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Module 3 Exam: HESI Module 3 Exam: HESI Module 3 Exam: HESI

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Module 3 Exam: HESI Module 3 Exam: HESI Module 3 Exam: HESI 7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1... 519719 1/146 Question 1 1 / 1 pts 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? Projection Sublimation Correct! Correct! Displacement Identification 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. Test-Taking Strategy: Use the process of elimination and knowledge regarding the subject, defense mechanisms. Focusing on the data in the question and the child’s behavior will direct you to the correct option. Review these defense mechanisms if you had difficulty with this question. Cognitive Ability: Understanding Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Question 2 1 / 1 pts7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 2/146 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? “Sounds fine to me. Let’s meet again in 6 months.” “I don’t believe that you have been following your diet because you haven’t lost any weight.” “Well, you’ve talked about diet in your terms, but perhaps I should test you on specific things.” “Some people have added exercise to diet and medication therapy and gotten positive results. Do you think that this would work for you?” Correct! Correct! 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: Use the process of elimination and therapeutic communication techniques. Noting the words “working phase” in the question will direct you to the correct option. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 3/146 Question 3 1 / 1 pts 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? “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.” “Perhaps you can start by sharing some of your most recent concerns.” Correct! Correct! “Don’t worry. Everyone who comes in here for the first time feels reluctant to talk.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 4/146 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: Use your knowledge of therapeutic communication techniques. Focusing on the client’s feelings will direct you to the correct option. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 4 1 / 1 pts 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? “Well, I guess you could move out and live on your own if you wanted to.” “It seems that your parents expect you to follow their rules when you live under their roof.” Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 5/146 “You tell me you live rent free, yet you expect the same privileges as an adult who supports the household?” “Well, if you directly discussed your concerns with them, I guess it’s a case of ‘When in Rome, do as the Romans do.’” 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 selfexploration. 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 if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 6/146 Question 5 1 / 1 pts A nurse is participating in a care planning conference regarding care for a client whose spouse recently died. The registered nurse formulates a nursing diagnosis of dysfunctional grieving. Which priority intervention does the nurse expect to see incorporated into the plan? Monitoring the client’s sleep pattern Obtaining a physician’s prescription for an antidepressant Determining the client’s risk for violence toward self and others Correct! Correct! Assisting the client in resolving the grief through emotional, cognitive, and behavioral means 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 physician’s prescription for an antidepressant is not a priority. Test-Taking Strategy: Use the process of elimination and the steps of the nursing process. Both monitoring the client’s sleep pattern and determining 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 if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 7/146 Question 6 1 / 1 pts 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”? “You’re making the most money, so the decisions should be left to you.” “How do you feel the money decisions could best be handled in your household?” Correct! Correct! “You seem frustrated with your husband’s habit of controlling financial decisions.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 8/146 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 that “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 as correct. By 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 if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 7 1 / 1 pts A nurse is attending a care planning conference for a client who recently received a diagnosis of acquired immunodeficiency syndrome and is experiencing difficulty adjusting to the illness. The nurse should question which planned intervention for this client? Monitoring the client for signs of self-harm Helping the client verbalize concerns related to fear Assisting the client with problem-solving and decision-making7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 9/146 Discouraging social networking to prevent the spread of infection Correct! Correct! 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: Use the process of elimination and note the strategic word “question.” Recalling that social support is important will direct you to the correct option. Also, note the relationship between the word “question” in the question and “discouraging” in the correct option. Review interventions for a client experiencing difficulty in adjusting to an illness if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Planning Content Area: Mental Health Question 8 0.75 / 1 pts How does a client who has lost a spouse show that she is successfully completing the tasks of mourning? Select all that apply. Relating that its better “he went first” Correct! Correct! Reporting that sleeping alone was hard at first Correct! Correct! Purchasing a smaller car she is comfortable driving Correct Answer Correct Answer Heard explaining to family that illness “took” her husband Correct! Correct! Heard explaining to family that illness took her husband7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 10/146 Question 9 1 / 1 pts A nurse is caring for a 15-year-old girl who has been hospitalized on the mental health unit for bipolar disorder. The client tells the nurse that she had her hair styled just like her young math teacher, whom she admires. The nurse recognizes that the client is using which defense mechanism? Projection Regression Correct! Correct! Identification Intellectualization Rationale: Identification is the process by which a person tries to become like someone he or she admires by taking on the beliefs, mannerisms, or tastes of that person. Projection is attributing one’s thoughts or impulses to another person. Regression is retreating to a behavior characteristic of an earlier level of development. Intellectualization is excessive reasoning or logic used to avoid experiencing disturbed feelings. Test-Taking Strategy: Use the process of elimination, focusing on the data in the question. Noting that the client is mimicking a characteristic of another person will direct you to the correct option. Review these defense mechanisms if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 11/146 Question 10 1 / 1 pts A 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? “No? Why not?” “You seem to be saying no. Would you tell me more about your reluctance?” Correct! Correct! “OK, but I hope you will let me know when you feel ready to attend a group session at the clinic.” “Perhaps a group session would be too overwhelming for you right now. How about just seeing me?”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 12/146 Rationale: The therapeutic nursing statement is seeking clarification. In this statement, the nurse is asking the client to put his ideas into words and explain what he means or feels. This encourages the client to express his reluctance and to try to work out any reservations about attending the group session. In responding, “No? Why not?” the nurse is using a confrontational style, which could lead to a regressive struggle. The nurse expresses doubt and uses a laissez-faire style regarding attending a group session at the clinic when the nurse states “… let me know when you feel ready to attend.” In stating “Perhaps a group session would be too overwhelming for you right now. How about just seeing me?” the nurse prematurely guesses the reasons for the client’s refusal, and this is not appropriate. Test-Taking Strategy: Draw on your knowledge of therapeutic communication techniques to answer this question. First eliminate the option containing the word “why.” To select from the remaining options, focus on the information in the question. The correct option provides the client the opportunity to verbalize feelings. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 11 1 / 1 pts 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? “Boys who are cared for only by their moms are at highest risk for violent behavior.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 13/146 “There is quite a bit that you can do. Let’s talk about what you’re already doing first.” Correct! Correct! “Do you know all of your son’s friends, or is he left alone after school because you work?” “Many young people die of gunshots every day in this country, so your son’s behavior is unacceptable.” Rationale: It is important to help parents to identify children at risk for violent behavior. Unfortunately, this young person has already engaged in threatening and potentially violent behavior, but there are parenting measures and therapies that this single parent can use to help her son express his feelings of anger verbally rather than by acting out. The nurse responds nontherapeutically in telling the mother that boys who are cared for only by their mothers are at high risk for violence; this response could generate guilt in the mother. Asking “Do you know all of your son’s friends, or is he left alone after school because you work?” is both inappropriate and premature. Telling the woman that her son’s behavior is unacceptable is lecturing an upset parent, which is inappropriate. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques, and focus on the information in the question. Note that the client of the question (the mother) is asking the nurse for assistance. The correct option is the only option that addresses the mother’s concern and encourages verbalization. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 12 1 / 1 pts7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 14/146 A client says to the nurse, “My health care provider 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? “Your physician feels that your body is physically ready to make the change in medication.” “I think you need to listen to your physician when it comes to taking such strong medication.” “Well, your health care provider is concerned that you will become physically dependent on the first painkiller.” “Perhaps if I medicate you about a half-hour before you plan to start your daily activities, the medicine will be more effective.” Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 15/146 Rationale: The most supportive response is the one that addresses the client’s concern and provides a plan that will help minimize the client’s pain. If this nursing measure does not afford pain relief, then the nurse can report the client’s continued pain to the physician. In stating “Your physician feels that your body is physically ready to make the change in medication,” the nurse is shifting attention from the client’s feelings to the physician’s view. In telling the client that he or she needs to listen to the physician, the nurse is nontherapeutically giving advice and patronizing the client. Stating “Well, your health care provider is concerned that you will become physically dependent on the first painkiller” is a defensive response, and the nurse’s assertion about dependence may not be based on fact. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques and focus on the subject, the client’s concern about pain relief. Eliminate the comparable or alike options that focus on the physician, not the client. From the remaining options, select the one that addresses the client’s concern. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 13 1 / 1 pts 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? Correct! Correct! “Have you shared your feelings with your wife?”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 16/146 “You seem to feel that a less prestigious job would be humiliating for you.” “Oh, I agree with you. Let her get another job if she needs that much money.” “How soon will you be able to find work? If this is permanent, you may need to swallow your pride.” Rationale: The therapeutic response is the one that helps determine whether the client is sharing his feelings with his wife and providing her with the opportunity to join in the decision-making process. Stating “You seem to feel that a less prestigious job would be humiliating for you” is reflection to some degree; however, its focus is nontherapeutic because the nurse is making a premature judgment of the client’s concerns. In stating “Oh, I agree with you. Let her get another job if she needs that much money,” the nurse is using a nontherapeutic response of giving approval. “How soon will you be able to find work? If this is permanent, you may need to swallow your pride” is a probing question that the client is probably unable to answer and gives an unsolicited opinion, which is a nontherapeutic communication. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Note the words “shared your feelings” in the correct option. Remember to focus on the client’s feelings. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 14 1 / 1 pts7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 17/146 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? “Oh, me too. I always pick the worst kind of men, so I know just how you feel.” “Divorce is more difficult for children. Maybe you should focus on them for now.” “You’ve been unfortunate, but you seem to be focusing on yourself and what you have to do.” “You talk about how the divorces affected you. Tell me how your children are dealing with the loss.” Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 18/146 Rationale: When clients experience loss, they can become self-absorbed. In responding, “You talk about how the divorces affected you. Tell me how your children are dealing with the loss,” the nurse is trying to refocus the client’s attention on her children and their needs during this time. By stating “Oh, me too. I always pick the worst kind of men, so I know just how you feel,” the nurse personalizes and exaggerates the client’s problems, using a nontherapeutic response. In stating “Divorce is more difficult for children. Maybe you should focus on them for now,” the nurse is being judgmental when he or she should be refocusing the client’s energies. In stating “You’ve been unfortunate, but you seem to be focusing on yourself and what you have to do,” the nurse is responding with empathy, but the choice of wording suggests that the nurse is judging and blaming the client for not focusing on her children. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Eliminate the option that is a nontherapeutic response and does not focus on the client’s concern. To select from the remaining options, note that the correct option is the only option that encourages the client to discuss the loss and its effect on her children. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 15 1 / 1 pts 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? “Mental illness always has its roots in the family.” “Mental illness is a result of environmental factors.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 19/146 “Today we know that all mental illness is genetically inherited.” “There are many possible physical causes of mental illness, and they include problems in the brain.” Correct! Correct! Rationale: Biologically based mental illnesses are caused by neurotransmitter dysfunction, abnormal brain structure, inherited genetic factors, or other biological causes. Biologically influenced illnesses include schizophrenia, bipolar disorder, major depression, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, autism, anorexia nervosa, and attentiondeficit/hyperactivity disorder. Stating that all mental illness is a result of genetic factors or that it is caused by environmental factors or family dynamics is incorrect and not associated with a biologically based disorder. Test-Taking Strategy: Use the process of elimination. Eliminate the options that include the closed-ended words “always” and “all.” To select from the remaining options, focus on the words “biologically based” in the question, which will direct you to the correct answer. Review the causes of mental illness if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 16 1 / 1 pts A 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 nursing response would be therapeutic?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 20/146 Correct! Correct! “You seem to be feeling very troubled.” “You are working to get better, but you’re worrying about things that aren’t going to happen.” “You seem to be feeling very powerless right now, yet you’re getting better, so why worry about what won’t happen?” “I am troubled that you are worried over the worst possible things that could happen rather than worrying about the efforts needed to strengthen your family situation.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 21/146 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 if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 17 1 / 1 pts 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.” The nurse recognizes that the client is engaging in the use of which defense mechanism? Correct! Correct! Denial7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 22/146 Psychosis Delusions Displacement Rationale: Defense mechanisms protect us against anxiety. Denial is the defense mechanism used to block out painful or anxiety-inducing events or feelings. In this case, the client cannot deal with the upcoming cancer surgery and therefore denies that he or she is ill. Psychosis and delusions are not defense mechanisms. Displacement is acting out in anger or frustration with people who did not arouse the feelings. Test-Taking Strategy: Use the process of elimination and focus on the subject, defense mechanisms. First, eliminate the options that are not defense mechanisms. From the remaining options, focus on the data in the question to find the correct option. Review defense mechanisms if you had difficulty with this question Cognitive Ability: Understanding Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Question 18 1 / 1 pts 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.” On the basis of the client’s statement, what is the appropriate nursing intervention? Teaching the client’s wife to write down her thoughts and feelings and to read them to her husband7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 23/146 Saying to the client, “It sounds to me like your wife is truly comfortable and doesn’t want you to worry needlessly.” Talking with both the client and his wife about the importance of expressing their feelings and how to do it in healthy ways Correct! Correct! Talking with all family members, including the daughter, about the importance of expressing their concerns and feelings to the dying client Rationale: The appropriate nursing intervention is to help the client and spouse describe feelings that, left unspoken, might cause disruption and delay resolution. Teaching the client’s wife to write down her thoughts and feelings and read them to her husband is inappropriate without a prior determination of the wife’s feelings. In saying to the client, “It sounds to me as if your wife is truly comfortable and doesn’t want you to worry needlessly,” the nurse verbalizes a statement without a basis in fact, a nontherapeutic technique. Talking with all family members is inappropriate and could violate client confidentiality. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Eliminate the option that does not address the client’s feelings and places the client’s feelings on hold. Next, eliminate the comparable or alike options because they both address an intervention with a family member before determining their feelings. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 19 1 / 1 pts7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 24/146 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? “I wonder why you left your wife and children.” “What would you expect your wife and children to do? They didn’t leave you.” “You seem to be very angry about carrying out your responsibility to your children.” “Do you feel that child support is designed to help children, not punish spouses who leave?” Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 25/146 Rationale: The nurse employs the therapeutic communication technique of seeking clarification to support the client in processing his feelings more specifically. In maintaining a neutral, unbiased, and nonjudgmental stance, the nurse can establish a trusting relationship with the client. In stating “I wonder why you left your wife and children,” the nurse changes the focus of the client’s concern and uses a “why” question that implies criticism and could cause the client to become defensive. “What would you expect your wife and children to do? They didn’t leave you” is sarcasm, which is nontherapeutic and alienates the client. In stating “You seem very angry about carrying out your responsibility to your children,” the nurse is making an interpretation and labeling the client’s feelings prematurely. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Eliminate the option containing the word “why.” Next, eliminate the option that is sarcastic and the option that labels the client’s feelings. Also note that the correct option is the only option that focuses on the client’s concern and encourages the client to further verbalize feelings. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 20 1 / 1 pts 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? “I don’t know what to say. It was a terrible fire. I’m so sorry this happened.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 26/146 “It seems that you’re blaming yourself for something that was beyond your control.” Correct! Correct! “It seems to me that you’re making this all about you when many people died in that fire.” “You should be thankful that you’re a survivor. The victims and their families lost, not you.” Rationale: The correct option involves the use of the communication technique of reflection and encourages the client to further verbalize his thoughts and feelings. In stating “I don’t know what to say. It was a terrible fire. I’m so sorry this happened,” the nurse is using a social response and the nontherapeutic communication technique of agreeing. In stating “It seems to me that you’re making this all about you when many people died in that fire,” the nurse is using the nontherapeutic communication techniques of disapproval and judging. In stating “You should be thankful that you’re a survivor. The victims and their families lost, not you,” the nurse is nontherapeutically lecturing the client. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. The correct option is the only option that is therapeutic, involves the use of reflection, and encourages verbalization of the client’s feelings. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 21 1 / 1 pts7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 27/146 When assisting with the plan of 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? Correct! Correct! “I’d like to have my family here when I die.” “I’ll be ready to die once my daughter gets married.” “I want to go to my family reunion; then I’ll be ready to die.” “I just want to live to see my grandchildren graduate from college.” Rationale: Acceptance is often characterized by plans for death. Often the client wants loved ones near. Therefore the statement “I’d like to have my family here when I die” indicates acceptance of impending death. The incorrect options reflect the bargaining stage of coping, in which the client tries to negotiate with his or her God or with fate. Test-Taking Strategy: Use the process of elimination. Eliminate the comparable or alike options that demonstrate negotiation for something else to happen before death occurs. The correct option is the option that reflects acceptance. Review the stages of death and dying if you had difficulty with this question. Cognitive Ability: Evaluating Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Evaluation Content Area: Mental Health Question 22 1 / 1 pts A client says to the nurse at the mental health clinic, “My husband and sister-in-law both have terminal illnesses, and my family7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 28/146 thinks that because I’m a nurse I should be able to handle everything.” Which nursing response would be therapeutic? “Are you saying you are overly involved and will need to emotionally distance yourself to be therapeutic for your family?” “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.” “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.” “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! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 29/146 Rationale: The therapeutic response is the one in which the nurse makes observations and then clarifies his or her perception of what the client has said. Stating “Are you saying you are overly involved and will need to emotionally distance yourself to be therapeutic for your family?” is paraphrasing, a therapeutic technique, but this response is premature and reflects unfounded assumptions. In stating “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,” the nurse expresses disapproval, a nontherapeutic communication technique, and then offers to “beat up” the family verbally in a family intervention. The statement “I’m sorry to hear that your loved ones are so ill. As a nurse, you should be able to assist them, using your professional expertise. Perhaps that’s what your family expects from you,” expresses sympathy but also lectures the client. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. The correct option is the only option that specifically addresses the client’s feelings and encourages verbalization about the client’s concern. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 23 1 / 1 pts 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 pounds this month.” Which initial nursing statement should the nurse make to the client?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 30/146 “I’m calling the health care provider immediately to obtain a homemaker for you!” “It seems as if you feel lost without your wife and maybe a bit ignored by your children.” Correct! Correct! “First things first. What are you doing eating bacon and eggs? That’s not a good meal for you.” “Meals-on-Wheels can help you minimize the frustration you are having cooking. Are you a member of the local senior center?”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 31/146 Rationale: The client is exhibiting grief over the recent loss of his wife; feelings of insecurity, inexperience, and helplessness; weight loss (a vegetative sign of depression); evidence of poor nutritional habits; isolation; and a lack of safety in activities of daily living. The initial nursing statement should seek clarification of the client’s feelings so that the nurse can estimate the extent of mood alteration. In stating “I’m calling the health care provider immediately to obtain a homemaker for you!” the nurse is responding too abruptly. Although the stated intervention may be a part of mutual planning, the client may not need or qualify for such support at this time; more data should be gathered. In stating “First things first. What are you doing eating bacon and eggs? That’s not a good meal for you,” the nurse begins by ordering data from the client but veers off into expressing disapproval of the one meal that the client has cited, which may not be representative of his dietary habits. The nurse jumps to conclusions on the basis of inadequate information, and being judgmental is nontherapeutic. Saying, “Meals-on-Wheels can help you minimize your frustration. Are you a member of the local senior center?” jumps prematurely to referral to community resources that may be helpful. However, it is too early to address resources; a complete assessment of the client’s stated complaints should be obtained first. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. This will direct you to the correct option, which is the only option that addresses the client’s feelings. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 24 1 / 1 pts A physician tells a client that she has cancer, that her illness is terminal, and that she has a 6-month prognosis. After the physician leaves the client’s room, which therapeutic statement should the nurse make to the client?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 32/146 “I am so sorry about this. You are my favorite client, and I will take good care of you.” “What did your health care provider tell you about your condition? Can you tell me what you’re thinking about?” Correct! Correct! “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.” “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?”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 33/146 Rationale: When communicating with the dying client and those who grieve, the nurse should use statements that indicate a willingness to follow the client’s lead. Openended statements such as “Can you tell me what you are thinking about?” are appropriate and encourage verbalization of feelings. In stating “I am so sorry about this. You are my favorite client, and I will take good care of you,” the nurse expresses sympathy but provides only a social response. By stating “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,” the nurse begins with a therapeutic response but then gives a false reassurance. By stating “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?” the nurse demonstrates discomfort and is seemingly reluctant to offer help. In this statement the nurse tells the client that the nurse would prefer that the client discuss feelings and concerns with loved ones. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques and remember to focus on the client’s feelings. The correct option focuses on the client’s feelings and encourages client verbalization. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 25 1 / 1 pts The wife of a client who is dying says to the nurse, “I am able to take off the 6 months from work our health care provider feels that my husband will live, but what if he lives beyond that time?” Which therapeutic response should the nurse make? “Only you and your husband can determine how you should best allocate your work leave.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 34/146 “Your husband has managed to be active up to now, so he could live longer than predicted, but his actual life span remains unclear.” “Are there other options for you in taking work leave? What are your thoughts about reducing your work hours at first so that you can extend your compassionate leave?” Correct! Correct! “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?”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 35/146 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 if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 26 1 / 1 pts 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?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 36/146 “It isn’t unusual for family to suffer from anticipatory grief when a loved one is dying.” Correct! Correct! “I cannot emphasize how much your husband needs you to be there for him right now. He is in the stage of denial.” “You will need to concentrate on getting to these appointments on time and write down what everyone says so you will remember.” “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.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 37/146 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 comparable or alike options that express disapproval of the spouse’s behavior. Next, eliminate the option that demeans the spouse’s behavior, another nontherapeutic technique. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 27 1 / 1 pts7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 38/146 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? “Could you share your feelings with your son just as you have with me?” Correct! Correct! “Sounds as if your son will never grow up and learn to take care of himself.” “Goodness. At 22, I supported myself and never asked my mother for anything.” “I wonder why you’re so worried about your adult son when you need to concentrate on you?”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 39/146 Rationale: It is important for both the dying client and his or her significant others to resolve concerns by discussing issues, and the nurse needs to encourage this communication. “Sounds as if your son will never grow up and learn to take care of himself,” and “Goodness. At 22, I supported myself and never asked my mother for anything” are both judgmental responses. By stating “I wonder why you are so worried about your adult son when you need to concentrate on you?” the nurse diverts the focus from the client’s expressed concerns. Changing the subject is nontherapeutic when the client’s feelings are ignored. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Eliminate the comparable or alike options that are judgmental responses and ignore the client’s feelings. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 28 1 / 1 pts 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? “Of course you’re angry. Who wouldn’t be? Yet nothing is ever clear cut, is it?” “You not only lost your husband but also learned it was at the hands of someone you looked up to.” Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 40/146 “You’re having stomach pain? You should get checked for an ulcer or other gastric problem.” “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.” Rationale: The therapeutic statement is the one that seeks clarification. By stating “Of course you’re angry. Who wouldn’t be? Yet nothing is ever clear cut, is it?,” the nurse agrees with the widow and then uses a social philosophic stance. This response is nontherapeutic. By stating “You’re having stomach pain? Sounds like you need to get checked for an ulcer or other gastric problem,” the nurse changes the focus from the widow’s expression of feelings to an expression of somatic distress. Sensations of somatic distress are common for a brief time during bereavement. However, if these symptoms were to persist, the nurse would then be correct to encourage the widow to get checked for physical problems. By stating “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,” the nurse agrees with the widow and judges the perpetrator. This response is also nontherapeutic. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. The correct option is the only option that focuses on the subject, encourages the client’s (widow’s) expression of feelings, and seeks clarification. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 29 1 / 1 pts7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 41/146 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? Scheduling the client for an appointment with the psychiatrist because this is a pathological manifestation Calling the physician to report that the client is at a high risk for suicide and increasing the frequency of visits with the client Seeking emergency certification for the psychiatric inpatient unit at the community hospital because of high lethality concerns and visiting the client daily Explaining that bereaved persons often describe intrusive thoughts of negative experiences with the deceased and then increasing the frequency of nurse-client visits Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 42/146 Rationale: It is common for grieving people to experience intrusive reexperiences or compulsive reenactments of interactions, including negative ones, with deceased loved ones. Bad dreams and diminished ability to concentrate may also occur. Therefore, scheduling an appointment with the psychiatrist is unnecessary, as is seeking emergency certification for the psychiatric inpatient unit. These options indicate that the nurse is making a premature interpretation that the client is at high risk for suicide. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Eliminate the comparable or alike options that indicate that the client is a lethality risk. To select from the remaining options, note the relationship between the data in the question and the correct option. Review the grief response if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Safe and Effective Care Environment Integrated Process: Nursing Process/Planning Content Area: Mental Health Question 30 1 / 1 pts A client who is a physician 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? Correct! Correct! “Your family is caring for you now.” “Well, you’d expect them to care for you, wouldn’t you?” “It is an honor for all of us to care for you. We want to help you.” “You can look back on so many wonderful people you saved and cared for.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 43/146 Rationale: The client makes a statement that reflects powerlessness. In the correct option, the nurse uses the therapeutic communication technique of paraphrasing to enable the client to hear his own statement and express his feelings more completely, if he is able to express them. By stating “Well, you’d expect them to care for you, wouldn’t you?” the nurse uses sarcasm that implies that his care may be a responsibility his family feels burdened by. “It is an honor for all of us to care for you. We want to help you” and “You can look back on so many wonderful people you saved and cared for” are nontherapeutic platitudes that do not focus on the client’s concern. Test-Taking Strategy: Use the process of elimination and your knowledge of therapeutic communication techniques. Eliminate the comparable or alike options that do not address the client’s feelings. From the remaining options, select the option that addresses the client’s feelings and encourages expression of feelings. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 31 1 / 1 pts 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? “Young people don’t always obey their parents.” “Everyone feels guilt or anger when they lose a loved one.” “Does anyone in the family have a drinking or drug problem?”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 44/146 “Your sadness over losing your daughter is mixed with anger at her driving while intoxicated.” Correct! Correct! Rationale: Anger, a component of the bereavement phenomenon, is a common emotion. In saying, “Young people don’t always obey their parents,” the nurse makes a closed-ended statement that is lecturing in tone. In stating “Everyone feels guilt or anger when they lose a loved one,” the nurse makes a preachy and nontherapeutic intellectualization statement. In stating “Does anyone in the family have a drinking or drug problem?” the nurse changes the subject and takes the focus away from facilitation of the expression of feelings with an insensitive statement that may intensify the parents’ anger. Test-Taking Strategy: Use the process of elimination. Note the relationship between the data in the question and the correct option. Also note that the correct option is the only option that focuses on the clients’ feelings. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 32 1 / 1 pts 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? Telling the student not to disturb the family until the end of shift7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 45/146 Calling their family priest immediately to come help them to let their son go Asking the emergency department physician to join the student in requesting that the family let the nursing staff care for their son 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! Correct! Rationale: This question presents a sad and troubling story of a family needing time to grieve in the face of a catastrophic loss. The nurse’s plan to join the family will provide support to the family. The nurse should call the family priest but first must ascertain that the family does wish to talk to a priest. Telling the student not to disturb the family until the end of shift does not provide support to the family. Asking the emergency department physician to join the student in requesting that the family let the nursing staff care for their son is inappropriate. This also represents a redundancy of tasks for personnel in a busy emergency department. Test-Taking Strategy: Use the process of elimination. Focus on the subject in the question, and note that the correct option is the only option that provides support to the victim’s family. Review nursing interventions related to grief and loss if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Planning Content Area: Mental Health Question 33 1 / 1 pts A nurse is caring for a bereaved man with acquired immunodeficiency syndrome who lost his twin brother in a rock-7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 46/146 climbing accident a month ago. Which statement by the client should cause the nurse to be concerned? Correct! Correct! “Lately I’ve been feeling that life isn’t that great.” “You’d have thought that I would be the one to die first.” “I should have made him stay home. He was always clumsy.” “I miss him so much. We were close and talked almost daily.” Rationale: The nurse needs to be alert to statements by clients that might be indicative of suicidal ideation. On hearing such a statement, the nurse must conduct a lethality assessment to examine the meaning of the client’s statement more closely. The client statement “Lately I’ve been feeling that life isn’t that great” should alert the nurse that the client may be experiencing suicidal ideation. In the statement “You’d have thought that I would be the one to die first,” the client is expressing anger and guilt, both normal components of bereavement. In the statement “I should have made him stay home. He was always clumsy,” the client is expressing guilt. In the statement “I miss him so much. We were close and talked almost daily,” the client is expressing normal sorrow and mourning. Test-Taking Strategy: Focus on the subject, the statement by the client that would be of concern to the nurse. Eliminate the comparable or alike options that include statements that reveal normal components of grieving. Also note that in the correct option the client expresses a feeling indicating the potential for self-harm. Review the normal grieving process if you had difficulty with this question. Cognitive Ability: Analyzing Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 47/146 Question 34 0 / 1 pts 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? “You need to stop your visits immediately, or your daughter will have you examined for a mental disorder.” “Perhaps you could reduce your visits to his grave to once a month and meet your daughter for coffee like you used to.” Y You Answered ou Answered “I think your visits are perfectly normal. After all, you were married for a long time. You’ll stop when the winter weather comes.” “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 Answer Correct Answer7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 48/146 Rationale: In the correct option, the nurse seeks information from the client about her feelings; this is a therapeutic action. Stating “You need to stop your visits immediately, or your daughter will have you examined for a mental disorder” is a nontherapeutic response that gives advice and ridicules the client about a matter that is serious to the client. In stating “Perhaps you could reduce your visits to his grave to once a month and meet your daughter for coffee like you used to,” the nurse gives advice before making a complete assessment; to base a solution on inadequate information is inappropriate and premature. The client has been mourning for only 2 months and may need to make the visits to resolve her grief about her husband’s death. By stating “I think your visits are perfectly normal. After all, you were married for a long time. You’ll stop when the winter weather comes,” the nurse again makes a premature judgment on the basis of inadequate information, and the response is somewhat sarcastic, which is insensitive and nontherapeutic. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. The correct option is the only option that encourages expression of how the client feels. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 35 1 / 1 pts A nurse is talking to a client whose spouse died 10 months ago. Which statement by the client indicates successful mourning? “I’m planning a trip to England next fall to tour the mansions and their gardens.” Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 49/146 “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.” “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.” “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.” Rationale: The tasks of successful mourning include acceptance of the reality of loss, sharing in the process of working through the pain of grief, adjustment to the environment without the lost loved one, reinvesting in other relationships and life pursuits, and restructuring family relationships. Therefore the client’s statement about planning a trip to England indicates successful mourning. The remaining options identify clinical manifestations of dysfunctional grieving. Test-Taking Strategy: Use the process of elimination and focus on the subject, successful mourning. Eliminate the comparable or alike options that identify clinical manifestations of dysfunctional grieving. Review the grieving process if you had difficulty with this question. Cognitive Ability: Evaluating Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Evaluation Content Area: Mental Health Question 36 1 / 1 pts 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 cared7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 50/146 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? “Are you thinking of ending your life because your time has come?” Correct! Correct! “Did you know that many people live happier lives without children?” “It must seem very lonely to you. I can’t believe that you never had any children.” “When my dad died, my mother said some of the things you’re saying now, and she had three kids.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 51/146 Rationale: The client exhibits clinical manifestations of depression and alludes to suicidal ideation. Because dysfunctional grieving can manifest as suicidal ideation, the nurse must conduct a lethality assessment and ask the client whether he is thinking of ending his life. By stating “Did you know that many people live happier lives without children?” the nurse gives a nontherapeutic response, changing the subject and focusing attention away from the client’s expression of feelings. By stating “It must seem very lonely to you. I can’t believe that you never had any children,” the nurse begins by reflecting, which is a therapeutic response, but changes the subject (a nontherapeutic response) and expresses disdain over the client’s not having had children, which is insensitive and unprofessional. By stating “When my dad died, my mother said some of the things you’re saying now and she had three kids,” the nurse changes the focus from the client’s feelings to other content, which is nontherapeutic. Test-Taking Strategy: Use knowledge of the subject, suicidal risks and therapeutic communication techniques, to assist you with the process of elimination. Note the relationship of the client’s statement “I’m more than ready to go when the time comes” in the question and the correct option. Also note that the correct option is the only option that encourages expression of the client’s feelings. Review therapeutic communication techniques and suicidal risks if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 37 1 / 1 pts A nurse coordinates the use of hospice care to visit a dying client who will be going home with his family. The nurse tells the family that which is one function of hospice services? Helping the client focus completely on his physical health7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 52/146 Providing bereavement support to the family after the client’s death Correct! Correct! Helping the family stop the client’s efforts to go out at night with his friends Working with the client to sustain hope by talking of recent research breakthroughs regarding his illness Rationale: Hospice care includes holistic care that respects the client’s dignity and control, provides pain-free support, and encourages choice while treating the client and family before and after death. Helping the family stop the client’s efforts to go out at night with his friends and helping the client focus completely on his physical health are both incorrect because they are not holistic approaches. Working with the client to sustain hope by talking of recent research is inappropriate in that it falsely reassures the dying client rather than allowing him to seek resolution. Test-Taking Strategy: Use the process of elimination. Eliminate the option that contains the closed-ended word “completely.” Next eliminate the option that provides false reassurance. To select from the remaining options, noting the words “bereavement support” will direct you to this option. Review the purpose and function of hospice care if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 38 1 / 1 pts A dying client with agoraphobia says to the nurse, “I’ve been unable to leave this house without tremendous effort for so long,7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 53/146 and now it doesn’t matter.” Which statement by the nurse would be therapeutic? Correct! Correct! “It doesn’t matter? Can you share your feelings with me?” “Your gardens are beautiful now. Would you like to stroll in them after our work?” “Did you go through systematic desensitization with your health care provider? I understand that it works well.” “I know what you mean. I spent more than $2,000 on a dental implant and still wound up with false teeth.” Rationale: The client has made a depressive statement, and the nurse must further assess the statement to determine its meaning. By stating “Your gardens are beautiful now. Would you like to stroll in them after our work?” the nurse uses distraction as a strategy and closes off the expression of feelings prematurely. By stating “Did you go through systematic desensitization with your health care provider? I understand that it works well,” the nurse changes the subject (nontherapeutic) and closes off the client’s expression of feelings. In the statement “I know what you mean. I spent more than $2,000 on a dental implant and still wound up with false teeth,” the nurse again changes the subject (nontherapeutic) and provides a social response. Test-Taking Strategy: Use the process of elimination. Note the relationship between the data in the question and the correct option. Also, the correct option is the only option that encourages expression of the client’s feelings. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 54/146 Question 39 1 / 1 pts A dying client says to the nurse, “How do I tell my parents that I am dying of AIDS when they don’t even know that I’m gay?” Which statement by the nurse would be therapeutic? “Well, isn’t it better that they learn from you than for them to learn on their own?” “Sounds as if you’re thinking that it’s time for you to tell your parents about your disease.” Correct! Correct! “I’ve worked with this illness for many years now, and there just doesn’t seem to be an easy way to do this.” “Are you saying that your parents don’t know about your sexual orientation and must learn about that and of your illness, too?”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 55/146 Rationale: The client is asking the nurse to help him determine how and when to talk with his parents about his diagnosis and sexual orientation. In the correct option, the nurse makes a statement that is open-ended and provides an opening for the client to talk about his thoughts, feelings, concerns, and fears more openly. This process may help the client decide when and how to tell his parents. In asking “Well, isn’t it better that they learn from you than to learn on their own?” the nurse makes a social response. “I’ve worked with this illness for many years now and there just doesn’t seem to be an easy way to do this” validates the client’s difficulties and is context free but also discourages the client rather than providing support. By stating “Are you saying that your parents don’t know about your sexual orientation and must learn about that and of your illness, too?” the nurse engages in catastrophizing, which will only increase the client’s anxiety level. Test-Taking Strategy: Use knowledge of therapeutic communication techniques to assist you with the process of elimination. Eliminate the option that constitutes a social response and the option that could be interpreted as discouraging to the client. From the remaining options, select the option that encourages the client to express his feelings and concerns and does not increase the client’s anxiety regarding the task that he is facing. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 40 1 / 1 pts 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?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 56/146 “Get a lawyer! That’s what you all need to do.” “Do you believe that a class action suit is the correct thing and that you are in the right?” “You’re saying that being left a widow with children is difficult enough, but now you’ve got to fight for your benefits.” Correct! Correct! “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?” Rationale: In the correct option, the nurse uses the therapeutic communication technique of seeking clarification to facilitate the expression of feelings by the widow. By stating “Get a lawyer! That’s what you all need to do,” the nurse makes a social response, which is nontherapeutic. By stating “Do you believe that a classaction suit is the correct thing and that you are in the right?” the nurse engages in probing, which is premature and nontherapeutic. By stating “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?” the nurse gives a social opinion and expresses disapproval or disagreement. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Note the relationship between the data in the question and the correct option. This is the only option that encourages expression of the client’s feelings. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 41 1 / 1 pts7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 57/146 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? “Hello? You go girl! You can see it’s only natural, can’t you?” “By the end of a year, most people are able to renew their interest in other people and activities.” Correct! Correct! “Nonsense. Your children need a new father, as your family knows. Your husband would want you to go on with life.” “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.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 58/146 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 if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 42 1 / 1 pts 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 health care provider?” Which statement by the nurse would be therapeutic?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 59/146 “Absolutely. It sounds as if she may be experiencing a severe depression.” “To be safe, it would not hurt to have her see your family health care provider, or maybe you have a member of the clergy she can talk to.” “The reluctance to resume activities and overprotect your other children is a normal part of bereavement and will subside in 2 months.” “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! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 60/146 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 health care provider, 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 that “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 subject, 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 if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 43 1 / 1 pts A young nurse has just completed postmortem care of a 16-yearold 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?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 61/146 “Next time, take someone else in with you for postmortem care, OK?” “Your feelings are normal and will go away after a good night’s sleep.” “Let’s go for coffee and talk about this some more, shall we? We’re both due for our coffee breaks.” Correct! Correct! “I should never have assigned you someone so close to your own age. I’ll be more careful in the future.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 62/146 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 if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 44 1 / 1 pts The 45-year-old husband of a client with breast cancer who just died says to the nurse, “If our health care provider had operated sooner, my wife would be alive now.” Which statement by the nurse would be therapeutic?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 63/146 Say nothing. Simply nod and say “Mm-hmm” noncommittally. “Sounds as if you’re feeling angry and pretty helpless right now.” Correct! Correct! “Let’s focus not on what was not done but instead on what wasdone for your wife.” “Your health care provider did all he could for your wife. You know, physicians 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 health care providers. The nurse’s use of reflection will help this client 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 health care provider did all he could for your wife. You know, physicians 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 if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 64/146 Question 45 1 / 1 pts 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? Self-blame Correct! Correct! Avoidance Reframing Wishful thinking Rationale: The negative stress response of avoidance is when a client elects not to deal directly with negative feelings about a situation. Self-blame is focused on minimizing one’s self-esteem rather than on seeking help. Reframing is a positive stress response in which the client redefines a situation to view both its positive and negative sides. Wishful thinking is a form of denial in which the client believes that everything will turn out fine. Test-Taking Strategy: Use the process of elimination and recall the subject, the description of each item in the options. Focus on the client’s statement and note the relationship between the statement and the correct option. Review coping mechanisms if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Data Collection Content Area: Mental Health Question 46 1 / 1 pts7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 65/146 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? “So you’re saying that you let your feelings build up and then you just explode?” “Have you tried standing in front of the television when your dad is watching it?” “What makes you feel that you have the right to fly off the handle just because you feel ignored?” “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! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 66/146 Rationale: Assertiveness is a good way to ease the anxiety and conflict that result from stressful interpersonal relationships. Assertiveness helps the client express opinions that may have emotionally charged feelings attached to them and to express those feelings without using hurtful, aggressive language. In stating “So you’re saying that you let your feelings build up and then you just explode?” the nurse is using the therapeutic communication of reflection, but the statement does not teach assertive behavior. In stating “Have you tried standing in front of the television when your dad is watching television?” the nurse is using sarcastic humor, a nontherapeutic communication strategy. In stating “What makes you feel that you have the right to fly off the handle just because you feel ignored?” the nurse challenges and belittles the client’s feelings, which constitutes nontherapeutic communication. Test-Taking Strategy: Use the process of elimination. Focusing on the subject, assertive behavior, will help you eliminate the incorrect options. Review the principles related to assertiveness if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 47 1 / 1 pts 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? Correct! Correct! “Can you tell me a little more about this?” “I would dig ditches if it contributed to my family’s well-being.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 67/146 “Sounds as if you’re lucky to have your wife’s job to fall back on.” “I’m surprised that such a hardworking man is not able to find a job.” Rationale: In using the therapeutic communication of exploration, the nurse is trying to learn more about the situation and the client’s coping style. In stating “I would dig ditches if it would contribute to my family’s well-being,” the nurse uses the nontherapeutic communication of disapproval. In stating “Sounds as if you’re lucky to have your wife’s job to fall back on,” the nurse is using the nontherapeutic communication technique of making a judgment or offering an opinion. In stating “I’m surprised that such a hardworking man is not able to find a job,” the nurse is using the nontherapeutic techniques of sarcasm and giving an opinion. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques, and remember to focus on the client’s feelings and provide the client an opportunity to express feelings. This will direct you to the correct option. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 48 1 / 1 pts A 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? Reframing7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 68/146 Locus of control Correct! Correct! Problem-solving Use of social supports Rationale: In avoidance, the client elects not to deal with a situation, which allows negative feelings and situations to build up and become chronic. Problem-solving is the positive stress response of figuring out how to deal with a situation. Reframing and use of social supports are positive stress responses to self-blame and wishful thinking. Locus of control is not a positive stress response; instead, it refers to one’s sense of control (internal or external). Test-Taking Strategy: Focus on the subject, a positive stress response for dealing with avoidance and denial. Focusing on the client’s behavior and use of coping mechanisms will direct you to the correct option. Review positive stress responses if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Planning Content Area: Mental Health Question 49 1 / 1 pts 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 health care provider 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? “Let’s talk more about what has been helpful to you in the past.” Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 69/146 “Before we talk about stress management, let’s discuss your children.” “You have a lot of problems. How long does your wife have to live, and what is her relationship with your children?” “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.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 70/146 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: Use the process of elimination. Eliminate the comparable or alike options that 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 if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 50 1 / 1 pts 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?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 71/146 “Sounds as if you’re exaggerating your situation and looking only at the half-full glass.” “It seems that you measure your life and what you need to do against the behaviors of others.” “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.” “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! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 72/146 Rationale: Reframing is a positive response in which the client redefines a situation to view both its positive and negative sides. The correct statement is the one that helps the client redefine the situation in this fashion and see how the situation could be used to the client’s advantage. In stating “Sounds as if you’re exaggerating your situation and looking only at the half-full glass,” the nurse gives advice and expresses an opinion, both of which are nontherapeutic. In stating “It seems that you measure your life and what you need to do against the behaviors of others,” the nurse uses the therapeutic response of reflection, but it does not teach the client reframing. “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” is sarcastic and belittles the client; hence it is nontherapeutic. Test-Taking Strategy: Focus on the subject, reframing. Recalling that reframing is a positive response in which the client redefines the situation to view both its positive and negative sides will direct you to the correct option. Review this coping behavior if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 51 1 / 1 pts A 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? “You know, you could work and make money serving food to people.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 73/146 “I agree. If you can do all that for your husband, he should treat you better.” “It seems that you feel that your husband could treat you well just as you treat him.” Correct! Correct! “Ask your husband to do the things you’d like. If he doesn’t, tell him you’re leaving him.” Rationale: In the correct response, the nurse uses the therapeutic communication of seeking clarification. In stating “You know, you could work and make money serving food to people,” the nurse uses a social response that is tinged with sarcasm. In stating “I agree. If you can do all that for your husband, he should treat you better,” the nurse uses the nontherapeutic technique of agreeing and giving an opinion. In stating “Ask your husband to do the things you’d like. If he doesn’t comply, tell him you’re leaving him,” the nurse is giving advice. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Eliminate the comparable or alike options that give advice to the client. Next, eliminate the option that is sarcastic. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 52 1 / 1 pts A client says to the nurse, “My health care provider wants me to start keeping a journal every day about what’s happening in my job.” Which response by the nurse is appropriate?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 74/146 “You can erase your stresses by identifying things that set off negative physical experiences.” “Well, it has always helped me to write down daily happenings and relate them to my stress level.” “Yes, that is an excellent suggestion. You need to keep a meticulous diary of your day with all of the details.” “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! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 75/146 Rationale: Journal-keeping can help the client identify situations that produce stress. In stating “You can erase your stresses by identifying things that set off negative physical experiences,” the nurse discusses the issue of stress reduction but is misleading to the client: It may not be possible to actually “erase” stresses. In stating “Well, it has always helped me to write down daily happenings and relate them to my stress level,” the nurse provides a personal example for feedback, but its timing and use are nontherapeutic because the statement has a lecturing tone and focuses on the nurse. “Yes, that is an excellent suggestion. You need to keep a meticulous diary of your day with all of the details” is nontherapeutic because the statement gives approval. Additionally, journal-keeping needs to be effortless, with just a few key words used to remind the client of what took place and its effects on him or her. It is not meant to be a chore, which would only increase stress. Test-Taking Strategy: Use knowledge of therapeutic communication techniques to assist you with the process of elimination. Eliminate the option that focuses on the nurse, not the client. Next, eliminate the options that use the words “erase” and “all of the details.” Review the advantages of journal-keeping if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 53 1 / 1 pts 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, now I’m suddenly a golf widow.” Which response by the nurse is appropriate? “Do other people call you a golf widow?”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 76/146 Correct! Correct! “Have you shared your feelings with your husband?” “When you can’t beat ’em, join ’em—that’s what I always say. Why not play golf with him?” “Some women wish they had your problem. My mother keeps complaining that Dad is always messing around in the house, driving her nuts.” Rationale: The correct option, encouraging the client to share her feelings with her husband, helps the client begin to problem-solve. Asking “Do other people call you a golf widow?” is nontherapeutic probing. “When you can’t beat ’em, join ’em—that’s what I always say. Why not play golf with him?” is a nontherapeutic cliché. In stating “Some women wish they had your problem. My mother keeps complaining that Dad is always messing around in the house, driving her nuts,” the nurse offers a nontherapeutic social response that is focused on the nurse instead of on the client. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Select the option that is focused on the client’s sharing of feelings with her husband. Review therapeutic communication techniques and the process of problem-solving if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 54 1 / 1 pts 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 daughter7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 77/146 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? “My parents would be devastated if they lost me and my sister, too. How can I be of service to you?” “Your feelings are appropriate for the extent of your loss and how your children’s deaths happened.” “Your loss touches me so. How truly devastated you both must be. Can you share what things you have been doing to grieve?” Correct! Correct! “Your loss is incalculable. Perhaps you could consider some ways in which to commemorate their lives for you and in your community.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 78/146 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 offers 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 the process of elimination and 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 if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 55 1 / 1 pts The slightly overweight mother of a morbidly obese 11-year-old girl says, “My family physician 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 was7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 79/146 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? “Well, it seems very bleak to you, but your daughter is responsible for her eating and exercising, too.” “What about her father? Isn’t it partly his fault, too? I want to meet with you, him, and your daughter tomorrow.” “It’s all this fast food and TV-watching these days. If our kids aren’t watching television, they’re playing with their computers.” “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! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 80/146 Rationale: Self-blame is a negative stress response in which self-esteem is minimized, which will stop the client from acting to solve problems effectively. The use of a support system is the positive stress response recommended to help the client mobilize and stop the selfblame. By stating “Well, it seems very bleak to you, but your daughter is responsible for her eating and exercising, too,” the nurse offers reflection but prematurely interprets the client’s feelings. “What about her father? Isn’t it partly his fault, too? I want to meet with you, him, and your daughter tomorrow” is nontherapeutic because it is social and peremptory. “It’s all this fast food and TV-watching these days. If our kids aren’t watching television, they’re playing with their computers” is nontherapeutic because it is a social response that does not assist the client in stopping self-blame. Test-Taking Strategy: Use the process of elimination and your knowledge of therapeutic communication techniques. Focusing on the subject, reducing the client’s self-blame, will direct you to the correct option, which is the only option that addresses the subject and shows the nurse attempting to problem-solve. Review measures to reduce the client’s self-blame if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 56 1 / 1 pts A client says to the nurse, “My health care provider 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? “PMR requires training sessions. Let’s check into classes that you can attend to learn the technique.” Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 81/146 “I want you to practice it as often as you can. Play soft, soothing music in the background when you practice your exercises.” “For it to be effective and produce deep relaxation, the technique requires your complete receptivity to its benefit and your need for it.” “I could never master the technique myself, so I understand your frustration. Would you like me to explain its difficulty for you to the health care provider?”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 82/146 Rationale: Progressive muscle relaxation, or PMR, a technique designed to help the client achieve relaxation by eliminating muscle contraction through systematic tensing and releasing of various muscles, requires the client to attend training for its use. The client learns to discriminate between sensations of tension and relaxation. In stating “I want you to practice it as much as you can. Play soft, soothing music in the background when you practice your exercises,” the nurse does not address the client’s need for teaching and learning. “For it to be effective and produce deep relaxation, the technique requires your complete receptivity to its benefit and your need for it” is nontherapeutic because the nurse is offering incorrect information and implying that the client is unreceptive to learning. In stating “I could never master the technique myself, so I understand your frustration. Would you like me to explain its difficulty for you to the health care provider?” the nurse uses a nontherapeutic response that is social and does not support the client’s need for mastery. Test-Taking Strategy: Knowledge regarding the subject, this relaxation technique, is needed to answer this question. Note that the question indicates the client is having difficulty learning this relaxation technique. The correct option is the only option that assists the client in learning the technique. Review progressive muscle relaxation technique if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 57 1 / 1 pts A nurse is teaching assertiveness training to a client with angermanagement issues. Which instruction would the nurse give for helping the client assertively confront someone?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 83/146 Emphasize how much you like the person but insist that the other person make the changes you need. Tell the person that the behavior has become intolerable for you and that the behavior must be changed immediately. Demonstrate that you understand how the other person feels but state that you still expect the other person to make the changes you need. 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! Correct! Rationale: The formula for confrontational assertion is to “ask for private time to talk and point out facts without being accusatory, then determine areas of mutual misunderstanding and request the changes that you need.” The incorrect options identify aggressive rather than assertive approaches. Test-Taking Strategy: Use the process of elimination and focus on the subject, assertiveness. Eliminate the options that contain the closed ended words “insist,” “must,” and “expect.” These words indicate aggressiveness, not assertiveness. Review assertiveness principles if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Teaching and Learning Content Area: Mental Health Question 58 1 / 1 pts7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 84/146 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? “Perhaps you need to focus on being happy that you survived.” “You’re saying basically that you feel useless without your hand?” Correct! Correct! “Don’t worry about all of that at this point. You’re going to be fine.” “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.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 85/146 Rationale: In the correct option, the nurse summarizes, refocuses, and seeks to reframe the client’s thinking, an intervention that may help relieve some of the stress the client is experiencing. In stating “Perhaps you need to focus on being happy that you survived,” the nurse is nontherapeutic and preaching to the client, in addition to making a closed-ended statement. “Don’t worry about all of that at this point. You’re going to be fine” is false reassurance. “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” is nontherapeutic, social, and sarcastic. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. The correct option is the only option that focuses on the client’s feelings. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 59 1 / 1 pts 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? “You didn’t know that he had AIDS? How did he see the family physician without your knowing?” “Your poor son. How troubled he must have been. It’s a shame he couldn’t talk to you and get some help.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 86/146 “Your son had an autopsy because he committed suicide, but the coroner didn’t have to tell you that he was ill.” “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! Correct! Rationale: The therapeutic response is the one that makes observations and is helpful in supporting the client as he or she grieves. “You didn’t know he had AIDS? How did he see the family physician without your knowing?” is a redundant question that simply places emphasis on the client’s not having the child’s confidence. It is also nontherapeutic, because the nurse is changing the subject. “Your poor son. How troubled he must have been. It’s a shame he couldn’t talk to you and get some help” is nontherapeutic because it is social and fosters a sense of guilt. In stating “Your son had an autopsy because he committed suicide, but the coroner didn’t have to tell you that he was ill,” the nurse makes a social statement that changes the focus and moves away from the client’s grief. Test-Taking Strategy: Use therapeutic communication techniques to assist you with the process of elimination. The correct option is the only one that shows supportiveness of the client. Review measures for providing support to a client who is grieving if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 60 1 / 1 pts A recently widowed client says, “I lived my whole life for my husband and children. Now he’s dead and my daughter and son7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 87/146 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? “Your children seem very distant. They hardly ever call?” “Are you thinking of hurting yourself just because you’re alone?” “You’re feeling pretty useless right now, but I wonder if you’ve taken enough time to grieve?” “You seem to be identifying some issues in your life that are troubling, and you sound very down right now.” Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 88/146 Rationale: The therapeutic response is the one that reflects the client’s losses and proceeds to focus on the client’s depressive symptoms by making an observation and seeking clarification. After the nurse validates these 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 if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 61 1 / 1 pts 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?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 89/146 Correct! Correct! “I am sorry you’ve had so many losses.” “I lost my nephew in that nightclub fire, so I understand your sorrow.” “Your grandchildren sound as if they will give you a run for your money.” “Don’t you just want to scream at someone when such bad things happen? Do you have to work to support your grandchildren?” Rationale: The correct option provides an empathetic response to the client. In stating “I lost my nephew in that nightclub fire, so I understand your sorrow,” the nurse changes the focus of the client’s expression of feelings to her own loss, a nontherapeutic communication. “Your grandchildren sound as if they will give you a run for your money” and “Don’t you just want to scream at someone when such bad things happen? Do you have to work to support your grandchildren?” are both social responses. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Eliminate the comparable or alike options that are social responses. Next, eliminate the option that focuses on the nurse rather than the client. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 62 1 / 1 pts The family of a client who is being discharged after trying to kill himself with one of his father’s guns asks for a family meeting7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 90/146 with the nurse to discuss their son’s situation. Which statement by the nurse would be the most therapeutic start to the meeting? “I must begin by saying that I am uncomfortable meeting without your son here to talk for himself.” “Let’s start by introducing ourselves and talking about what is most troubling to each of you about having your son home.” “Why don’t we all introduce ourselves and say what our relationship is to your son? I’ll begin, because I’m the nurse who’ll be seeing him after he goes home.” “I am going to begin by talking in general terms about your son’s return home and some of the things that might happen. I can suggest measures that might be helpful, and then you can ask questions.” Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 91/146 Rationale: Family therapy is a good idea when violence is part of a crisis or if the family requests help. By offering ways to cope and support the client, the nurse can relieve any hesitation on the part of the family about discussing their concerns. In stating “I must begin by saying that I am uncomfortable meeting without your son here to talk for himself,” the nurse uses a confrontational style of speaking that is not pertinent to the issues at hand. The family members have a right to their own counseling and to teaching on how to assess mood and suicidal ideation. At the appropriate time the nurse can request that the client be invited to attend the family therapy sessions. In stating “Let’s start by introducing ourselves and talking about what is most troubling to each of you about having your son home,” the nurse uses an orientation and broad opening technique that may be helpful but is not the best of the options provided. By stating “Why don’t we all introduce ourselves and say what our relationship is to your son? I’ll begin, because I’m the nurse who’ll be seeing him after he goes home,” the nurse uses a style that is introductory, but then the nurse changes the focus to herself, which is not therapeutic. Test-Taking Strategy: Use knowledge of the subject, therapeutic communication techniques, to help you with the process of elimination. Note that the family members requested a meeting. Note that the correct option is the option that provides information and encourages the family members to verbalize concerns. Review the principles of family therapy if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 63 1 / 1 pts A client with depression says to a nurse, “Why is my family meeting with you? Are you telling them about me?” Which response by the nurse would be therapeutic?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 92/146 “Have you talked with your family? What have they said to you about the meetings?” “I am committed to keeping everything you say to me confidential, so it is troubling when you accuse me of talking to your family.” “You sound concerned that I would tell your family something about you even though you know that what we talk about is confidential.” “Your family is learning about depression and how best to help you so that they can be supportive of you. We do not talk about you or anything confidential about you.” Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 93/146 Rationale: The therapeutic response is the one that helps the client understand that the family meetings are educational. This openness and the assurance of confidentiality will help allay the client’s fears and build trust. In stating “Have you talked with your family? What have they said to you about the meetings?” the nurse changes the focus and places responsibility on the family, which is nontherapeutic. In stating “I am committed to keep everything you say to me confidential, so it is troubling when you accuse me of talking to your family,” the nurse shifts the focus from the client’s concerns to the feelings of the nurse. By stating “You sound concerned that I would tell your family something about you even though you know that what we talk about is confidential,” the nurse focuses on the client’s concerns but does so in a challenging way. Test-Taking Strategy: Use the process of elimination and your knowledge of therapeutic communication techniques. Eliminate the option that avoids the client’s concern and places the responsibility on the family. Next, eliminate the option that challenges the client. From the remaining options, select the option that focuses on the client’s feelings. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 64 0 / 1 pts A client who has been referred for group therapy asks the nurse about the therapy. The nurse tells the client that this type of therapy is focused on which aspect(s)? Y You Answered ou Answered Social skills training Social functioning in groups7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 94/146 Cognitive behavioral therapy The development of interpersonal skills, resolution of family problems, and effective use of community support Correct Answer Correct Answer Rationale: Group therapy is especially effective in helping clients develop interpersonal skills, resolve family problems, and use community support effectively. Group therapy is also used to solve everyday problems, to express feelings and emotions, to ask questions, and to share experiences. It does not provide social skills training and is not focused on social function or cognitive behavioral therapy. Test-Taking Strategy: Use the process of elimination and focus on the subject, group therapy. Eliminate the options that are comparable or alike and address social skills and social function. Of the remaining options, note that the correct option is the umbrella option, addressing several functions of the therapy. Review the functions of group therapy if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 65 1 / 1 pts The parents of an adopted child schedule an appointment at a psychiatric clinic, and when they arrive, the nurse conducts an initial interview. One of the parents says to the nurse, “We need to speak to a psychiatrist about our adopted daughter. Could you please get one for us?” Which intervention by the nurse would be therapeutic? “I’d like to accommodate you, but he is busy right now and you will have to talk to me.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 95/146 “Do you feel that I am incompetent to talk with you? Everyone who comes here sees me first.” “That is not the procedure here. If you can’t work with the system, you’re free to go elsewhere.” “The health care providers here feel that clients are best served when I conduct the initial interview after which the psychiatrist will see you with complete information.” Correct! Correct! Rationale: The therapeutic intervention is the one that explains the clinic’s procedure to the parents and moves on from there. “I’d like to accommodate you, but he is busy right now and you will have to talk to me” is abrupt, which is dismissive and nontherapeutic. In stating “Do you feel that I am incompetent to talk with you? Everyone who comes here sees me first,” the nurse personalizes the client’s request for the psychiatrist and is nontherapeutic. By stating the policy in a baiting, snide style, the nurse creates a barrier and will meet resistance from the clients. In stating “That is not the procedure here. If you can’t work with the system, you’re free to go elsewhere,” the nurse is nontherapeutic, making the policy known in a pedantic style of communication. The patronizing style of the communication is nontherapeutic and will serve as a barrier when the nurse tries to elicit data. Test-Taking Strategy: Use the process of elimination and your knowledge of therapeutic communication techniques. The correct option is the only option that describes the procedures of the unit and facilitates a nurse-client relationship. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 96/146 Question 66 1 / 1 pts A 45-year-old fireman says to the nurse, “I’ve worked at some fires recently that were just devastating, but last week was the worst. I carried this little girl from a fire—she was badly burned and lived just a few minutes after I brought her out, and she said to me, ‘Tell my mom and Rudy I love them both very much.’ Her mom told me that Rudy is their dog, and he just mopes around the house since the little girl died. I keep thinking about her and just don’t know if I can go on.” Which response by the nurse would be therapeutic? “Maybe you could help the mother find a home for Rudy, and then your troubling thoughts would go away.” “Would you listen to yourself? You’ve seen firemen stress out before. What is your responsibility in all this?” “You’ve helped victims of some horrific fires lately, and yet you question your calling. Do you feel the need to resign?” “You’re questioning your job because you’re upset about the little girl you tried to save. Work stress can be treated and help you cope better. It is so important for you to seek treatment.” Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 97/146 Rationale: The fireman may be experiencing work-related stress that, if untreated, could evolve into posttraumatic stress disorder. In the correct option, the nurse offers an observation in a neutral style, stressing that the fireman will benefit from seeking treatment. With the suggestion “Maybe you could help the mother find a home for Rudy, and then your nightmares would go away,” the nurse changes the subject, is insensitive, and is nontherapeutic. In saying, “Would you listen to yourself? You’ve seen firemen stress out before. What is your responsibility in all this?” the nurse nontherapeutically lectures and chastises the client. In stating “You helped victims of some horrific fires lately, and yet you question your calling. Do you feel the need to resign?” the nurse reflects the fireman’s positive contributions that he already knows and then asks him whether he is thinking of acting on his ruminations. Although the nurse clearly strives to determine the client’s problems, it is nontherapeutically timed and the nurse has no basis for making this judgment. Test-Taking Strategy: Use the process of elimination and therapeutic communication techniques. Note that the correct option is the umbrella option and addresses the seeking of treatment. Review care of the client who has experienced emotional trauma if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 67 1 / 1 pts A 68-year-old client whose husband died 2 months ago says to the nurse, “I’m having trouble sleeping lately, even though I don’t nap in the daytime. I’ve been using warm milk without any results.” Which statement by the nurse would be therapeutic? “So you’ve started having sleeping problems but no other problems?”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 98/146 “Perhaps you should join the grieving spouses group that meets on Monday nights.” “Since you’ve lost your husband, have you experienced any other problems besides trouble sleeping?” “One of the things that I’ve found has helped others is a small snack with your warm milk before sleep and a moderate increase in walking during the day. Is that something you could try?” Correct! Correct! Rationale: The therapeutic statement is the one that offers additional strategies to aid sleep and gauges whether the client can follow the suggestion. In stating “So you’ve started having sleeping problems but no other problems?” the nurse probes the client for other problems, which is a nontherapeutic response. By stating “Perhaps you should join the grieving spouses group that meets on Monday nights,” the nurse changes the focus of the client’s concerns and is nontherapeutic in prematurely suggesting the group therapy. By asking “Since you’ve lost your husband, have you experienced any other problems besides trouble sleeping?” the nurse nontherapeutically reminds the client of her loss and links the sleeplessness to the loss. Test-Taking Strategy: Use the process of elimination. Eliminate the comparable or alike options that ask the client about experiencing other problems. Next, eliminate the option that does not address the client’s concern. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 68 1 / 1 pts7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 99/146 A 25-year-old client says to the nurse, “I got my degree in criminal justice. I graduated first in my class from the police academy and had just started as a patrolman when my partner and I responded to a domestic violence call in the most rural part of our patrol area. Someone started shooting at us, and I’m terrified. Maybe I’m not right for this job.” Which statement by the nurse would be therapeutic? “You’re saying that because you felt afraid in a violent situation, you may not be right for the job?” Correct! Correct! “Did you really think that you wouldn’t be frightened? You’re fortunate if this is the first time you’ve ever been afraid.” “You seem to be surprised that you were frightened by the violence. Have you talked with your coworkers about their experiences?” “My earlier work as a nurse involved trips through our local crack houses. Wait until you’ve had some experience working narcotics and then tell me how you feel.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 100/146 Rationale: The therapeutic response is the one that reflects what the client says so that the client can reexamine his feelings in a more reflective context. The client is surprised that he felt fear when placed in the actual situation and believes that policemen should not be afraid. If he reexamines his feelings, he will realize that his thinking is irrational. In stating “Did you really think that you wouldn’t be frightened? You’re fortunate if this is the first time you’ve ever been afraid,” the nurse nontherapeutically lectures the client and is somewhat dismissive. In stating “You seem to be surprised that you were frightened by the violence. Have you talked with your coworkers about their experiences?” the nurse makes observations and offers the suggestion that the client talk with coworkers. Although this may be an option, it is not the best one, because the client has already sought out professional assistance. In stating “My earlier work as a nurse involved trips through our local crack houses. Wait until you’ve had some experience working narcotics and then tell me how you feel,” the nurse nontherapeutically changes the subject to a personal experience and belittles the client’s feelings. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. This will direct you to the correct option because it is the option that reflects back what the client says so that the client can reexamine his feelings. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 69 1 / 1 pts A home care nurse makes a new-baby visit to a young husband and wife. The visit takes 2.5 hours because the parents are so detailed in giving information and asking questions of the nurse. Which intervention by the nurse would be therapeutic?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 101/146 Ordering a follow-up visit to the family pediatrician and mental health clinical specialist Informing all home care nurses to schedule their visits to the couple as their last visit of the day Having the home care office secretary call the nurse’s cell phone 20 minutes after starting the visit to expedite the nurse’s departure Blocking out more time for the next visit and scheduling a followup visit as soon as possible to assess how they are coping and gauge their level of anxiety Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 102/146 Rationale: The young parents of a new baby are likely working hard to cope with anxiety and to deal with their fears of doing something wrong with the baby. Therefore the nurse should block out more time for the next visit and schedule another visit as soon as possible to assess how they are coping and gauge their level of anxiety. Ordering a follow-up visit to the family pediatrician and mental health clinical specialist is incorrect because it is premature without a total assessment of the parents’ coping skills. Informing all home care nurses to schedule their visits to the couple as their last visit of the day and having the home care office secretary call the nurse’s cell phone 20 minutes after starting the visit to expedite the nurse’s departure are unprofessional. Additionally, the nurse needs to be assertive enough to set limits on the duration of the meetings. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques and eliminate the options that are unprofessional actions. Also, use the steps of the nursing process and recall that assessment is the first step. The correct option is the one that addresses assessment. Review therapeutic interventions for the client experiencing anxiety if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 70 1 / 1 pts A 35-year-old recently divorced parent of twins comes to the intake office of the psychiatric clinic for the first time with a possible diagnosis of generalized anxiety disorder. The client says to the nurse, “My mother always called me a worrywart like my nana, so I guess I come by my problems naturally. I keep worrying about things I can’t change, like my divorce, and blaming myself when I know I’m not the only one responsible for the divorce.” Which nursing statement would be therapeutic?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 103/146 “Yet you seem to be dwelling on the thought that the divorce is all your fault.” “Can you tell me more about the worrying and blaming you are experiencing?” Correct! Correct! “I wonder whether you think you’re responsible for making everything turn out right.” “So you’re a natural worrywart, divorced with twins. I guess you can be forgiven for a little worrying, but tell me about the blaming you’ve been doing.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 104/146 Rationale: Generalized anxiety disorder is characterized by excessive worrying that cannot be controlled. Therefore, the therapeutic response is the one that explores and seeks clarification of the client’s comment. The nurse will further assess the client for restlessness, fatigue, irritability, muscle tension, sleep disturbances, and difficulty concentrating. By focusing on the excessive worrying and blame, the nurse is checking to determine whether any of these problems is present. In stating “Yet you seem to be dwelling on the thought that the divorce is all your fault,” the nurse prematurely interprets the client’s concerns. In stating “I wonder whether you think you’re responsible for making everything turn out right,” the nurse asks an inappropriate question before establishing trust in a one-on-one relationship. In stating “So you’re a natural worrywart, divorced with twins. I guess you can be forgiven for a little worrying, but tell me about the blaming you’ve been doing,” the nurse uses a social response and sarcastic humor. Test-Taking Strategy: Use the process of elimination and your knowledge of therapeutic communication techniques. Note the relationship between the information in the question and the correct option. Also note that the correct option is the only option that identifies the use of a therapeutic communication technique (exploring and seeking clarification of the client’s comment). Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 71 1 / 1 pts A female victim of incest says to the nurse, “I’ve had tons of therapy but still can’t let my fiancé get too close. He knows I’ve been sexually abused by my dad and older brother, but I’m wondering whether I’ll ever be able to lead a normal sexual life.” Which statement by the nurse would be therapeutic?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 105/146 “Can you share with me some of the strategies you’ve been using?” Correct! Correct! “Do you want a normal sexual life? If you do, you will have one, I’m sure.” “It almost seems that you’re saying that you will never be able to love your fiancé.” “You seem to be saying that you and your fiancé haven’t been close, yet you found each another.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 106/146 Rationale: The question presents a client who may have posttraumatic stress disorder (PTSD) as a result of incest in childhood. The client’s positive adaptive capacity is demonstrated by the ability to discuss the victimization and the attempt to reach out for a normal sexual relationship. The nurse should assist the client in focusing on her strengths and sources of support and using them to achieve optimal coping. In stating “Do you want a normal sexual life? If you do, you will have one, I’m sure,” the nurse nontherapeutically employs platitudes and makes an insensitive, pat social response. In stating “It almost seems that you are saying that you will never be able to love your fiancé,” the nurse nontherapeutically reflects the negative cognitive thinking pattern rather than aiding cognitive restructuring or other coping strategies. In stating “You seem to be saying that you and your fiancé haven’t been close, yet you found each another,” the nurse attempts to reflect the client’s feelings and to offer another way of looking at the relationship. Because data collection should be performed first, this is not the best response. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. The correct option is the only option that is open ended and encourages the client to talk about her situation. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 72 1 / 1 pts A client who witnessed her husband’s being shot and killed in an incident of road rage says to the nurse, “It’s been 3 months now, and I still can’t drive my car without acting crazy. My sister says I grip the wheel like I’m glued to it. I can’t merge with traffic until it’s almost completely clear, and I’m parking a mile from the mall when there’s plenty of parking close to the building.” Which statement by the nurse would be therapeutic?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 107/146 “I still grip the wheel when I merge with traffic, and I just wonder whether your sister needs to see me do it.” “If I were you, I’d have trouble driving the car again. Driving a car and being the victim of road rage are two very different things, and you need therapy and time to heal.” “Smart of you to take no chances. You should see the dents and dings on my car from mall parking. Does your sister depend on you for many things? It seems like she’s pushing you too hard.” “You’re seeking help appropriately, and there are many things you can do to get comfortable behind the wheel again. You’ve returned to driving, but remember, you’re still grieving. It’s normal to still feel this way.” Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 108/146 Rationale: The client in this question has witnessed an incident of violence on the road. In addition, she has lost her husband, so she is experiencing grief and the subjective feelings that accompany loss. The correct option supports the client and tells her that her actions to resolve her grief are appropriate. Even individuals with good coping and adaptive skills would need extra support after experiencing such a violent situation. In stating “I still grip the wheel when I merge into traffic, and I just wonder whether your sister needs to see me do it,” the nurse makes a nontherapeutic social response that first is off focus and does not facilitate feelings and then is sarcastic with regard to the client’s sister. In stating “If I were you, I’d have trouble driving the car again. Driving a car and being the victim of road rage are two very different things, and you need therapy and time to heal,” the nurse is trying to help the client realize that her fears and anxiety are common yet personalizes the situation and gives advice. In stating “Smart of you to take no chances. You should see the dents and dings on my car from mall parking. Does your sister depend on you for many things? It seems like she’s pushing you too hard,” the nurse’s own anxiety (perhaps because of fear of the road rage event) produces a nontherapeutic rambling style of communication and asks questions. Test-Taking Strategy: Use the process of elimination and your knowledge of therapeutic communication techniques. The correct option is the only option that provides support to the client and tells the client that she is appropriately seeking strategies to effectively resolve her grief. Review therapeutic communication techniques and effective coping skills if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 73 1 / 1 pts A 35-year-old client says to the nurse, “I got divorced less than a year after getting married. I left the Navy SEALs shortly after I7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 109/146 joined. Now I teach in the air marshal program to avoid being recalled for war, but I’d really like to quit. I start something, am great at it, then get bored and move on. I date, but I’m still living at home. I never seem to be on my own like other guys my age.” Which response by the nurse is most appropriate? “You made the Navy SEALs but can’t live on your own like an adult and can’t stick with anything.” “Can you tell me more about your marriage and relationships? If you leave home, what do you fear will happen?” Correct! Correct! “You have many years to find a new relationship, but moving out of your parents’ home is a first step to growing up.” “When will your mother let you go? Seems to me that jobs have come easy to you but that you can’t grow up and separate from your parents.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 110/146 Rationale: The client in the question admits his inability to maintain personal and work relationships and seems unable to leave home. The correct option focuses on the client’s concerns. In stating “You made the Navy SEALs but can’t live on your own like an adult and can’t stick with anything,” the nurse starts by recognizing the client’s achievement but then diminishes it by nontherapeutically and sarcastically accusing the client of not being able to stick with anything and being unable to grow up. In stating “You have many years to find a new relationship, but moving out of your parents’ home is a first step to growing up,” the nurse uses labeling. In asking “When will your mother let you go? Seems to me that jobs have come easy to you but that you can’t grow up and separate from your parents,” the nurse is premature in judging what is happening to this client. It is nontherapeutic to label the client’s struggles as not growing up. The client may interpret this as ridicule. Test-Taking Strategy: Use the process of elimination and your knowledge of therapeutic communication techniques. Eliminate the comparable or alike options that indicate the client is “not growing up.” Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 74 0 / 1 pts A client says to the nurse, “I have to do everything. My family can’t plan or organize anything. My wife just wants to go out and socialize. My grown son and his wife live with us. They never do anything around the house but ‘their’ stuff, because they say they pay rent. We really need their rent money since I lost my job. My wife could work but she says ‘it’s too late to start over’ for her. Well, that’s what I’m doing—more work at far less money.” Which response by the nurse would be therapeutic?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 111/146 “Do the terms ‘divorce’ and ‘leave the nest’ mean anything to you or your family?” “Would your family come in to see me so I can hear their version of the problems you cite?” “You seem to be going through quite a lot recently. I’d like to hear more from you about your concerns. Would your family come in and talk with us?” Correct Answer Correct Answer “You tell me that you do everything. You don’t say what happens when you stop doing everything. Does your wife understand that you are not able to work as you once did and that you need her help?” Y You Answered ou Answered7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 112/146 Rationale: In the correct option, the nurse acknowledges the client’s concerns, encourages the client to express his feelings and concerns, and addresses the family. Also, the client views the situation solely from his viewpoint, so it would be most therapeutic to work with the entire family; however, it is important to obtain the client’s permission to invite the family. In asking “Do the terms ‘divorce’ and ‘leave the nest’ mean anything to you or your family?” the nurse uses humor and sarcasm in a nontherapeutic way. Although the nurse is correct in viewing this as potentially being a family problem as well as an individual one, asking “Would your family come in to see me so I can hear their version of the problems you cite?” is nontherapeutic, with the potential to cause a negative response from the client. In saying, “You tell me that you do everything. You don’t say what happens when you stop doing everything. Does your wife understand that you are not able to work as you once did and that you need her help?” the nurse seems accusatory, which is nontherapeutic. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. The correct option is the umbrella option, which addresses the client’s concerns, encourages the client to express his feelings and concerns, and addresses the family. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Nursing Process/Implementation Content Area: Mental Health Question 75 1 / 1 pts On the initial visit to the mental health clinic, a client says to the nurse, “When I married my husband, more than 30 years ago, he was a big, handsome, competent professional who never wanted me to work and was so loving. Well, two kids later he’s a slob who gambles and loses one job after another. Now I’m the breadwinner, and he’s content to be a shiftless town joke.” Which statement by the nurse would be therapeutic?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 113/146 “You sound disgusted with your husband. Is this an accurate assessment? Why not divorce him?” “Can you tell me how long you have felt like this and how much longer you plan to continue this way?” “You seem to have changed your feelings about your husband completely. This didn’t happen overnight, so why are you here now?” “Many things have happened to you and your husband. Sounds as if you’ve both been struggling for some time. Would you like to have him come in with you to talk with me about all of this?” Correct! Correct!7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 114/146 Rationale: The client is telling the nurse that many things that have happened over time. These things did not occur at once, and it is important for the nurse to learn more from the couple and for the couple to hear each other. The correct option reflects this intervention. In stating “Can you tell me how long you have felt like this and how much longer you plan to continue this way?” the nurse uses confrontation and sarcasm, both of which are nontherapeutic. Saying “You sound as if you are disgusted with your husband. Is this an accurate assessment? Why not divorce him?” prematurely labels and judges the client’s feelings. “You seem to have changed your feelings about your husband completely. This didn’t happen overnight, so why are you here now?” is a “why” question, and the way that the nurse is challenging the client is nontherapeutic in the initial phase of a relationship. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques and the process of elimination. The correct option involves the therapeutic communication technique of reflection and addresses both the client and the client’s husband. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 76 1 / 1 pts A lesbian client says to the nurse, “I was cheating on my lover because I need the thrill of seeing someone new, and now my lover has left me to go live with this other woman. I know that this other woman wants more than friendship from my lover, and I can’t make my lover see that I love her and that my affairs are meaningless. I don’t want to lose her, but I can’t stop cheating because I need the thrill it brings.” Which statement by the nurse would be therapeutic?7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 115/146 “So she’s left you for cheating on her. If you can’t be monogamous, I guess you’ll have to be content with one-night stands.” “I’m confused. What is it that you’ve come to me for? It sounds like your lover refuses to share her lover with others, no matter how trivial the dalliances.” “Perhaps your task is not to make your lover see that your dalliances are meaningless but to look at your own behavior and determine what you would like or not like to be different.” Correct! Correct! “It sounds like you want to have your cake and eat it too. If you can’t have both things, which would you prefer, the thrill of onenight stands or the steady support of a loving relationship?”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 116/146 Rationale: The client is taking a narcissistic and entitled approach to her intimate relationship. The nurse needs to focus the client on her own behaviors and desires in a neutral way. Although the nurse’s neutrality may produce anger, the nurse must set boundaries and delimit the sphere of treatment to be covered. In the correct option, the nurse uses the therapeutic technique of summarizing and refocusing. In the remaining options, the nurse is judgmental. Also, in saying “It sounds like you want to have your cake and eat it too. If you can’t have both things, which would you prefer, the thrill of one-night stands or the steady support of a loving relationship?” the nurse is nontherapeutic, using clichés and predeterminations before all necessary information has been gathered. Test-Taking Strategy: Use your knowledge of therapeutic communication techniques. Eliminate the comparable or alike options in which the nurse is judgmental. Also note that the correct option is the only option in which the client is encouraged to focus on her own behavior. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation Content Area: Mental Health Question 77 1 / 1 pts A 52-year-old client is admitted to the hospital for surgery to treat lung cancer. The client says to the nurse, “I was an alcoholic for 15 years, and now that I’m 25 years sober, I’m being punished.” Which statement by the nurse would be therapeutic? “You started drinking at 12 years of age—is that why you feel that the cancer is retribution?”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 117/146 “Because you seem to be blaming yourself unnecessarily, perhaps we can talk about your illness and what caused it.” Correct! Correct! “Sounds like you feel that you’re being punished for your drinking, yet you’ve been sober, so perhaps you’re being rewarded by having a cancer that’s curable.” “You feel that you’re being punished even though you’ve been sober for 25 years. Your health care provider must have told you that the cancer is unrelated to alcohol.”7/19/2021 Module 3 Exam: HESI VN TXGRP 1912COHORT(VNE 39) https://concorde.instructure.com/courses/18612/quizzes/83923?module_item_id=1519719 118/146 Rationale: The client in this question is expressing guilt and anxiety regarding his cancer diagnosis and impending surgery. Because he is anxious, the most therapeutic approach is to avoid trying to convince him that he is blameless in his cancer diagnosis and to move to health teaching and anticipatory guidance that may help reduce his anxiety and relieve his guilt. In asking “You started drinking at 12 years of age—is that why you feel that the cancer is retribution?” the nurse focuses on his early onset of alcoholism and the need to convince him that he’s faultless. In stating “Sounds like you feel that you’re being punished for your drinking, yet you’ve been sober, so perhaps you’re being rewarded by having a cancer that’s curable,” the nurse starts by trying to convince the client that he is blameless for the cancer and then tries to restructure but does not use logic. In stating “You feel that you’re being punished even though you’ve been sober 25 years. Your health care provider must have told you that the cancer is unrelated to alcohol,” the nurse reflects his guilt back to him. Test-Taking Strategy: Use the process of elimination and your knowledge of therapeutic communication techniques. The correct option is the only option that addresses the client’s feelings and encourages the client to share them. Review therapeutic communication techniques if you had difficulty with this question. Cognitive Ability: Applying Client Needs: Psychosocial Integrity Integrated Process: Communication and Documentation [Show More]

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