HESI EXTRA CREDIT HESI MODULE 3 – MENTAL HEALTH CONCEPTS | 2022 LATEST UPDATE

HESI EXTRA CREDIT HESI MODULE 3 – MENTAL HEALTH CONCEPTS 1. Questions 1. 1.ID: 0 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? A. Projection B. Sublimation C. Displacement Correct D. Identification Awarded 1.0 points out of 1.0 possible points. 2. 2.ID: 6 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? A. “Sounds fine to me. Let’s meet again in 6 months.” B. “I don’t believe that you have been following your diet, because you haven’t lost any weight.” C. “Well, you’ve talked about diet in your terms, but perhaps I should test you on specific things.” D. “Some people have added exercise to diet and medication therapy and gotten positive results. Do you think that this would work for you?” Correct Awarded 1.0 points out of 1.0 possible points. 3. 3.ID: 8 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? A. “Why not just start talking and see where it takes you?” B. “If I were you, I’d begin with what you were doing this morning.” C. “Perhaps you can start by sharing some of your most recent concerns.” Correct D. “Don’t worry. Everyone who comes in here for the first time feels reluctant to talk.” Awarded 1.0 points out of 1.0 possible points. 4. 4.ID: 0 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? A. “Well, I guess you could move out and live on your own if you wanted to.” B. “It seems that your parents expect you to follow their rules when you live under their roof.” Correct C. “You tell me you live rent free, yet you expect the same privileges as an adult who supports the household?” D. “Well, if you directly discussed your concerns with them, I guess it’s a case of ‘When in Rome, do as the Romans do.’” Awarded 1.0 points out of 1.0 possible points. 5. 5.ID: 5 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? A. Monitoring the client’s sleep pattern B. Assessing the client’s risk for violence toward self and others health care provider Correct C. Obtaining a health care provider’s prescription for an antidepressant D. Assisting the client in resolving the grief through emotional, cognitive, and behavioral means Awarded 1.0 points out of 1.0 possible points. 6. 6.ID: 0 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? A. “Have you told your husband to back off”? B. “You’re making the most money, so the decisions should be left to you.” C. “How do you feel the money decisions could best be handled in your household?” Correct D. “You seem frustrated with your husband’s habit of controlling financial decisions.” Awarded 1.0 points out of 1.0 possible points. 7. 7.ID: 8 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? A. Monitoring the client for signs of self-harm B. Helping the client verbalize concerns related to fear C. Assisting the client with problem-solving and decision-making D. Discouraging social networking to prevent the spread of infection Correct Awarded 1.0 points out of 1.0 possible points. 8. 8.ID: 6 How does a client who has lost a spouse show that she is successfully completing the tasks of mourning? Select all that apply. A. Relating that its better “he went first” B. Reporting that sleeping alone is so hard now C. Purchasing a smaller car she is comfortable driving D. Placing a picture of her husband on the bedside stand Correct E. Heard explaining to family that illness “took” her husband Correct Awarded 4.0 points out of 4.0 possible points. 9. 9.ID: 8 The psychiatric nurse is caring for a 15-year-old girl who has been hospitalized for bipolar disorder. The client tells the nurse that she had her hair styled just like her young math teacher, whom she admires. Which defense mechanism should the nurse recognize that the client is using? A. Projection B. Regression C. Identification Correct D. Intellectualization Awarded 1.0 points out of 1.0 possible points. 10. 10.ID: 2 The mental health home care nurse says to the client, “Do you feel ready to try attending a group session at the clinic?” The client shakes his head. Which nursing statement would be therapeutic? A. “No? Why not?” B. “You seem to be saying no. Would you tell me more about your reluctance?” Correct C. “OK, but I hope you will let me know when you feel ready to attend a group session at the clinic.” D. “Perhaps a group session would be too overwhelming for you right now. How about just seeing me?” Awarded 1.0 points out of 1.0 possible points. 11. 11.ID: 0 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 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? A. “Boys who are cared for only by their moms are at highest risk for violent behavior.” B. “There is quite a bit that you can do. Let’s talk about what you’re already doing first.” Correct C. “Do you know all of your son’s friends, or is he left alone after school because you work?” D. “Many young people die of gunshots every day in this country, so your son’s behavior is unacceptable.” Awarded 1.0 points out of 1.0 possible points. 12. 12.ID: 0 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? A. “Your health care providerhealth care provider feels that your body is physically ready to make the change in medication.” B. “I think you need to listen to your health care provider health care providerwhen it comes to taking such strong medication.” C. “Well, your health care provider is concerned that you will become physically dependent on the first painkiller.” D. “Perhaps if I medicate you about a half-hour before you plan to start your daily activities, the medicine will be more effective.” Correct Awarded 1.0 points out of 1.0 possible points. 13. 13.ID: 0 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? A. “Have you shared your feelings with your wife?” Correct B. “You seem to feel that a less prestigious job would be humiliating for you.” C. “Oh, I agree with you. Let her get another job if she needs that much money.” D. “How soon will you be able to find work? If this is permanent, you may need to swallow your pride.” Awarded 1.0 points out of 1.0 possible points. 14. 14.ID: 8 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? A. “Oh, me too. I always pick the worst kind of men, so I know just how you feel.” B. “Divorce is more difficult for children. Maybe you should focus on them for now.” C. “You’ve been unfortunate, but you seem to be focusing on yourself and what you have to do.” D. “You talk about how the divorces affected you. Tell me how your children are dealing with the loss.” Correct Awarded 1.0 points out of 1.0 possible points. 15. 15.ID: 2 A client says to the nurse, “What does my psychiatrist mean when she says that my illness is biologically based?” Which nursing statement would be the most informative? A. “Mental illness always has its roots in the family.” B. “Mental illness is a result of environmental factors.” C. “Today we know that all mental illness is genetically inherited.” D. “There are many possible physical causes of mental illness, and they include problems in the brain.” Correct Awarded 1.0 points out of 1.0 possible points. 16. 16.ID: 7 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? A. “You seem to be feeling very troubled.” Correct B. “You are working to get better, but you’re worrying about things that aren’t going to happen.” C. “You seem to be feeling very powerless right now, yet you’re getting better, so why worry about what won’t happen?” D. “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.” 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. Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care (p. 82). St. Louis: Saunders. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Giddens Concepts: Clincal Judgment, Communication HESI Concepts: Clinical Decision-Making/Clinical Judgment, Communication Awarded 1.0 points out of 1.0 possible points. 17. 17.ID: 0 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? A. Denial Correct B. Psychosis C. Delusions D. Displacement Awarded 1.0 points out of 1.0 possible points. 18. 18.ID: 6 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? A. Teaching the client’s wife to write down her thoughts and feelings and to read them to her husband B. Saying to the client, “It sounds to me like your wife is truly comfortable and doesn’t want you to worry needlessly” C. Talking with both the client and his wife about the importance of expressing their feelings and how to do it in healthy ways Correct D. Talking with all family members, including the daughter, about the importance of expressing their concerns and feelings to the dying client Awarded 1.0 points out of 1.0 possible points. 19. 19.ID: 0 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? A. “I wonder why you left your wife and children.” B. “What would you expect your wife and children to do? They didn’t leave you.” C. “You seem to be very angry about carrying out your responsibility to your children.” D. “Do you feel that child support is designed to help children, not punish spouses who leave?” Correct Awarded 1.0 points out of 1.0 possible points. 20. 20.ID: 6 A survivor of a nightclub fire that killed more than 100 people says to the nurse, “It should have been me. How come I got out and they didn’t?” Which response by the nurse is appropriate? A. “I don’t know what to say. It was a terrible fire. I’m so sorry this happened.” B. “It seems that you’re blaming yourself for something that was beyond your control.” Correct C. “It seems to me that you’re making this all about you when many people died in that fire.” D. “You should be thankful that you’re a survivor. The victims and their families lost, not you.” Awarded 1.0 points out of 1.0 possible points. 21. 21.ID: 8 In planning the care of a client dying of cancer, the nurse seeks to have the client verbalize acceptance of his impending death. Which statement indicates to the nurse that this goal has been met? A. “I’d like to have my family here when I die.” Correct B. “I’ll be ready to die once my daughter gets married.” C. “I want to go to my family reunion; then I’ll be ready to die.” D. “I just want to live to see my grandchildren graduate from college.” Awarded 1.0 points out of 1.0 possible points. 22. 22.ID: 8 A client says to the nurse at the mental health clinic, “My husband and sister-in- law both have terminal illnesses, and my family thinks that because I’m a nurse I should be able to handle everything.” Which nursing response would be therapeutic? A. “Are you saying you are overly involved and will need to emotionally distance yourself to be therapeutic for your family?” B. “Shame on them for expecting so much from you. Perhaps we need to schedule a family meeting so I can help you set them straight.” C. “I’m sorry to hear that your loved ones are so ill. As a nurse, you should be able to assist them by using your professional expertise. Perhaps that’s what your family expects from you.” D. “You’ve seen your loved ones dealing with some troubling events recently. Sounds as if you feel that your family expects more from you than from others in the family because you’re a nurse.” Correct Awarded 1.0 points out of 1.0 possible points. 23. 23.ID: 6 A 79-year-old client, recently widowed, says to the nurse, “My wife kept up our condominium single-handedly, and now my kids expect me to cook and clean for myself. I’m not lazy, but I don’t know how to cook and I’ve burnt myself twice just frying up what was supposed to be bacon and eggs. I’m so frustrated and I’ve already lost 10 lb (4.5 kg) this month. Which initial nursing statement should the nurse make to the client? A. “I’m calling the doctor immediately to obtain a homemaker for you!” B. “Seems as if you feel lost without your wife and maybe a bit ignored by your children.” Correct C. “First things first. What are you doing eating bacon and eggs? That’s not a good meal for you.” D. “Meals-on-Wheels can help you minimize the frustration you are having cooking. Are you a member of the local senior center?” Awarded 1.0 points out of 1.0 possible points. 24. 24.ID: 4 A health care provider (HCP) tells a client that she has cancer, that her illness is terminal, and that she has a 6-month prognosis. After the health care providerHCP leaves the client’s room, which therapeutic statement should the nurse make to the client? A. “I am so sorry about this. You are my favorite client, and I will take good care of you.” B. “What did your HCP tell you about your condition? Can you tell me what you’re thinking about?” Correct C. “Do you have any questions about what is happening with you? I can assure you that I will do everything I can to help minimize your pain.” D. “Do you want me to get the phone so you can talk to your loved ones, or do you have questions for me about what’s happening with you?” Awarded 1.0 points out of 1.0 possible points. 25. 25.ID: 0 The wife of a client who is dying says to the nurse, “I am able to take off the 6 months from work our doctor feels that my husband will live, but what if he lives beyond that time?” Which therapeutic response should the nurse make? A. “Only you and your husband can determine how you should best allocate your work leave.” B. “Your husband has managed to be active up to now, so he could live longer than predicted, but his actual lifespan remains unclear.” C. “Are there other options for you in taking work leave? Perhaps you could simply reduce your work hours at first so that you can extend your compassionate leave.” Correct D. “Why not write down the pros and cons of taking work leave all at once and any other options and then decide with your husband and family which would be most helpful?” Rationale: In end-of-life nursing care, the caregiver is often asked, “How long?” or “What should I do?” by family members and the dying clients themselves. The nurse can convey information and make limited but realistic predictions, such as presenting the client’s stable or deteriorating physiological condition. Discussing options and alternative solutions with the family that can be added to the process of decision-making can be helpful. Simple alternatives can be used as examples if the family or client seems unable to begin to problem- solve. By stating, “Only you and your husband can determine how you should best allocate your work leave,” the nurse avoids any discussion with the family member. By stating, “Your husband has managed to be active up to now, so he could live longer than predicted, but his lifespan remains unclear,” the nurse begins to discuss physiological issues but is so vague that in the end the statement offers no support. By stating, “Why not write down the pros and cons of taking work leave all at once and any other options, and then decide with your husband and family which would be most helpful?” the nurse makes suggestions but leaves the family member with little to use for decision-making. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. The correct option is the only option that assesses and explores with the client (the wife). Review: therapeutic communication techniques . References: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 27-31). St. Louis: Mosby. Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care (p. 450). St. Louis: Saunders. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Giddens Concepts: Cellular Regulation, Communication HESI Concepts: Cellular Regulation, Communication Awarded 1.0 points out of 1.0 possible points. 26. 26.ID: 4 The wife of a dying man is ignoring his rapid physiological decline and imminent death. She continues with her usual activities, exhibits inability to remember what others have just told her, and misses important appointments. Which therapeutic statement should the nurse make to the wife? A. “It isn’t unusual for family to suffer from anticipatory grief when a loved one is dying.” Correct B. “I cannot emphasize how much your husband needs you to be there for him right now. He is in the stage of denial.” C. “You will need to concentrate on getting to these appointments on time and write down what everyone says so you will remember.” D. “Can you talk about what’s happening to you right now? Your behavior is not appropriate at this stage of your husband’s illness. You seem to be having sympathy pains for him, like men during their wives’ pregnancies.” Rationale: Anticipatory grief is premourning with specific clinical manifestations. The signs of anticipatory grief include feeling empty and lost, fatigued, and numb. Other behaviors include unreality and disbelief, periods of weeping or rage, a desire to run away from the situation, micromanagement of the client’s care, anger at the caregivers and the dying client, pronounced dependency, and fear. By describing this syndrome as common, the nurse offers understanding and assists the spouse in becoming more aware of her feelings and behaviors. This will free her from guilt and enhance her ability to deal with the situation. In stating, “I cannot emphasize how much your husband needs you to be there for him right now. He is in the stage of denial,” or “You will need to concentrate on making these appointments on time and write down what everyone says so you will remember,” the nurse expresses disapproval of the spouse’s behavior, a nontherapeutic response that will probably cause the client to feel guilty. In stating, “Can you talk about what’s happening to you right now? Your behavior is not appropriate at this stage of your husband’s illness. You seem to be having sympathy pains for him, like men during their wives’ pregnancies,” the nurse demeans the spouse’s behavior and makes a judgmental comment that will probably result in an angry and guilty response from the spouse. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Eliminate the options that are comparable or alike and express disapproval of the spouse’s behavior. Next, eliminate the option that demeans the spouse’s behavior, another nontherapeutic technique. Review: therapeutic communication techniques . References: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 27-31). St. Louis: Mosby. Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care (pp. 448, 449). St. Louis: Saunders. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Giddens Concepts: Cellular Regulation, Communication HESI Concepts: Cellular Regulation, Communication Awarded 1.0 points out of 1.0 possible points. 27. 27.ID: 6 An older adult client who is dying says to the nurse, “My son is 40 years old, but he works in a very poorly paying job and is always borrowing money from me. I don’t know how he’s going to manage without me.” Which response by the nurse would be therapeutic? A. “Could you share your feelings with your son just as you have with me?” Correct B. “Sounds as if your son will never grow up and learn to take care of himself.” C. “Goodness. At 22, I supported myself and never asked my mother for anything.” D. “I wonder why you’re so worried about your adult son when you need to concentrate on you?” Awarded 1.0 points out of 1.0 possible points. 28. 28.ID: 0 The widow of a man who was killed a week ago in a hit-and-run accident while walking the family dog says, “I should have just let the dog run in the backyard or gone with my husband. Our own parish priest hit my husband and finally surrendered to the police. He brought a lawyer with him because he’s worried about himself, not my husband. I hate him so much, my stomach hurts.” Which nursing statement would be therapeutic? A. “Of course you’re angry. Who wouldn’t be? Yet nothing is ever clear cut, is it?” B. “You not only lost your husband but also learned it was at the hands of someone you looked up to.” Correct C. “You’re having stomach pain? You should get checked for an ulcer or other gastric problem.” D. “I wouldn’t blame you if you never entered a church again. This is a terrible thing for the head of a church to do.” Awarded 1.0 points out of 1.0 possible points. 29. 29.ID: 6 A single mother whose only son died 2 months ago says to the nurse, “I’ve been bothered at work with thoughts of my son. Suddenly I’ll think of something awful I said to him years ago or some punishment I gave him because he’d been bad.” Which plan should the nurse include in caregiving? A. Scheduling the client for an appointment with the psychiatrist, because this is a pathological manifestation. B. Calling the health care provider to report that the client is a high risk for suicide and increasing the frequency of visits with the client. C. Seeking emergency certification for the psychiatric inpatient unit at the community hospital because of high lethality concerns and visiting the client daily. D. Explaining that bereaved persons often describe intrusive thoughts of negative experiences with the deceased and then increasing the frequency of nurse-client visits. Correct Awarded 1.0 points out of 1.0 possible points. 30. 30.ID: 4 A client who is a health care provider says to the nurse, after receiving a diagnosis of terminal lung cancer, “All my life I took care of my clients, and now my family is taking care of me.” Which statement is a therapeutic nursing response? A. “Your family is caring for you now.” Correct B. “Well, you’d expect them to care for you, wouldn’t you?” C. “It is an honor for all of us to care for you. We want to help you.” D. “You can look back on so many wonderful people you saved and cared for.” Awarded 1.0 points out of 1.0 possible points. 31. 31.ID: 2 The parents of a 20-year-old who was killed while driving drunk say to the nurse, “We’re so devastated, but we are also angry that she would drink and drive when we told her over and over not to.” Which statement by the nurse would be therapeutic? A. “Young people don’t always obey their parents.” B. “Everyone feels guilt or anger when they lose a loved one.” C. “Does anyone in the family have a drinking or drug problem?” D. “Your sadness over losing your daughter is mixed with anger at her driving while intoxicated.” Correct Awarded 1.0 points out of 1.0 possible points. 32. 32.ID: 8 A nursing student is assigned to work in the emergency department to assist victims after a tornado. The student says to the nurse in charge, “I don’t know how to help these parents. Their son was just decapitated by a flying piece of glass, and they won’t leave him. They did mention that they are Catholic.” Which intervention does the nurse suggest for inclusion in a plan of immediate care for the family? A. Telling the student not to disturb the family until the end of shift B. Calling their family priest immediately to come help them to let their son go C. Asking the emergency department health care provider to join the student in requesting that the family let the nursing staff care for their son D. Joining the family and, after they have been able to be with their son for some time, helping them relinquish their son’s body to the nurses Correct Awarded 1.0 points out of 1.0 possible points. 33. 33.ID: 6 The nurse is caring for a bereaved man with acquired immunodeficiency syndrome who lost his twin brother in a rock-climbing accident a month ago. Which statement by the client should cause the nurse to be concerned? A. “Lately I’ve been feeling that life isn’t that great.” Correct B. “You’d have thought that I would be the one to die first.” C. “I should have made him stay home. He was always clumsy.” D. “I miss him so much. We were close and talked almost daily.” Awarded 1.0 points out of 1.0 possible points. 34. 34.ID: 6 A client whose husband died 2 months ago says to the nurse, “After church, I visit my husband’s grave and talk to him. It comforts me, but my daughter thinks I’m morbid and crazy and is upset with me because I don’t want to meet her for coffee after church like I used to.” Which statement by the nurse would be therapeutic? A. “You need to stop your visits immediately, or your daughter will have you examined for a mental disorder.” B. “Perhaps you could reduce your visits to his grave to once a month and meet your daughter for coffee like you used to.” C. “I think your visits are perfectly normal. After all, you were married for a long time. You’ll stop when the winter weather comes.” D. “Sounds as if you have had difficulty letting your husband go from your life. What would happen if you visited his grave less frequently?” Correct Awarded 1.0 points out of 1.0 possible points. 35. 35.ID: 2 The nurse is talking to a client whose spouse died 10 months ago. Which statement by the client indicates successful mourning? A. “I’m planning a trip to England next fall to tour the mansions and their gardens.” Correct B. “I must confess that I have taken to drinking more than I should at night, but a drink or two helps me to sleep alone in that big house.” C. “My son has taken over managing my money because I got into a little mischief with my charge cards. I’m restricted to one debit card now.” D. “Last night they had to treat me in the emergency department because I swallowed a few too many pills. Lately I’ve felt as if I can’t go on alone.” Awarded 1.0 points out of 1.0 possible points. 36. 36.ID: 8 A 74-year-old widower of 3 months says to the nurse, “When my wife died, I lost my love and my best friend. Everyone I cared about is dead. We both were only children, and we had no kids. I’m more than ready to go when the time comes.” Which nursing response should the nurse make? A. “Are you thinking of ending your life because your time has come?” Correct B. “Did you know that many people live happier lives without children?” C. “It must seem very lonely to you. I can’t believe that you never had any children.” D. “When my dad died, my mother said some of the things you’re saying now, and she had three kids.” Awarded 1.0 points out of 1.0 possible points. 37. 37.ID: 4 The nurse coordinates the use of hospice care to visit a dying client who will be going home with his family. Which is a function of hospice services that the nurse should tell the family? A. Helping the client focus completely on his physical health B. Providing bereavement support to the family after the client’s death Correct C. Helping the family stop the client’s efforts to go out at night with his friends D. Working with the client to sustain hope by talking of recent research breakthroughs regarding his illness Awarded 1.0 points out of 1.0 possible points. 38. 38.ID: 8 A dying client with agoraphobia says to the nurse, “I’ve been unable to leave this house without tremendous effort for so long, and now it doesn’t matter.” Which statement by the nurse would be therapeutic? A. “It doesn’t matter? Can you share your feelings with me?” Correct B. “Your gardens are beautiful now. Would you like to stroll in them after our work?” C. “Did you go through systematic desensitization with your doctor? I understand that it works well.” D. “I know what you mean. I spent more than $2,000 on a dental implant and still wound up with false teeth.” Awarded 1.0 points out of 1.0 possible points. 39. 39.ID: 8 A dying client says to the nurse, “How do I tell my parents that I am dying of AIDS ?” Which statement by the nurse would be therapeutic? A. “Well, isn’t it better that they learn from you than for them to learn on their own?” B. “Sounds as if you’re thinking that it’s time for you to tell your parents about your disease.” Correct C. “I’ve worked with this illness for many years now, and there just doesn’t seem to be an easy way to do this.” D. “Are you saying that your parents don’t know about your illness?” Awarded 1.0 points out of 1.0 possible points. 40. 40.ID: 5 The wife of a victim of a gas explosion says, “It’s not bad enough that I’ve been left alone to care for two children — now the company is denying our claim for compensation and we have to join a class action suit to get my husband’s pension.” Which statement by the nurse would be therapeutic? A. “Get a lawyer! That’s what you all need to do.” B. “Do you believe that a class action suit is the correct thing and that you are in the right?” C. “You’re saying that being left a widow with children is difficult enough, but now you’ve got to fight for your benefits.” Correct D. “Walk away. It’s too much to even think about at your age, and how can you get caught up in all this with children and work, too?” Awarded 1.0 points out of 1.0 possible points. 41. 41.ID: 3 A young widow of 18 months says to the nurse, “I’m going to need a babysitter, because I’m going on a blind date at my brother and sister-in-law’s house. They fixed me up, but I think it may be too soon.” Which statement by the nurse would be therapeutic? A. “Hello? You go girl! You can see it’s only natural, can’t you?” B. “By the end of a year, most people are able to renew their interest in other people and activities.” Correct C. “Nonsense. Your children need a new father, as your family knows. Your husband would want you to go on with life.” D. “If it were me, I would be dating other men by now. After 6 months of mourning, most of society feels that it’s okay.” Rationale: In this question, the widow is seeking confirmation from the nurse that resocialization is acceptable. Giving approval is as nontherapeutic as giving disapproval. Therefore the most therapeutic statement is “By the end of a year, most people are able to renew their interest in other people and activities.” It is natural for the bereaved person to experience renewed interest in people and activities. Successful grieving will release the bereaved from one interpersonal relationship and provide the freedom to form new ones. In stating, “Hello? You go girl! You can see it’s only natural, can’t you?,” the nurse offers a social response that is unprofessional and insensitively belittles the client’s concern. In stating, “Nonsense. Your children need a new father, as your family knows. Your husband would want you to go on with life,” the nurse gives a social response and is insensitive in assuming what her client’s husband would want. By stating, “If it were me, I would be dating other men by now. After 6 months of mourning, most of society feels that it’s okay,” the nurse changes the focus from the client to herself and gives incorrect information, a nontherapeutic communication. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. The correct option is the only option that provides information and support to the client in a professional manner. Review: therapeutic communication techniques . Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 27-31, 299). St. Louis: Mosby. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Giddens Concepts: Communication, Coping HESI Concepts: Communication, Stress and Coping Awarded 1.0 points out of 1.0 possible points. 42. 42.ID: 1 A client who is an attorney says to the clinic nurse, “I’m worried about my wife. She’s been so distant and disorganized since our son died of leukemia 4 months ago. She never suggests that we go out or take our other children anywhere. Is this normal, or do I need to get her to a doctor?” Which statement by the nurse would be therapeutic? A. “Absolutely. It sounds as if she may be experiencing a severe depression.” B. “To be safe, it would not hurt to have her see your family doctor, or maybe you have a member of the clergy she can talk to.” C. “The reluctance to resume activities and overprotect your other children is a normal part of bereavement and will subside in 2 months.” D. “It’s normal, but by the end of a year you can expect that your wife is improving and able to redirect her energy. Have you expressed your concerns to her?” Correct Rationale: The nurse should provide the husband with correct information and let him know that disorganization and a depressive mood usually ease over the course of a year’s bereavement and that loneliness and aimlessness usually peak 6 to 9 months after a death. In stating, “Absolutely. It sounds as if she may be experiencing a severe depression,” the nurse overreacts and offers a pseudodiagnosis. This is nontherapeutic and unprofessional. In stating, “To be safe, it would not hurt to have her see your family doctor, or maybe you have a member of the clergy she can talk to,” the nurse offers a good source of support as a referral, which may be helpful, but it is incorrect to allow the spouse to be concerned. Stating, “The reluctance to resume activities and overprotect your other children is a normal part of bereavement and will subside in 2 months” is a partly correct response, but because depression usually peaks between 6 and 9 months after a death, a component of the option is incorrect. Test-Taking Strategy: Focus on the data in the question and use your knowledge of the grieving process to answer the question. Eliminate the options that would increase the husband’s concern. Also note that the correct option provides accurate information and encourages the husband to express his concerns to his wife. Review: the grieving process. Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 205, 299). St. Louis: Mosby. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Giddens Concepts: Communication, Coping HESI Concepts: Communication, Stress and Coping Awarded 1.0 points out of 1.0 possible points. 43. 43.ID: 2 The young nurse has just completed postmortem care of a 16-year-old client who died of cancer. The nurse says to the nurse manager, “I never get sick, and this client kept telling me that he couldn’t remember not being ill. I feel terrible and so bad for him and about what he went through.” Which statement by the nurse manager would be therapeutic? A. “Next time, take someone else in with you for postmortem care, OK?” B. “Your feelings are normal and will go away after a good night’s sleep.” C. “Let’s go for coffee and talk about this some more, shall we? We’re both due for our coffee breaks.” Correct D. “I should never have assigned you someone so close to your own age. I’ll be more careful in the future.” Rationale: The young nurse is being appropriate in approaching the nurse manager to share these feelings. Strong emotional responses, positive or negative, may indicate countertransference, and the nurse who identifies this phenomenon is correct to encourage expression of feelings. The nurse manager responds empathetically and uses a coffee break to allow the nurse to further explore feelings. This is the therapeutic broad opening of offering self. By stating, “Next time take someone else in with you for postmortem care, OK?” the nurse manager suggests calling for assistance, which is therapeutic, but the nurse manager uses a nontherapeutic approach by not addressing the young nurse’s feelings. By stating, “Your feelings are normal and will go away after a good night’s sleep,” the nurse manager correctly identifies the nurse’s response but then dismisses and minimizes the young nurse’s feelings. In stating, “I should never have assigned you someone so close to your own age. I’ll be more careful in the future,” the nurse manager personalizes the young nurse’s comments and focuses on what the nurse manager can do to problem- solve. This is nontherapeutic and does not facilitate expression of the young nurse’s feelings. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. The correct option is the only option that encourages the client (the young nurse) to express feelings. Review: therapeutic communication techniques . References: Ignatavicius, D., & Workman, M. (2010). Medical-surgical nursing: Patient-centered collaborative care (6th ed., p. 112). St. Louis: Saunders. Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 27- 31). St. Louis: Mosby. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Giddens Concepts: Communication, Coping HESI Concepts: Communication, Stress and Coping Awarded 1.0 points out of 1.0 possible points. 44. 44.ID: 2 The 45-year-old husband of a client with breast cancer who just died says to the nurse, “If our doctor had operated sooner, my wife would be alive now.” Which statement by the nurse would be therapeutic? A. Say nothing. Simply nod and say “Mm-hmm” noncommittally. B. “Sounds as if you’re feeling angry and pretty helpless right now.” Correct C. “Let’s focus not on what was not done but instead on what was done for your wife.” D. “Your doctor did all he could for your wife. You know, health care providers can only apply their best clinical judgment.” Rationale: Anger is not uncommon during the first month of grief and at times throughout the first year after the loss of a loved one. The nurse should not be surprised to hear the bereaved husband displace his anger onto the healthcare providers. The nurse’s use of reflection will help him explore sadness and loss more easily. By saying nothing and simply saying “Mm-hmm” noncommittally, the nurse uses a response that may mislead the bereaved husband to think that the nurse agrees with his displaced anger. Although it may be a therapeutic response, it will not help the husband focus on his feelings. By stating, “Let’s not focus on what was not done, but what was done for your wife,” the nurse uses a social response of distraction and does not facilitate expression of the husband’s feelings. “Your doctor did all he could for your wife. You know, health care providers can only apply their best clinical judgment” is defensive and lecturing. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques and remember to focus on the client’s feelings. This will direct you to the correct option. Review: therapeutic communication techniques . Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 27-31). St. Louis: Mosby. Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care (p. 447). St. Louis: Saunders. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Giddens Concepts: Communication, Coping HESI Concepts: Communication, Grief and Loss Awarded 1.0 points out of 1.0 possible points. 45. 45.ID: 2 During a one-to-one nurse-client session, the client plays with her pack of cigarettes and says, “I just get a couple of DVDs and watch movies so I won’t have to look at my husband or talk to him.” Which coping mechanism does the nurse recognize in the client’s behaviors? A. Self-blame B. Avoidance Correct C. Reframing D. Wishful thinking Awarded 1.0 points out of 1.0 possible points. 46. 46.ID: 4 A 16-year-old client says, “My dad thinks I’m evil, but we get into fights because I let things build up. He never has any time for me because he’s always glued to the TV. He doesn’t even look at me when he talks.” Which statement by the nurse encourages the client to use assertive behavior with his father? A. “So you’re saying that you let your feelings build up and then you just explode?” B. “Have you tried standing in front of the television when your dad is watching it?” C. “What makes you feel that you have the right to fly off the handle just because you feel ignored?” D. "Have you tried saying that directly to your dad? For example, you could say, ‘I notice that you watch television when I’m telling you things that are important to me.’" Correct Awarded 1.0 points out of 1.0 possible points. 47. 47.ID: 2 A client who was formerly a workaholic has lost his job and is being supported financially by his wife. The client says to the nurse, “I know that my wife is disappointed in me, but I can’t seem to get a job doing what I’ve done for 25 years. Why should I take a low-level job when she’s able to support us financially?” Which response by the nurse would be therapeutic? A. “Can you tell me a little more about this?” Correct B. “I would dig ditches if it contributed to my family’s well-being.” C. “Sounds as if you’re lucky to have your wife’s job to fall back on.” D. “I’m surprised that such a hardworking man is not able to find a job.” Awarded 1.0 points out of 1.0 possible points. 48. 48.ID: 4 The psychiatrist notes that a client being admitted to the inpatient mental health unit uses avoidance and denial to cope with stress. Which positive stress response will the nurse plan to focus on when working with the client? A. Reframing B. Locus of control C. Problem-solving Correct D. Use of social supports Awarded 1.0 points out of 1.0 possible points. 49. 49.ID: 4 The husband of a terminally ill client says to the nurse, “My company went bankrupt, my son is a drug addict, my daughter is an alcoholic, and now this! My doctor wants me to try some stress reduction because my blood pressure is up. Whose wouldn’t be? I’ve tried music and relaxation, but they don’t work.” Which statement by the nurse would be therapeutic? A. “Let’s talk more about what has been helpful to you in the past.” Correct B. “Before we talk about stress management, let’s discuss your children.” C. “You have a lot of problems. How long does your wife have to live, and what is her relationship with your children?” D. “Can you afford to pay for therapy sessions? I see that your benefits are pretty much maxed out, and I’d hate to ask you to take on any additional burden.” Rationale: The client is specifically asking the nurse to help him choose stress- management techniques and has already identified two that are not effective for him. Although the nurse will explore the client’s stressors, the problem that is directly harming the client physically is his blood pressure, so the nurse focuses on this first and determines what stress-management strategies have been effective in the past. By stating, “Before we talk about stress management, let’s discuss your children,” the nurse changes the subject, a nontherapeutic communication. By stating, “You have a lot of problems. How long does your wife have to live, and what is her relationship to your children?” the nurse changes the subject and engages in probing, both of which are nontherapeutic actions. “Can you afford to pay for therapy sessions? I see that your benefits are pretty much maxed out, and I’d hate to ask you to take on any additional burden?” is an inappropriately timed and somewhat probing question that changes the subject. Test-Taking Strategy: Eliminate the options that are comparable or alike and change the subject of the client’s concern. Next, note the relationship of the words “I’ve tried music and relaxation, but they don’t work” in the question and the correct option. Review: therapeutic communication techniques and stress management techniques . Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 27-31, 253). St. Louis: Mosby. Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care (p. 40). St. Louis: Saunders. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Awarded 1.0 points out of 1.0 possible points. 50. 50.ID: 6 A young adult client says to the nurse, “All my friends are married and have children. I can’t seem to meet anyone, and I know I’ll never be happy until I meet someone I can care about enough to marry.” Which statement by the nurse would assist the client in reframing the situation? A. “Sounds as if you’re exaggerating your situation and looking only at the half-full glass.” B. “It seems that you measure your life and what you need to do against the behaviors of others.” C. “Aren’t you a little young to be thinking in such negative terms? You do still have plenty of time before your biological clock winds down.” D. “You can’t seem to meet someone that you care about? You can still find enjoyment in friendships, work, books, and other things as well.” Correct Awarded 1.0 points out of 1.0 possible points. 51. 51.ID: 2 The client says to a nurse, “Do you know that after 24 years of marriage I still serve my husband breakfast in bed? After all I do for him, he still doesn’t treat me well. He should treat me better.” Which nursing response is appropriate? A. “You know, you could work and make money serving food to people.” B. “I agree. If you can do all that for your husband, he should treat you better.” C. “It seems that you feel that your husband could treat you well just as you treat him.” Correct D. “Ask your husband to do the things you’d like. If he doesn’t, tell him you’re leaving him.” Awarded 1.0 points out of 1.0 possible points. 52. 52.ID: 8 A client says to the nurse, “My doctor wants me to start keeping a journal every day about what’s happening in my job.” Which response by the nurse is appropriate? A. “You can erase your stresses by identifying things that set off negative physical experiences.” B. “Well, it has always helped me to write down daily happenings and relate them to my stress level.” C. “Yes, that is an excellent suggestion. You need to keep a meticulous diary of your day with all of the details.” D. “Journal-keeping that identifies what seems to cause a strain in a person’s life is a good way of improving one’s health.” Correct Awarded 1.0 points out of 1.0 possible points. 53. 53.ID: 7 A 62-year-old woman says, “Since my husband retired, 4 months ago, he’s started playing golf 24/7, so after rearing our children alone while my workaholic husband ran his business I’m suddenly a golf widow.” Which response by the nurse is appropriate? A. “Do other people call you a golf widow?” B. “Have you shared your feelings with your husband?” Correct C. “‘When you can’t beat ’em, join ’em’ — that’s what I always say. Why not play golf with him?” D. “Some women wish they had your problem. My mother keeps complaining that Dad is always messing around in the house, driving her nuts.” Awarded 1.0 points out of 1.0 possible points. 54. 54.ID: 8 A client’s son and daughter were killed during a fellow student’s murderous rampage at their high school 9 months ago. The client says to the nurse, “My wife and I just feel empty and exhausted. I can’t believe that I had a vasectomy after our son and daughter were born because we wanted to give them both whatever they needed. We have college funds for both of them that they’ll never use now.” The nurse should make which appropriate statement to the client? A. “My parents would be devastated if they lost me and my sister, too. How can I be of service to you?” B. “Your feelings are appropriate for the extent of your loss and how your children’s deaths happened.” C. “Your loss touches me so. How truly devastated you both must be. Can you share what things you have been doing to grieve?” Correct D. “Your loss is incalculable. Perhaps you could consider some ways in which to commemorate their lives for you and in your community.” Rationale: The parents in this question have experienced a truly devastating loss. Although there are no set strategies for this situation, certain actions are important. First, the nurse communicates to the parents that the terrible loss is sad for others and offer empathy. Second, the nurse gathers data about what has happened to the parents over the 9 months since the loss. In stating, “My parents would be devastated if they lost me and my sister, too. How can I be of service to you?” the nurse nontherapeutically uses a social response that personalizes and shifts the focus from their feelings. In stating, “Your feelings are appropriate for the extent of your loss and how their deaths happened,” the nurse lectures and moves away from the parents’ expressed feelings to intellectualize. By stating, “Your loss is incalculable. Perhaps you could consider some ways in which to commemorate their lives for you and in your community,” the nurse is empathetic and then begins to try to guide them toward creating a memorial. There may be a time when the nurse can help the parents reframe what has happened and think of ways to commemorate their children’s lives, but they have not moved to that level of mourning yet, probably because of the nature of their children’s deaths. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. The correct option is the only option that addresses the client’s and his wife’s feelings and encourages sharing. Review: the grief process and therapeutic communication techniques . References: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 27-31). St. Louis: Mosby. Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care (p. 450). St. Louis: Saunders. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Giddens Concepts: Communication, Coping HESI Concepts: Stress and Coping, Grief and Loss Awarded 1.0 points out of 1.0 possible points. 55. 55.ID: 6 The slightly overweight mother of a morbidly obese 11-year-old girl says, “My family health care provider is wild over my daughter’s weight gain. He says she’s not eating correctly and is too sedentary, and now she’s at risk for diabetes. He says the sugar in her blood was up this month. It’s all my fault because I eat the wrong things, too, and I never get off the couch.” Which statement by the nurse would be therapeutic in easing the client’s self-blame? A. “Well, it seems very bleak to you, but your daughter is responsible for her eating and exercising, too.” B. “What about her father? Isn’t it partly his fault, too? I want to meet with you, him, and your daughter tomorrow.” C. “It’s all this fast food and TV-watching these days. If our kids aren’t watching television, they’re playing with their computers.” D. “Your daughter has a serious problem, but there are many successful programs that you can join with her to lose weight and improve your overall lifestyle.” Correct Awarded 1.0 points out of 1.0 possible points. 56. 56.ID: 2 A client says to the nurse, “My doctor tells me that I need to start progressive muscle relaxation(PMR) to ease my stress, but I just can’t get the hang of it.” Which response by the nurse would be most helpful? A. “PMR requires training sessions. Let’s check into classes that you can attend to learn the technique.” Correct B. “I want you to practice it as often as you can. Play soft, soothing music in the background when you practice your exercises.” C. “For it to be effective and produce deep relaxation, the technique requires your complete receptivity to its benefit and your need for it.” D. “I could never master the technique myself, so I understand your frustration. Would you like me to explain its difficulty for you to the doctor?” Awarded 1.0 points out of 1.0 possible points. 57. 57.ID: 8 The nurse is teaching assertiveness training to a client with anger-management issues. Which instruction would the nurse give for helping the client assertively confront someone? A. Emphasize how much you like the person but insist that the other person make the changes you need. B. Tell the person that the behavior has become intolerable for you and that the behavior must be changed immediately. C. Demonstrate that you understand how the other person feels but state that you still expect the other person to make the changes you need. D. Ask for private time to talk and point out the facts without being accusatory, then determine areas of mutual misunderstanding and request the changes you need. Correct Awarded 1.0 points out of 1.0 possible points. 58. 58.ID: 8 A client who recently lost his hand in a workplace accident says to the nurse, “I don’t know how I’m going to support my family with a plastic hand. I might as well be dead.” Which nursing response would be therapeutic? A. “You’re saying that you feel useless without your hand?” Correct B. “Perhaps you need to focus on being happy that you survived.” C. “Don’t worry about all of that at this point. You’re going to be fine.” D. “You’ll never need to worry about work again, because your employer will cover all of your expenses and make a settlement that will support you for life.” Awarded 1.0 points out of 1.0 possible points. 59. 59.ID: 6 A client whose adolescent son committed suicide by hanging himself in the family’s garage says to the nurse, “The coroner just informed us that our son had AIDS.” Which response to the client by the nurse is appropriate? A. “You didn’t know that he had AIDS? How did he see the family health care provider without your knowing?” B. “Your poor son. How troubled he must have been. It’s a shame he couldn’t talk to you and get some help.” C. “Your son had an autopsy because he committed suicide, but the coroner didn’t have to tell you that he was ill.” D. “Your son was keeping a very troubling diagnosis to himself. I am so sorry. No matter how close and loving children are to their parents, some children just aren’t able to confide in their parents.” Correct Awarded 1.0 points out of 1.0 possible points. 60. 60.ID: 2 A recently widowed client says, “I lived my whole life for my husband and children. Now he’s dead and my daughter and son have each married and moved across the country. They hardly ever call or visit. It’s just that there’s really nothing much for me to do.” Which response by the nurse to the client is appropriate? A. “Your children seem very distant. They hardly ever call?” B. “Are you thinking of hurting yourself just because you’re alone?” C. “You’re feeling pretty useless right now, but I wonder if you’ve taken enough time to grieve?” D. “You seem to be identifying some issues in your life that are troubling, and you sound very down right now.” Correct observations, questions about suicidal ideation or plans would be appropriate. The nurse will attempt to reframe the situation with this client, helping her understand that major decisions should not be made until some time has passed and these issues have been effectively resolved. “Your children seem very distant. They hardly ever call?” is nontherapeutic because the nurse is making a premature judgment and offering opinions on the basis of few facts. (The client might describe her children as hardly calling even though they call weekly.) Asking, “Are you thinking of hurting yourself just because you’re alone?” is nontherapeutic because the question is belittling and minimizes the client’s feelings. The lethality assessment is appropriate only after the nurse has clarified the client’s loss. In saying, “You’re feeling pretty useless right now, but I wonder if you’ve taken enough time to grieve?” the nurse prematurely interprets that the client is feeling useless, but that may not be how she feels; it’s important to let her tell the nurse if she can. It is not helpful at this point to tell the client that she hasn’t grieved long enough. Test-Taking Strategy: Focus on the data in the question. The correct option is the only option that addresses the client’s losses and focuses on the client’s feelings. Review: the grief process . References: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th ed., pp. 27-31). St. Louis: Mosby. Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health nursing: A communication approach to evidence-based care (pp. 447, 448). St. Louis: Saunders. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Giddens Concepts: Communication, Development HESI Concepts: Communication, Developmental Awarded 1.0 points out of 1.0 possible points. 61. 61.ID: 4 A 61-year-old client whose two sons and daughter-in-law died in a nightclub fire says to the nurse, “We were going to retire early, but now we are the only ones who can care for our two grandchildren.” Which response by the nurse would be therapeutic? A. “I am sorry you’ve had so many losses.” Correct B. “I lost my nephew in that nightclub fire, so I understand your sorrow.” C. “Your grandchildren sound as if they will give you a ru