1. D.

Rationale: Responding to the feelings expressed by a client is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the client’s experience and do not facilitate exploration of the client’s expressed feelings. In addition, use of the word why is nontherapeutic.

Test-Taking Strategy: Use therapeutic communication techniques to direct you to the option that directly addresses the client’s feelings and concerns. Also, the correct option is the only one stated in the form of a question that is open-ended, which will encourage the verbalization of feelings.

Review: Therapeutic communication techniques
Level of Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Priority Concepts: Communication; Mood and Affect
Reference: Halter & Varcarolis (2013); Videbeck & Miller (2019); Townsend & Morgan (2018).

2. B.

Rationale: Knowing the client’s interests is the best place to begin to help the client resocialize. Knowing with whom the client wishes to socialize, what transportation she has, or how much spending money she has may be relevant questions, but should be asked after the question concerning what activities the client enjoyed in the past.

Review: Psychosocial adaptation
Level of Cognitive Ability: Synthesizing
Client Needs: Psychosocial Integrity
Integrated Process: Communication
Content Area: Mental Health
Priority Concepts: Interpersonal interaction
Reference: (Billings, 2019); Videbeck & Miller (2019).

3. A.

Rationale: Open-ended questions and silence are strategies used to encourage clients to discuss their problems. Sharing personal food preferences is not a client-centered intervention. The remaining options are not helpful to the client because they do not encourage the client to express feelings. The nurse should not offer opinions and should encourage the client to identify the reasons for the behavior.

Test-Taking Strategy: Use therapeutic communication techniques. First eliminate options that do not support the client’s expression of feelings. Any option that is not client-centered should be eliminated next. Focusing on the client’s feelings will direct you to the correct option.

Review: Therapeutic communication techniques
Level of Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Priority Concepts: Communication; Psychosis
Reference: Halter & Varcarolis (2013); Videbeck & Miller (2019); Townsend & Morgan (2018).

4. A, F.

Rationale: The stages of group development include the initial stage, the working stage, and the termination stage. During the initial stage, the group members become acquainted with one another, and some structuring of group norms, roles, and responsibilities takes place. During the initial stage, group interaction involves superficial conversation. During the working stage, the real work of the group is accomplished. During the termination stage, the group evaluates the experience and explores members’ feelings about the group and the impending separation.

Test-Taking Strategy: Focus on the subject, the termination stage. Reading each item presented and recalling the stages of group development and the definition of termination will assist you in answering this question.

Review: Therapeutic communication techniques
Level of Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Priority Concepts: Communication; Collaboration
Reference: Halter & Varcarolis (2013); Videbeck & Miller (2019); Townsend & Morgan (2018).

5. C.

Rationale: Restating is a therapeutic communication technique in which the nurse repeats what the client says to show understanding and to review what was said. While it is appropriate for the nurse to attempt to assess the client’s ability to discuss feelings openly with family members, it does not help the client to discuss the feelings causing the anger. The nurse’s direct attempt to expect the client to talk more about the anger is premature. The nurse would never make a judgment regarding the reason for the client’s feeling; this is nontherapeutic in the one-to-one relationship.

Test-Taking Strategy: Use therapeutic communication techniques. The correct option is the only one that identifies the use of a therapeutic technique (restatement) and focuses on the client’s feelings.

Review: Therapeutic communication techniques
Level of Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Priority Concepts: Communication; Family Dynamics
Reference: Halter & Varcarolis (2013); Videbeck & Miller (2019); Townsend & Morgan (2018).

6. D.

Rationale: In general, clients seek voluntary admission. If a client seeks voluntary admission, the most likely expectation is that the client will participate in the treatment program since he or she is actively seeking help. The remaining options are not characteristics of this type of admission. Fearfulness, anger, and aggressiveness are more characteristic of an involuntary admission. Voluntary admission does not guarantee that a client understands his or her illness, only the client’s desire for help.

Test-Taking Strategy: Focus on the subject, voluntary admission. This should direct you to the correct option. Note the relationship between the word voluntary and the correct option.

Review: Therapeutic communication techniques
Level of Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Priority Concepts: Adherence; Caregiving
Reference: Halter & Varcarolis (2013); Videbeck & Miller (2019); Townsend & Morgan (2018).

7. B, D, C, A

Rationale: The nurse should first assess the client’s risk for harm, especially because the client could direct her anger to her ex-husband or the nurse. Then it is important to know more about her current situation and her immediate needs. Obtaining information from the ex-husband’s case manager might help clarify the risk of harm to the client. Problems leading to the divorce are less important than the situation following the divorce 

Level of Cognitive Ability: Synthesizing
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Leadership/Management—Ethical/Legal
Priority Concepts: Safety- Self Harm
Reference: (Billings, 2019); Videbeck & Miller (2019).

8. A.

Rationale: Involuntary admission is necessary when a person is a danger to self or others or is in need of psychiatric treatment regardless of the client’s willingness to consent to the hospitalization. A written request is a component of a voluntary admission. Providing written information regarding the illness is likely premature initially. The family may have had no role to play in the client’s admission.

Test-Taking Strategy: Focus on the subject, involuntary admission. Use Maslow’s Hierarchy of Needs theory. Safety is the priority if a physiological need does not exist. This should direct you to the correct option. Also, note that the remaining options are not always true of an involuntary admission.

Review: Involuntary admission
Level of Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process—Implementation
Content Area: Mental Health
Priority Concepts: Interpersonal Violence; Safety
Reference: Halter & Varcarolis (2013); Videbeck & Miller (2019); Townsend & Morgan (2018).

9. D.

Rationale: Making observations can indicate to the patient that the nurse is providing her full attention, thereby noticing her inappropriate behavior. When making this statement, it is important for the nurse to objectively point out what she sees in the patient and then provide an opportunity for her to verbalize what she feels.

Test-Taking Strategy: Focus on the subject, the patient’s inappropriate affect and how to turn the interaction into one that would provide the nurse a chance to seek out further information from the patient.

Review: Therapeutic communication techniques
Level of Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Mental Health
Priority Concepts: Communication
Reference: Videbeck & Miller (2019); Townsend & Morgan (2018); (Irwin & Burckhardt, 2018).

10. B.

Rationale: Clients with paranoid schizophrenia experience alterations in thought resulting in introspection, confusion, and distraction from external reality. Simple tasks that require concentration and effort, including activities involving self-care, may be difficult for the client, especially during the acute phase of the illness. However, the mother should not need to do everything for her daughter. Rather, the mother should encourage the daughter to do things for herself with guidance. Visits from friends should be discussed with the client, and the client should be encouraged to visit with friends to minimize the risk of social isolation. Although relapse typically occurs with medication noncompliance, vulnerability to stress, a low threshold for stress, the number of stresses, and the client’s lack of adaptive coping behaviors contribute to relapse.

Review:  Schizophrenia symptoms
Level of Cognitive Ability: Evaluating
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process—Evaluation
Content Area: Mental Health
Priority Concepts: Reality Orientation
Reference: (Billings, 2019); Videbeck & Miller (2019).

11. A.

Rationale: The nurse is required to maintain confidentiality regarding the client and the client’s care. Confidentiality is basic to the therapeutic relationship and is a client’s right. The most appropriate response to the neighbor is the statement of that responsibility in a direct, but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal client information may be taken as disrespectful and uncaring. The remaining options identify statements that do not maintain client confidentiality.

Test-Taking Strategy: Note the strategic words, most appropriate. Focusing on maintaining confidentiality will direct you to the correct option. This focus will also assist you in eliminating options that inappropriately give such information without being unnecessarily blunt or rude.

Review: Confidentiality issues
Level of Cognitive Ability: Applying
Client Needs: Safe and Effective Care Environment
Integrated Process: Communication and Documentation
Content Area: Leadership/Management—Ethical/Legal
Priority Concepts: Ethics; Health Care Law
Reference: Halter & Varcarolis (2013); Videbeck & Miller (2019); Townsend & Morgan (2018).

12. B, C, E.

Rationale: False imprisonment is an act with the intent to confine a person to a specific area. The nurse can be charged with false imprisonment if the nurse prohibits a client from leaving the hospital if the client has been admitted voluntarily and if no agency or legal policies exist for detaining the client. Assault and battery are related to the act of restraining the client in a situation that did not meet criteria for such an intervention. Libel and slander are not applicable here since the nurse did not write or verbally make untrue statements about the client.

Test-Taking Strategy: Focus on the subject, legal ramifications of nursing actions related to hospital admission. Noting the words admitted voluntarily will assist you in = selecting the options related to inappropriately preventing the client from leaving the hospital, a right to which a voluntarily committed client is entitled. The remaining options do not relate to acts that prevent the client from leaving the hospital.

Review: Client rights related to hospital admission
Level of Cognitive Ability: Analyzing
Client Needs: Safe and Effective Care Environment
Integrated Process: Nursing Process—Implementation
Content Area: Leadership/Management—Ethical/Legal
Priority Concepts: Health Care Law; Safety
Reference: Halter & Varcarolis (2013); Videbeck & Miller (2019); Townsend & Morgan (2018).

13. A, B, D, E.

Rationale: Therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings and open-ended questions, focusing and refocusing, restating, clarifying and validating, sharing perceptions, reflecting, providing acknowledgment and feedback, giving information, presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, and summarizing. Asking “Why” is often interpreted as being accusatory by the client and should also be avoided. Providing advice or giving approval or disapproval are barriers to communication.

Test-Taking Strategy: Use therapeutic communication techniques. This will assist you in both selecting the correct answers and eliminating the examples of nontherapeutic communication.

Review: Therapeutic and nontherapeutic communication techniques
Level of Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Priority Concepts: Caregiving; Communication
Reference: Halter & Varcarolis (2013); Videbeck & Miller (2019); Townsend & Morgan (2018).

14. C.

Rationale: The nurse must pay attention to the non-verbal cues of the nurse in the same way she does with the verbal cues. In some patients, non-verbal cues can give the nurse another avenue to further assess the patient’s mood and behavior and help plan for a set of interventions for whatever issues she may assess.

Review: Verbal and non-verbal cues to communication
Level of Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process—Assessment
Content Area: Mental Health
Priority Concepts: Communication; Mood and Affect
Reference: (Billings, 2019); Videbeck & Miller (2019).

15. A.

Rationale: All treatment team members are viewed as significant and valuable to the client’s successful treatment outcomes in milieu therapy. Interpersonal therapy is based on a one-to-one or group therapy approach in which the therapist-client relationship is often used as a way for the client to examine other relationships in his or her life. Behavior modification is based on rewards and punishment. Support groups are based on the premise that individuals who have experienced and are insightful concerning a problem are able to help others who have a similar problem.

Test-Taking Strategy: Focus on the subject, characteristics of a type of therapy. Note the relationship between the words helping the clients to meet their goals and the correct option.

Review: Types of therapy
Level of Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process—Implementation
Content Area: Mental Health
Priority Concepts: Care Coordination; Caregiving
Reference: Halter & Varcarolis (2013); Videbeck & Miller (2019); Townsend & Morgan (2018).

References

  1. Billings, D. (2019). Lippincott Q & A Review For NCLEX-RN (13th ed.). Wolters Kluwer Medical.
  2. Halter, M. J., & Varcarolis, E. M. (2014). Varcarolis’ foundations of psychiatric mental health nursing: a clinical approach. 7th ed. / St. Louis, Mo.: Elsevier/Saunders.
  3. Irwin, B., & Burckhardt, J. (2018). NCLEX-RN Prep 2018 (1st ed.). Kaplan Publishing.
  4. Townsend, M., & Morgan, K. (2018). Pocket Guide to Psychiatric Nursing, 10e. Philadelphia: F.A. Davis.
  5. Videbeck, S., & Miller, C. (2019). Psychiatric-Mental Health Nursing (8th ed.). Wolters Kluwer. Lippincott.

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