Nursing Elites

1. A LPN/LVN is preparing to care for a dying client, and several family members are at the client's bedside. Select the therapeutic techniques that the nurse would use when communicating with the family. Select one that does not apply.

• A. Discourage reminiscing
• B. Make decisions for the family
• C. Encourage expression of feelings, concerns, and fears
• D. Explain everything that is happening to all family members

Correct answer: B

Rationale: Encouraging the expression of feelings, concerns, and fears is a therapeutic technique that helps the family cope with the situation and express their emotions. This approach fosters trust and emotional release. Making decisions for the family is not appropriate because it takes away their autonomy and control during a difficult time. Discouraging reminiscing may hinder the family's coping mechanisms by discouraging them from sharing memories and finding comfort in the past. Explaining everything that is happening to all family members promotes transparency and understanding, which can help reduce anxiety and fear.

2. The nurse asks a female client with borderline personality disorder, 'How do you feel about your children not coming to visit this weekend?' The client looks out the window and replies, 'I really don't care.' Which response is best for the nurse to provide?

• A. I noticed you were looking out the window when discussing your feelings.
• B. I think you're lying and it bothers you that your children aren't coming.
• C. I think you should discuss your children not coming in the group meeting.
• D. Why do you think your children didn't want to come visit you this weekend?

Correct answer: A

Rationale: Acknowledging the client's non-verbal behavior, such as looking out the window, demonstrates active listening and provides the client with an opportunity to explore their feelings further. Choice B is incorrect as it accuses the client of lying without any evidence, which can damage the therapeutic relationship. Choice C is inappropriate as it dismisses the client's feelings and suggests a group discussion without addressing the client's emotions directly. Choice D is also incorrect as it focuses on the children's actions rather than the client's feelings, missing an opportunity for therapeutic communication.

3. A female client with borderline personality disorder expresses fear of being abandoned by the nursing staff. What is the best nursing intervention?

• A. Reassure the client that she will not be abandoned.
• B. Set limits on the client's behavior and enforce them consistently.
• C. Encourage the client to talk about her fears.
• D. Rotate the nursing staff assigned to the client frequently.

Correct answer: B

Rationale: The best nursing intervention for a client with borderline personality disorder expressing fear of abandonment is to set limits on the client's behavior and enforce them consistently. This approach helps establish boundaries and provides a sense of security for the client. Choice A may provide temporary reassurance but does not address the core issue or help the client develop coping strategies. Choice C is important but should be accompanied by setting limits to address the underlying fear of abandonment. Choice D of rotating staff frequently can exacerbate the client's fear of abandonment by reinforcing the idea of being left.

4. A male client is admitted to the psychiatric unit with a medical diagnosis of paranoid schizophrenia. During the admission procedure, the client looks up and states, 'No, it's not MY fault. You can't blame me. I didn't kill him, you did.' What action is best for the nurse to take?

• A. Reassure the client by telling him that his fear of the admission procedure is to be expected.
• B. Tell the client that no one is accusing him of murder and remind him that the hospital is a safe place.
• C. Assess the content of the hallucinations by asking the client what he is hearing.
• D. Ignore the behavior and make no response at all to his delusional statements.

Correct answer: C

Rationale: The correct action for the nurse to take in this situation is to assess the content of the hallucinations by asking the client what he is hearing (C). Further assessment is needed to understand the nature of the client's delusions and hallucinations. Choice A is incorrect as it focuses on reassuring the client about his fear, which is not addressing the underlying issue of the delusional statement. Choice B is incorrect as it argues with the client's delusion and offers false reassurance, which is not therapeutic. Choice D is incorrect as ignoring the behavior and making no response disregards the client's needs for assessment and support.

5. On admission to a residential care facility, an elderly female client tells the nurse that she enjoys cooking, quilting, and watching television. Twenty-four hours after admission, the nurse notes that the client is withdrawn and isolated. It is best for the nurse to encourage this client to become involved in which activity?

• A. Clean the unit kitchen cabinets.
• B. Participate in a group quilting project.
• C. Watch television in the activity room.
• D. Bake a cake for a resident's birthday.

Correct answer: B

Rationale: Peer interaction in a group activity (B) such as participating in a group quilting project will help to prevent social isolation and withdrawal. This will provide the elderly client with an opportunity to engage with others, share experiences, and feel a sense of belonging. Choices (A, C, and D) are activities that can be accomplished alone, without peer interaction, which may not effectively address the client's feelings of withdrawal and isolation.

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