NURSING 2362 MODULE 3 EXAM
Questions
1. ID: 8The 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 Sub...
nursing 2362 module 3 exam questions 1 id 8482587678the mother of a 3 year old child tells the nurse that her child hit her doll after the mother scolded her for picking
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NURSING 2362 MODULE 3 EXAM
Questions
1. ID: 8482587678The 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
Displacement Correct
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: Note the subject of the question, 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 .
Reference: Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental
health nursing: A communication approach to evidence-based care (p. 133). St. Louis: Saunders.
Cognitive Ability: Understanding
Client Needs: Psychosocial Integrity
Integrated Process: Nursing Process/Assessment
Content Area: Mental Health
Giddens Concepts: Development, Mood and Affect
HESI Concepts: Developmental, Mood and Affect Awarded 1.0 points out of 1.0
possible points.
2. ID: 8482589936A 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
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: Note the strategic word “most” and remember therapeutic
communication techniques. Noting the words “working phase” in the question will direct you to
the correct option. Review: therapeutic communication techniques .
Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th
ed., pp. 27-31, 553). St. Louis: Mosby.
, Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Communication, Health Promotion
HESI Concepts: Communication, Health, Wellness, and Illness—
Health Promotion Awarded 1.0 points out of 1.0 possible points.
3. ID: 8482589970As 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
“Don’t worry. Everyone who comes in here for the first time feels reluctant to talk.”
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: Note the strategic word “most.” Use your knowledge of
therapeutic communication techniques. Focusing on the client’s feelings will direct you to the
correct option. Review: therapeutic communication techniques .
References: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th
ed., pp. 27-31). St. Louis: Mosby.
Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health
nursing: A communication approach to evidence-based care (pp. 117-118). St. Louis: Saunders.
Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Communication, Mood and Affect
HESI Concepts: Communication, Mood and Affect Awarded 1.0 points out of 1.0
possible points.
4. ID: 8482592914During 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
“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 self-exploration. 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 .
Reference: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th
ed., pp. 27-31). St. Louis: Mosby.
Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Communication, Family Dynamics
HESI Concepts: Communication, Developmental—Family Dynamics Awarded
1.0 points out of 1.0 possible points.
5. ID: 8482591943The nurse developing a plan of care for a client whose
spouse recently died determines the client has a problem with dysfunctional grieving. Which
priority intervention does the nurse incorporate into the plan?
Monitoring the client’s sleep pattern
Assessing the client’s risk for violence toward self and others health care provider Correct
Obtaining a health care provider’s prescription for an antidepressant
Assisting the client in resolving the grief through emotional, cognitive, and behavioral means
Incorrect
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 health care provider’s prescription for an antidepressant is
not a priority. In fact, chemical dependency can present a barrier to the client’s goal attainment.
Test-Taking Strategy: Use the steps of the nursing process. Both monitoring
the client’s sleep pattern and assessing 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 .
Reference: Fortinash, K., & Holoday-Worret, P. (2008). Psychiatric mental health
nursing (4th ed., pp. 596, 599-600). St. Louis: Mosby.
, Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Clinical Judgment, Mood and Affect
HESI Concepts: Clinical Decision-Making, Mood and Affect Awarded 0.0 points
out of 1.0 possible points.
6. ID: 8482589982A 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
“You seem frustrated with your husband’s habit of controlling financial decisions.” Incorrect
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, “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 correct. When 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 .
References: Stuart, G. (2009). Principles & practice of psychiatric nursing (9th
ed., pp. 27-31). St. Louis: Mosby.
Varcarolis, E., & Halter, M. (2009). Essentials of psychiatric mental health
nursing: A communication approach to evidence-based care (pp. 380, 381). St. Louis: Saunders.
Cognitive Ability: Applying
Client Needs: Psychosocial Integrity
Integrated Process: Communication and Documentation
Content Area: Mental Health
Giddens Concepts: Communication, Family Dynamics
HESI Concepts: Communication, Developmental—Family Dynamics Awarded
0.0 points out of 1.0 possible points.
7. ID: 8482589950The nurse is developing a plan of care for a client who recently
received a diagnosis of acquired immunodeficiency syndrome and is experiencing difficulty
adjusting to the illness. Which action is an inappropriate intervention for this client?
Monitoring the client for signs of self-harm
Helping the client verbalize concerns related to fear
Assisting the client with problem-solving and decision-making
Discouraging social networking to prevent the spread of infection
Correct
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