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The client angrily tells the nurse that the primary health care provider (HCP) purposefully provided incorrect information. Which responses by the nurse to the client support therapeutic communication?
- A. I'm certain that the HCP would not lie to you.
- B. I'm not sure what you mean by that statement.
- C. Can you describe the information that you are referring to?
- D. Do you think it would be helpful to talk to your doctor about this?
- E. You can check the information on lots of websites on the Internet.
Correct Answer: B,C,D
Rationale: Options 2 and 3 attempt to clarify the information to which the client is referring. Option 4 attempts to explore whether the client is comfortable talking to the HCP about this issue and encourages direct confrontation. Options 1 and 5 hinder communication by disagreeing with the client and referring the client to the Internet instead of his HCP for clarification. This technique could make the client defensive and block further communication.
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The mental health nurse is caring for a client with Cluster B personality disorder. The nurse would expect the client to exhibit which behaviors? Select all that apply.
- A. suspicious of others, magical thinking, eccentric behavior, paranoia, relationship deficits
- B. preoccupation with rules and details, hoarding, ritualistic behavior, extremely devoted to work
- C. easily bored, poor and shallow interpersonal relationships, enjoys being the center of attention
- D. impulsivity, unpredictable behavior, extreme mood shifts, easily angered, playing people against each other
- E. suspicious and untrusting of others, argumentative, controlling of others, thoughts of grandiosity
Correct Answer: C,D
Rationale: Cluster B personality disorders (e.g., histrionic, borderline) involve being easily bored, shallow relationships, attention-seeking (C), and impulsivity, mood shifts, and manipulative behavior (D). Options A and E describe Cluster A, and B describes Cluster C.
The nurse is caring for a client diagnosed with acute pulmonary edema. Which psychosocial strategy should the nurse plan to incorporate into the care of the client?
- A. Reducing anxiety
- B. Increasing fluid volume
- C. Decreasing cardiac output
- D. Promoting a positive body image
Correct Answer: A
Rationale: Reducing anxiety will help the client during treatment to increase cardiac output and decrease fluid volume. When cardiac output falls as a result of acute pulmonary edema, the sympathetic nervous system is stimulated. Stimulation of the sympathetic nervous system results in the fight-or-flight reaction, which further impairs cardiac function. A disturbed body image is not a common problem among clients with acute pulmonary edema.
A client diagnosed with catatonic schizophrenia demonstrates severe withdrawal by lying on the bed with the body pulled into a fetal position. Which intervention by the nurse is most appropriate to increase interpersonal communication?
- A. Ask the client direct questions to encourage talking.
- B. Leave the client alone and intermittently check on her or him.
- C. Sit beside the client in silence and occasionally ask open-ended questions.
- D. Take the client into the dayroom with the other clients, to encourage interaction.
Correct Answer: C
Rationale: Clients who are withdrawn may be immobile and mute, and they require consistent, repeated approaches. Intervention includes the establishment of interpersonal contact. The nurse facilitates communication with the client by sitting in silence, asking open-ended questions, and pausing to provide opportunities for the client to respond. Asking this client direct questions is not therapeutic. The client is not to be left alone. This client is not capable of interaction in the dayroom.
The nurse is caring for a client diagnosed with Hodgkin's disease who will be receiving radiation and chemotherapy. Which statement by the client indicates a positive coping mechanism to be used during these treatments?
- A. I won't leave the house bald.'
- B. Losing my hair won't bother me.'
- C. I will be one of the few who doesn't lose my hair.'
- D. I have selected a wig, even though I will miss my own hair.'
Correct Answer: D
Rationale: A combination of radiation and chemotherapy often causes alopecia. To make use of positive coping mechanisms, the client must identify personal feelings and positive interventions to deal with side effects. None of the remaining options are positive coping mechanisms.
A client is about to undergo a pericardiocentesis to help manage rapidly accumulating pericardial effusion. What is the best plan for the nurse to implement to alleviate the client's apprehension?
- A. Suggesting the client watch television during the procedure as a distraction
- B. Talking to the client from the foot of the bed and assisting with the procedure
- C. Staying beside the client to give information and encouragement during the procedure
- D. Assuring the client that even though there are other clients needing care, the client's needs are most important
Correct Answer: C
Rationale: Clients who develop sudden complications are in situational crisis and need therapeutic intervention. Staying with the client and giving information and encouragement is part of building and maintaining trust in the nurse-client relationship. Options 1 and 4 distance the nurse from the client psychosocially. The nurse should ask another caregiver to be available to assist with the procedure.