” and remember therapeutic
communication techniques. Noting the words “working phase” in the question will direct
you to the correct option. Review: therapeutic communication techniques .
3.ID: 9477084348
,As the nurse prepares to interview a client being admitted to the mental health unit, the
client says, “I asked my family to bring me in here to talk to someone, but now I don’t
know where to begin.” Which response by the nurse would be most helpful?
· “Perhaps you can start by sharing some of your most recent concerns.” Correct
· “Don’t worry. Everyone who comes in here for the first time feels reluctant to
talk.”
· “Why not just start talking and see where it takes you?”
· “If I were you, I’d begin with what you were doing this morning.”
Rationale: The intake interview is usually the first contact with the client. It is intended to
establish rapport, to help the nurse understand the client’s current problem and level of
functioning, and to help the nurse formulate a nursing care plan. The clinician usually
allows the client to set the pace of the interview and uses open-ended questions to elicit a
comprehensive diagnostic picture of the client’s problems and level of coping. Sharing
concerns is a good place to start the conversation, because it will allow the client to
express feelings. The response “Why not just start talking and see where it takes you?” is
too general and does not provide the client with a focus on self. Telling the client not to
worry is nontherapeutic and avoids addressing the client’s concerns.
Test-Taking Strategy: Note the strategic word “most.” Use your knowledge of therapeutic
communication techniques. Focusing on the client’s feelings will direct you to the correct
option. Review: therapeutic communication techniques .
4.ID: 9477092800
During a mental health intake interview, a young adult client who lives with his family
rent free says, “I’m tired of not being able to offer my friends a beer just because my
folks don’t believe in taking a drink socially.” Which nursing response would be
therapeutic?
· “You tell me you live rent free, yet you expect the same privileges as an adult who
supports the household?”
· “It seems that your parents expect you to follow their rules when you live under
their roof.” Correct
· “Well, if you directly discussed your concerns with them, I guess it’s a case of
‘When in Rome, do as the Romans do.’”
· “Well, I guess you could move out and live on your own if you wanted to.”
Rationale: The therapeutic nursing response uses reflection, in which the nurse directs
the content of the client’s message back for the client to review from a new perspective.
This technique also includes an element of focusing on the crux of the issue — in this
case, that it is his parents’ home and they set the rules for living in their home, just as he
someday will in his. Telling the client to move out is giving advice or suggestions to the
client prematurely. Although this technique can be useful in the working phase, it is
usually nontherapeutic when the nurse needs to promote client understanding and self-
exploration. Stating, “You tell me you live rent free, yet you expect the same privileges as
,an adult who supports the household?” is judgmental and poorly timed in that it
humiliates the client unnecessarily. The client has acknowledged that he pays no rent, so
there is no helpful purpose in reemphasizing this fact. Stating, “Well, if you directly
discussed your concerns with them, I guess it’s a case of ‘When in Rome, do as the
Romans do.’” is nontherapeutic in that it offers a cliché and expresses hopelessness and
powerlessness, two emotions that the client is no doubt already experiencing.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques.
This will direct you to the correct option, the nursing response that focuses on the client’s
concerns and feelings. Review: therapeutic communication techniques .
5.ID: 9477089705
The nurse developing a plan of care for a client whose spouse recently died determines
the client has a problem with dysfunctional grieving. Which priority intervention does the
nurse incorporate into the plan?
· Obtaining a health care provider’s prescription for an antidepressant
· Assisting the client in resolving the grief through emotional, cognitive, and
behavioral means
· Assessing the client’s risk for violence toward self and others health care provider
Correct
· Monitoring the client’s sleep pattern
Rationale: The priority intervention for a client with dysfunctional grieving is assessing
the client’s risk for violence toward self and others. Although the nurse will assist the
client in resolving the grief and will monitor the client’s sleep pattern, these are not
priorities in the list of options given. Obtaining a health care provider’s prescription for
an antidepressant is not a priority. In fact, chemical dependency can present a barrier to
the client’s goal attainment.
Test-Taking Strategy: Use the steps of the nursing process. Both monitoring the client’s
sleep pattern and assessing the client’s risk for violence toward self and others involve
assessment. From these options, select the one that addresses the safety of the client.
Review: interventions for a client with dysfunctional grieving .
6.ID: 9477084360
A client in the mental health unit tells the nurse, “My husband makes all the decisions
about money, but I’m the one who’s making the money now, not him. He needs to back
off, but he’s always directing every decision we make.” Which nursing response would
be the most therapeutic?
· “Have you told your husband to back off”?
· “How do you feel the money decisions could best be handled in your household?”
Correct
· “You seem frustrated with your husband’s habit of controlling financial
decisions.”
· “You’re making the most money, so the decisions should be left to you.”
, Rationale: The therapeutic nursing response is the one that provides a broad opening or
statement and is focused on the client’s feelings. In this response, the nurse will be able to
assess what the client believes concerning family financial decision-making. Asking,
“Have you told your husband to ‘back off’?” is improperly paraphrasing the client and
assumes that the client’s stance is correct. Stating, “You’re making the most money, so
decisions should be left to you,” is inappropriate restating and provides an opinion; this
response may be seen by the client as reassurance that her interpretation is being judged
correct. When stating, “You seem to feel frustrated….,” the nurse is sharing perceptions,
which may appear to be challenging to the client when used in this context.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques.
Remember to focus on the client’s feelings and to provide the client the opportunity to
communicate. This will direct you to the correct option. Review: therapeutic
communication techniques .
7.ID: 9477084328
The nurse is developing a plan of care for a client who recently received a diagnosis of
acquired immunodeficiency syndrome and is experiencing difficulty adjusting to the
illness. Which action is an inappropriate intervention for this client?
· Monitoring the client for signs of self-harm
· Helping the client verbalize concerns related to fear
· Discouraging social networking to prevent the spread of infection Correct
· Assisting the client with problem-solving and decision-making
Rationale: In planning care for a client experiencing difficulty in adjusting to an illness,
the nurse develops interventions to promote (not discourage) social networking that will
provide needed information to the client. The other options are appropriate interventions.
Test-Taking Strategy: Note the strategic word “inappropriate.” Recalling that social
support is important will direct you to the correct option. Also, note the relationship
between the word “inappropriate” in the question and “discouraging” in the correct
option. Review: interventions for a client experiencing difficulty in adjusting to an
illness.
Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp.
483, 484). St. Louis: Mosby.
8.ID: 9477084366
How does a client who has lost a spouse show that she is successfully completing the
tasks of mourning? Select all that apply.
· Placing a picture of her husband on the bedside stand Correct
· Purchasing a smaller car she is comfortable driving Correct
· Heard explaining to family that illness “took” her husband
Correct
· Relating that its better “he went first”
1.ID: 9477081360
The mother of a 3-year-old child tells the nurse that her child hit her doll after the mother
scolded her for picking the neighbors’ flowers. Which defense mechanism used by the
child does the nurse identify in the mother’s report?
· Displacement Correct
· Sublimation
· Identification
· Projection
Rationale: The defense mechanism of displacement involves the discharge of intense
feelings for one person onto a substitute person or object that is less threatening to satisfy
an impulse. Projection involves attributing an attitude, behavior, or impulse, such as that
which occurs in blaming or scapegoating, to someone else. Sublimation is the act of
rechanneling an impulse into a more socially acceptable object. Identification involves
modeling behavior after someone else's.
2.ID: 9477084316
A client says to the nurse, “I’ve been following my diet and taking my medication. What
else do you want to talk about today?” Which response would be most helpful during the
working phase of the therapeutic alliance?
· “Some people have added exercise to diet and medication therapy and gotten
positive results. Do you think that this would work for you?” Correct
· “Sounds fine to me. Let’s meet again in 6 months.”
· “Well, you’ve talked about diet in your terms, but perhaps I should test you on
specific things.”
· “I don’t believe that you have been following your diet, because you haven’t lost
any weight.”
Rationale: Although suggestion or overt giving of advice is sometimes nontherapeutic,
these strategies are therapeutic when used in the working phase, because in this situation
they will increase the client’s perception of all available options in the treatment plan.
Answering, “Sounds fine to me. Let’s meet again in 6 months” stops the communication
process. Stating to the client that he or she has not lost any weight implies disbelief and
does not explore the reasons for the client’s failure to lose weight. “Testing” challenges
the client and is nontherapeutic.
Test-Taking Strategy: Note the strategic word “most” and remember therapeutic
communication techniques. Noting the words “working phase” in the question will direct
you to the correct option. Review: therapeutic communication techniques .
3.ID: 9477084348
,As the nurse prepares to interview a client being admitted to the mental health unit, the
client says, “I asked my family to bring me in here to talk to someone, but now I don’t
know where to begin.” Which response by the nurse would be most helpful?
· “Perhaps you can start by sharing some of your most recent concerns.” Correct
· “Don’t worry. Everyone who comes in here for the first time feels reluctant to
talk.”
· “Why not just start talking and see where it takes you?”
· “If I were you, I’d begin with what you were doing this morning.”
Rationale: The intake interview is usually the first contact with the client. It is intended to
establish rapport, to help the nurse understand the client’s current problem and level of
functioning, and to help the nurse formulate a nursing care plan. The clinician usually
allows the client to set the pace of the interview and uses open-ended questions to elicit a
comprehensive diagnostic picture of the client’s problems and level of coping. Sharing
concerns is a good place to start the conversation, because it will allow the client to
express feelings. The response “Why not just start talking and see where it takes you?” is
too general and does not provide the client with a focus on self. Telling the client not to
worry is nontherapeutic and avoids addressing the client’s concerns.
Test-Taking Strategy: Note the strategic word “most.” Use your knowledge of therapeutic
communication techniques. Focusing on the client’s feelings will direct you to the correct
option. Review: therapeutic communication techniques .
4.ID: 9477092800
During a mental health intake interview, a young adult client who lives with his family
rent free says, “I’m tired of not being able to offer my friends a beer just because my
folks don’t believe in taking a drink socially.” Which nursing response would be
therapeutic?
· “You tell me you live rent free, yet you expect the same privileges as an adult who
supports the household?”
· “It seems that your parents expect you to follow their rules when you live under
their roof.” Correct
· “Well, if you directly discussed your concerns with them, I guess it’s a case of
‘When in Rome, do as the Romans do.’”
· “Well, I guess you could move out and live on your own if you wanted to.”
Rationale: The therapeutic nursing response uses reflection, in which the nurse directs
the content of the client’s message back for the client to review from a new perspective.
This technique also includes an element of focusing on the crux of the issue — in this
case, that it is his parents’ home and they set the rules for living in their home, just as he
someday will in his. Telling the client to move out is giving advice or suggestions to the
client prematurely. Although this technique can be useful in the working phase, it is
usually nontherapeutic when the nurse needs to promote client understanding and self-
exploration. Stating, “You tell me you live rent free, yet you expect the same privileges as
,an adult who supports the household?” is judgmental and poorly timed in that it
humiliates the client unnecessarily. The client has acknowledged that he pays no rent, so
there is no helpful purpose in reemphasizing this fact. Stating, “Well, if you directly
discussed your concerns with them, I guess it’s a case of ‘When in Rome, do as the
Romans do.’” is nontherapeutic in that it offers a cliché and expresses hopelessness and
powerlessness, two emotions that the client is no doubt already experiencing.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques.
This will direct you to the correct option, the nursing response that focuses on the client’s
concerns and feelings. Review: therapeutic communication techniques .
5.ID: 9477089705
The nurse developing a plan of care for a client whose spouse recently died determines
the client has a problem with dysfunctional grieving. Which priority intervention does the
nurse incorporate into the plan?
· Obtaining a health care provider’s prescription for an antidepressant
· Assisting the client in resolving the grief through emotional, cognitive, and
behavioral means
· Assessing the client’s risk for violence toward self and others health care provider
Correct
· Monitoring the client’s sleep pattern
Rationale: The priority intervention for a client with dysfunctional grieving is assessing
the client’s risk for violence toward self and others. Although the nurse will assist the
client in resolving the grief and will monitor the client’s sleep pattern, these are not
priorities in the list of options given. Obtaining a health care provider’s prescription for
an antidepressant is not a priority. In fact, chemical dependency can present a barrier to
the client’s goal attainment.
Test-Taking Strategy: Use the steps of the nursing process. Both monitoring the client’s
sleep pattern and assessing the client’s risk for violence toward self and others involve
assessment. From these options, select the one that addresses the safety of the client.
Review: interventions for a client with dysfunctional grieving .
6.ID: 9477084360
A client in the mental health unit tells the nurse, “My husband makes all the decisions
about money, but I’m the one who’s making the money now, not him. He needs to back
off, but he’s always directing every decision we make.” Which nursing response would
be the most therapeutic?
· “Have you told your husband to back off”?
· “How do you feel the money decisions could best be handled in your household?”
Correct
· “You seem frustrated with your husband’s habit of controlling financial
decisions.”
· “You’re making the most money, so the decisions should be left to you.”
, Rationale: The therapeutic nursing response is the one that provides a broad opening or
statement and is focused on the client’s feelings. In this response, the nurse will be able to
assess what the client believes concerning family financial decision-making. Asking,
“Have you told your husband to ‘back off’?” is improperly paraphrasing the client and
assumes that the client’s stance is correct. Stating, “You’re making the most money, so
decisions should be left to you,” is inappropriate restating and provides an opinion; this
response may be seen by the client as reassurance that her interpretation is being judged
correct. When stating, “You seem to feel frustrated….,” the nurse is sharing perceptions,
which may appear to be challenging to the client when used in this context.
Test-Taking Strategy: Use your knowledge of therapeutic communication techniques.
Remember to focus on the client’s feelings and to provide the client the opportunity to
communicate. This will direct you to the correct option. Review: therapeutic
communication techniques .
7.ID: 9477084328
The nurse is developing a plan of care for a client who recently received a diagnosis of
acquired immunodeficiency syndrome and is experiencing difficulty adjusting to the
illness. Which action is an inappropriate intervention for this client?
· Monitoring the client for signs of self-harm
· Helping the client verbalize concerns related to fear
· Discouraging social networking to prevent the spread of infection Correct
· Assisting the client with problem-solving and decision-making
Rationale: In planning care for a client experiencing difficulty in adjusting to an illness,
the nurse develops interventions to promote (not discourage) social networking that will
provide needed information to the client. The other options are appropriate interventions.
Test-Taking Strategy: Note the strategic word “inappropriate.” Recalling that social
support is important will direct you to the correct option. Also, note the relationship
between the word “inappropriate” in the question and “discouraging” in the correct
option. Review: interventions for a client experiencing difficulty in adjusting to an
illness.
Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp.
483, 484). St. Louis: Mosby.
8.ID: 9477084366
How does a client who has lost a spouse show that she is successfully completing the
tasks of mourning? Select all that apply.
· Placing a picture of her husband on the bedside stand Correct
· Purchasing a smaller car she is comfortable driving Correct
· Heard explaining to family that illness “took” her husband
Correct
· Relating that its better “he went first”
