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A client is undergoing systematic desensitization for an extreme fear of elevators. Which of the following actions should be implemented with this form of therapy?
- A. Demonstrate riding in an elevator, then ask the client to imitate the behavior.
- B. Advise the client to say "stop" out loud every time they begin to feel an anxiety response related to an elevator.
- C. Gradually expose the client to an elevator while practicing relaxation techniques.
- D. Stay with the client in an elevator until the anxiety response diminishes.
Correct Answer: C
Rationale: Systematic desensitization is a type of therapy used to help individuals overcome phobias or anxieties. It involves gradually exposing the client to the feared object or situation, in this case, an elevator, while simultaneously practicing relaxation techniques. This process helps the client associate relaxation with the previously feared stimulus, gradually reducing anxiety levels over time. Choice A is incorrect as it involves imitation rather than gradual exposure. Choice B is incorrect as it focuses on a verbal response rather than the systematic process of exposure and relaxation. Choice D is incorrect as it does not involve the systematic approach of gradually exposing the client while teaching relaxation techniques.
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A nurse is planning care for several clients attending community-based mental health programs. Which of the following clients should the nurse visit first?
- A. A client who received a burn on the arm while using a hot iron at home
- B. A client who requests a change of antipsychotic medication due to new adverse effects
- C. A client who reports hearing a voice saying that life is not worth living anymore
- D. A client who tells the nurse about experiencing manifestations of severe anxiety before and during a job interview
Correct Answer: C
Rationale: The nurse should visit the client who reports hearing a voice saying that life is not worth living anymore first. This statement indicates potential suicidal ideation, which requires immediate intervention to ensure the client's safety. Choices A, B, and D do not present an immediate threat to the client's life. While burns, adverse effects of medication, and severe anxiety are important concerns, they do not pose an immediate risk of self-harm or suicide.
When orienting a new client to a mental health unit, which of the following statements should the nurse make about the unit's community meetings?
- A. "Clients gather to discuss their treatment plans together."
- B. "Staff establish a specific agenda for community meetings."
- C. "Clients meet with staff to discuss common problems."
- D. "Community meetings provide an opportunity to explore personal mental health issues."
Correct Answer: C
Rationale: During community meetings in a mental health unit, clients come together with staff to discuss common problems they may be facing. These meetings are designed to foster a sense of community and provide support and guidance to clients. Choice A is incorrect because community meetings focus on discussions beyond individual treatment plans. Choice B is incorrect as while staff may facilitate the meetings, the focus is on clients' concerns, not a predetermined agenda. Choice D is incorrect as the primary purpose of community meetings is to address shared challenges, not individual mental health issues.
What principle about patient communication should guide a nurse's fear of 'saying the wrong thing' to a patient?
- A. Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.
- B. Patients are more interested in talking to you than listening to what you have to say, so they are not likely to be offended.
- C. Considering the patient's history, there is little chance that the comment will do any actual harm.
- D. Most people with a mental illness have, by necessity, developed a high tolerance for forgiveness.
Correct Answer: A
Rationale: Effective patient communication is guided by the principle that patients value genuine acceptance, respect, and concern from their caregivers. This approach helps to build trust and fosters effective communication, enhancing the nurse-patient relationship. Choice B is incorrect because patients value both talking and listening in effective communication. Choice C is incorrect because a nurse should always consider the impact of their words on the patient, regardless of the patient's history. Choice D is incorrect as it generalizes about people with mental illness and forgiveness, which is not directly relevant to patient communication.
A client is discussing free associations as a therapeutic tool with a nurse. Which of the following client statements indicates an understanding of this technique?
- A. "I will write down my dreams as soon as I wake up."
- B. "I might begin to associate my therapist with important people in my life."
- C. "I can learn to express myself in a nonaggressive manner."
- D. "I should say the first thing that comes to my mind."
Correct Answer: D
Rationale: Free association is a psychoanalytic technique where the client is encouraged to say the first thing that comes to their mind without censoring or filtering. This technique helps uncover unconscious thoughts and emotions. Choice D, "I should say the first thing that comes to my mind," indicates an understanding of free association as it aligns with the principle of allowing thoughts to flow freely without inhibition. Choices A, B, and C do not reflect an understanding of free association and its purpose, making them incorrect. A, focusing on writing down dreams, does not relate to the immediate expression of thoughts. B, associating the therapist with important people, and C, learning to express oneself nonaggressively, do not capture the essence of free association as a technique for exploring unconscious processes.
In planning care for the termination phase of a nurse-client relationship, which of the following actions should the nurse include in the plan of care?
- A. Discussing ways to use new behaviors
- B. Practicing new problem-solving skills
- C. Developing goals
- D. Establishing boundaries
Correct Answer: A
Rationale: During the termination phase of a nurse-client relationship, it is crucial to discuss ways to use new behaviors. This helps the client integrate and apply the skills and strategies they have acquired during the therapeutic process into their daily life. By focusing on the application of new behaviors, the client can maintain progress and continue to grow even after the professional relationship has ended. Practicing new problem-solving skills, developing goals, and establishing boundaries are important aspects of the therapeutic process but are more commonly addressed in earlier phases of the nurse-client relationship. Therefore, the correct action to include in the plan of care during the termination phase is discussing ways to use new behaviors.