A nurse is assisting in the care of a client who states, "I am overwhelmed by stress, and nobody is helping me." Which of the following represents a therapeutic response by the nurse?

“I am trying to help you, but you haven't told me why you are overwhelmed yet."

"Have you tried to avoid the situations that are causing you so much stress?"

“Tell me about what you are doing to reduce or cope with your stress."

“I would like to help you. Can you tell me more about what you are feeling?"

Answer and Explanation

The Correct Answer is D

A. "I am trying to help you, but you haven't told me why you are overwhelmed yet." This response sounds dismissive and places responsibility on the client, which may increase their frustration.

B. "Have you tried to avoid the situations that are causing you so much stress?" Avoidance is not a healthy coping mechanism and does not encourage the client to express their feelings.

C. "Tell me about what you are doing to reduce or cope with your stress." While this encourages self-reflection, it does not validate the client’s distress or express empathy.

D. "I would like to help you. Can you tell me more about what you are feeling?" This response shows empathy, offers support, and invites the client to express their emotions, which are key aspects of therapeutic communication.

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Correct Answer is A

Explanation

A. Upon admission: The best time to discuss policies on restraints and seclusion is at admission, when clients are calm and able to understand their rights.

B. While administering chemical or physical restraints : Explaining the policy during restraint use can increase client distress and agitation.

C. When a client becomes agitated: Discussing restraint policies while a client is already agitated is ineffective and could escalate distress.

D. During debriefing after restraint removal : While debriefing is important, waiting until after restraints are removed does not allow for proactive education.

A. "The effects of ACES affect adolescents, but they do not affect them once they reach adulthood." B. "Adults are more at risk for depression, while adolescents are more at risk for obesity." C. "Adults are at a higher risk for cancer and COPD, while adolescents are more at risk for attempted suicide." D. "ACES have the same effect on adults and adolescents."

Correct Answer is C

Explanation

A. "The effects of ACEs affect adolescents, but they do not affect them once they reach adulthood." This is incorrect because ACEs have lifelong consequences, increasing the risk for mental health disorders, chronic diseases, and risky behaviors well into adulthood.

B. "Adults are more at risk for depression, while adolescents are more at risk for obesity." While both depression and obesity can occur, ACEs increase the risk of mental and physical health issues at all stages of life, and obesity is not exclusive to adolescents.

C. "Adults are at a higher risk for cancer and COPD, while adolescents are more at risk for attempted suicide." Research shows that ACEs increase the risk of chronic illnesses (e.g., cancer, COPD) in adulthood and also elevate suicidal risk in adolescents.

D. "ACEs have the same effect on adults and adolescents." While ACEs affect all age groups, their manifestations differ: adolescents may experience mental health issues and risky behaviors, while adults may develop chronic illnesses and long-term emotional dysregulation.

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A nurse is assisting in the care of a client who states, "I am overwhelmed by stress, and nobody is helping me." Which of the following represents a therapeutic response by the nurse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in a mental health unit is discussing restraints and seclusion with a group of newly hired nurses. At which of the following times should a nurse discuss the restraint and seclusion policy with a client?

Correct Answer is A

Explanation

A nurse is reinforcing teaching with a newly licensed nurse about the effects of adverse childhood experiences (ACES) across the lifespan. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

Correct Answer is C

Explanation

Which statement by the newly hired staff member demonstrates an understanding of the legal guidelines for caring for clients on a mental health unit?

A nurse is reinforcing teaching with a newly licensed nurse about the importance of therapeutic communication. Which of the following statements should the nurse include?

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A nurse is discussing strategies to develop nurse-client therapeutic relationships with a newly licensed nurse. Which statement by the nurse accurately describes strategies for building a therapeutic relationship?

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