Capstone Psych
A client is admitted to the in-patient unit and is being considered for electroconvulsive
therapy (ECT). The client appears calm, but the family is hypervigilant and anxious. the
client's mother begins to cry and states, "my child's brain will be destroyed. How can the
doctor do this?" the nurse makes which therapeutic response?
1. "It sounds as though you need to speak to the psychiatrist."
2. "Perhaps you'd like to see the ECT room and speak to the staff"
3. "Your child has decided to have this treatment. you should be supportive of the decision"
4. "It sounds as though you have some concerns about the ECT procedure. Why don't we sit
down together and discuss any concerns you may have?" - ANS-4. "It sounds as though you
have some concerns about the ECT procedure. Why don't we sit down together and discuss
any concerns you may have?"
A client is admitted to the psychiatric unit after a serious suicidal attempt by hanging. the
nurse's most important aspect of care is to maintain client safety and plans to:
1. Request that a peer will remain with the client at all times
2. Remove the client's clothing and place the client in a hospital gown.
3. Assign a staff member to the client who will remain with him or her at all times
4. Admit the client to a seclusion room where all potentially dangerous articles are removed -
ANS-1. Request that a peer will remain with him or her at all times
A client tells the nurse that people from Mars are going to invade the earth. Which response
by the nurse would be most therapeutic?
A. "That must be frightening to you. Can you tell me how you feel about it?"
B. "There are no people living on Mars."
C. "What do you mean when you say they're going to invade the earth?"
D. "I know you believe the earth is going to be invaded, but I don't believe that." - ANS-A.
"That must be frightening to you. Can you tell me how you feel about it?"
This response addresses the client's underlying fears without feeding the delusion. Attempt
to understand the significance of these beliefs to the client at the time of their presentation.
Important clues to underlying fears and issues can be found in the client's seemingly illogical
fantasies.
Option B: Refuting the client's delusion would increase anxiety and reinforce the delusion.
Initially do not argue with the client's beliefs or try to convince the client that the delusions
are false and unreal. Arguing will only increase a client's defensive position, thereby
reinforcing false beliefs. This will result in the client feeling even more isolated and
misunderstood.
Option C: Asking the client to elaborate on the delusion would also reinforce it. Interact with
clients on the basis of things in the environment. Try to distract the client from their delusions
by engaging in reality-based activities (e.g., card games, simple arts and crafts projects, etc).
,When thinking is focused on reality-based activities, the client is free of delusional thinking
during that time. Helps focus attention externally.
Option D: Voicing disbelief about the delusion wouldn't help the client deal with underlying
fears. Show empathy regarding the client's feelings; reassure the client of your presence and
acceptance. The client's delusion can be distressing. Empathy conveys your caring, interest,
and acceptance of the client.
A client was admitted to the psychiatric unit for severe depression. After several days, the
client continues to withdraw from other clients. Which of the following would be the most
appropriate statement by the nurse to promote interaction with other clients?
A. "Your doctor thinks it's good for you to spend time with others."
B. "It is important for you to participate in group activities."
C. "Painting this picture will help you feel better."
D. "Come play Chinese Checkers with Gerry and me." - ANS-D. "Come play Chinese
Checkers with Gerry and me."
This gradually engages the client in interactions with others and uses positive behavioral
expectation. Initially, provide activities that require minimal concentration (e.g., drawing,
playing simple board games). Depressed people lack concentration and memory. Activities
that have no "right or wrong" or "winner or loser" minimizes opportunities for the client to put
himself/herself down.
Option A: When the client is at the most depressed state, Involve the client in one-to-one
activity. Maximizes the potential for interactions while minimizing anxiety levels. Involve the
client in gross motor activities that call for very little concentration (e.g., walking). Such
activities will aid in relieving tensions and might help in elevating the mood.
Option B: Eventually involve the client in group activities (e.g., group discussions, art
therapy, dance therapy). Socialization minimizes feelings of isolation. Genuine regard for
others can increase feelings of self-worth. Eventually maximize the client's contacts with
others (first one other, then two others, etc.). Contact with others distracts the client from
self-preoccupation.
Option C: Allow the patient to engage in simple recreational activities, advancing to more
complex activities in a group environment. The patient may feel overwhelmed at the start
when participating in a group setting. Encourage the client to participate in a group therapy
where the members share the same situations/feelings that they have to minimize the
feelings of isolation and provide an atmosphere where positive feedback and a more realistic
appraisal of self are available.
A client who is diagnosed with pedophilia and has been recently paroled as a sex offender
says "Im in treatment and I have served my time. Now this group has posters of me all over
the neighborhood telling about me with my picture on it" which of the following is an
appropriate response by the nurse?
1. "When children are hurt as you hurt them, people want you isolated"
2. "You're lucky it doesn't escalate into something pretty scary after your crime"
3. "You understand that people fear for their children, but you're feeling unfairly treated?"
4. "You seem angry, but you have committed serious crimes against several children, so
your neighbors are frightened?" - ANS-3. "You understand that people fear for their children,
but you're feeling unfairly treated?"
,A client with a diagnosis of narcissistic personality disorder has been given a day pass from
the psychiatric hospital. The client is due to return at 6 pm. At 5 pm the client telephones the
nurse in charge of the unit and says "6 o'clock is too early. I feel like coming back at 7:30."
The nurse would be most therapeutic by telling the client to:
A. Return immediately, to demonstrate control.
B. Return on time or restrictions will be imposed.
C. Come back at 6:45, as a compromise to set limits.
D. Come back as soon as possible or the police will be sent. - ANS-B. Return on time or
restrictions will be imposed.
This sets limits, points out reality, and places responsibility for behavior on the client. Be
clear with the client as to the unit/hospital/clinic policies. Give brief concrete reasons for the
rules, if asked, and then move on. Institutional policies provide structure and safety. Be very
clear about the consequences if policies/limits are not adhered to. Client needs to
understand the consequences of breaking the rules.
Option A: When limits or policies are not followed, enforce the consequences in a
matter-of-fact, nonjudgmental manner. Enforces that the client is responsible for his or her
own actions.
Option C: If the client becomes seductive, reiterate the therapeutic goals and boundaries of
treatment. The client is in the hospital/clinic for a reason. Being taken in by seductive
behavior undermines the effectiveness of the treatment.
Option D: Approach the client in a consistent manner in all interactions. Enhances feelings of
security and provides structure. Exceptions encourage manipulative behavior. If the client
becomes hostile or projects blame onto you or staff, project a neutral, calm demeanor, and
avoid power struggles. Focus on the client's underlying feelings.
A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know
what is really in those pills?" Which of the following is the best response?
A. Say, "You know it's your medicine."
B. Allow him to open the individual wrappers of the medication.
C. Say, "Don't worry about what is in the pills. It's what is ordered."
D. Ignore the comment because it's probably a joke. - ANS-B. Allow him to open the
individual wrappers of the medication.
This is correct because allowing a paranoid client to open his medication can help reduce
suspiciousness. Talk openly with the client about their beliefs and thoughts, showing
empathy and support. Help build trust and rapport with clients. Paranoid clients may be more
reluctant to trust anyone, but open communication generally offers more cooperation.
Explain all procedures clearly and carefully, and their purpose, before starting them.
Prevents aggressive behavior and suspicion. Promotes cooperation and compliance. Helps
develop trust.
Option A: This is incorrect because the client doesn't know that it's his medication and he's
obviously suspicious. Discuss feelings and help the client identify behaviors that cause
conflict or alienate others. Helping clients see the reality of their behaviors can help
treatment progress and lead to more appropriate behaviors and interactions.
, Option C: Discuss and have the client demonstrate (through role-play if appropriate) more
acceptable responses and reactions to behaviors and stressors. Helps the client develop
more positive coping skills for dealing with delusions, suspicions, and fears. Provide
reorientation as appropriate, but avoid confrontation of the delusions. The client may need to
be refocused to reality at times, but avoid confrontation that may be interpreted as
argumentative to avoid non-compliance and uncooperative behaviors.
Option D: Telling the client not to worry or ignoring the comment isn't supportive and doesn't
offer reassurance. Set behavior boundaries and enforce per facility protocols with
medications or restraints as necessary. Promote the safety of clients during agitated
moments and the safety of others from aggressive behaviors. Follow your facility's specific
protocol regarding superv
A client with antisocial personality disorder was admitted in a unit at Nurseslabs Hospital.
The newly admitted client stole money from an elderly in the unit. Which of the following is
the most appropriate for the nurse to say to this client?
A. "Why did you take the money?"
B. "Let's talk about how you felt when you took the money."
C. "The consequences of stealing are a loss of privileges."
D. "This client is defenseless against you." - ANS-C. "The consequences of stealing are loss
of privileges."
The most appropriate response is to reinforce the consequences of behavior that disregard
the rights of others. Be very clear about the consequences if policies/limits are not adhered
to. Client needs to understand the consequences of breaking the rules.
Option A: This client is likely to rationalize and excuse the behavior. Approach the client in a
consistent manner in all interactions. Enhances feelings of security and provides structure.
Exceptions encourage manipulative behavior.
Option B: The nurse should not encourage the client to provide excuses or explanations of
behaviors that are clearly against the rules. Be clear with the client as to the
unit/hospital/clinic policies. Give brief concrete reasons for the rules, if asked, and then move
on.
Option D: A client with antisocial personality disorder is unlikely to have compassion for
others and typically lacks respect for the rights of others. When limits or policies are not
followed, enforce the consequences in a matter-of-fact, nonjudgmental manner. Helps
minimize manipulations and might help encourage cooperation.
A client with antisocial personality is trying to convince a nurse that he deserves special
privileges and that an exception to the rules should be made for him. Which of the following
responses is the most appropriate?
A. "I believe we need to sit down and talk about this."
B. "Don't you know better than to try to bend the rules?"
C. "What you're asking me to do is unacceptable."
D. "Why don't you bring this request to the community meeting?" - ANS-C. "What you're
asking me to do is unacceptable."
These clients often try to manipulate the nurse to get special privileges or make exceptions
to the rules on their behalf. By informing the client directly when actions are inappropriate,
A client is admitted to the in-patient unit and is being considered for electroconvulsive
therapy (ECT). The client appears calm, but the family is hypervigilant and anxious. the
client's mother begins to cry and states, "my child's brain will be destroyed. How can the
doctor do this?" the nurse makes which therapeutic response?
1. "It sounds as though you need to speak to the psychiatrist."
2. "Perhaps you'd like to see the ECT room and speak to the staff"
3. "Your child has decided to have this treatment. you should be supportive of the decision"
4. "It sounds as though you have some concerns about the ECT procedure. Why don't we sit
down together and discuss any concerns you may have?" - ANS-4. "It sounds as though you
have some concerns about the ECT procedure. Why don't we sit down together and discuss
any concerns you may have?"
A client is admitted to the psychiatric unit after a serious suicidal attempt by hanging. the
nurse's most important aspect of care is to maintain client safety and plans to:
1. Request that a peer will remain with the client at all times
2. Remove the client's clothing and place the client in a hospital gown.
3. Assign a staff member to the client who will remain with him or her at all times
4. Admit the client to a seclusion room where all potentially dangerous articles are removed -
ANS-1. Request that a peer will remain with him or her at all times
A client tells the nurse that people from Mars are going to invade the earth. Which response
by the nurse would be most therapeutic?
A. "That must be frightening to you. Can you tell me how you feel about it?"
B. "There are no people living on Mars."
C. "What do you mean when you say they're going to invade the earth?"
D. "I know you believe the earth is going to be invaded, but I don't believe that." - ANS-A.
"That must be frightening to you. Can you tell me how you feel about it?"
This response addresses the client's underlying fears without feeding the delusion. Attempt
to understand the significance of these beliefs to the client at the time of their presentation.
Important clues to underlying fears and issues can be found in the client's seemingly illogical
fantasies.
Option B: Refuting the client's delusion would increase anxiety and reinforce the delusion.
Initially do not argue with the client's beliefs or try to convince the client that the delusions
are false and unreal. Arguing will only increase a client's defensive position, thereby
reinforcing false beliefs. This will result in the client feeling even more isolated and
misunderstood.
Option C: Asking the client to elaborate on the delusion would also reinforce it. Interact with
clients on the basis of things in the environment. Try to distract the client from their delusions
by engaging in reality-based activities (e.g., card games, simple arts and crafts projects, etc).
,When thinking is focused on reality-based activities, the client is free of delusional thinking
during that time. Helps focus attention externally.
Option D: Voicing disbelief about the delusion wouldn't help the client deal with underlying
fears. Show empathy regarding the client's feelings; reassure the client of your presence and
acceptance. The client's delusion can be distressing. Empathy conveys your caring, interest,
and acceptance of the client.
A client was admitted to the psychiatric unit for severe depression. After several days, the
client continues to withdraw from other clients. Which of the following would be the most
appropriate statement by the nurse to promote interaction with other clients?
A. "Your doctor thinks it's good for you to spend time with others."
B. "It is important for you to participate in group activities."
C. "Painting this picture will help you feel better."
D. "Come play Chinese Checkers with Gerry and me." - ANS-D. "Come play Chinese
Checkers with Gerry and me."
This gradually engages the client in interactions with others and uses positive behavioral
expectation. Initially, provide activities that require minimal concentration (e.g., drawing,
playing simple board games). Depressed people lack concentration and memory. Activities
that have no "right or wrong" or "winner or loser" minimizes opportunities for the client to put
himself/herself down.
Option A: When the client is at the most depressed state, Involve the client in one-to-one
activity. Maximizes the potential for interactions while minimizing anxiety levels. Involve the
client in gross motor activities that call for very little concentration (e.g., walking). Such
activities will aid in relieving tensions and might help in elevating the mood.
Option B: Eventually involve the client in group activities (e.g., group discussions, art
therapy, dance therapy). Socialization minimizes feelings of isolation. Genuine regard for
others can increase feelings of self-worth. Eventually maximize the client's contacts with
others (first one other, then two others, etc.). Contact with others distracts the client from
self-preoccupation.
Option C: Allow the patient to engage in simple recreational activities, advancing to more
complex activities in a group environment. The patient may feel overwhelmed at the start
when participating in a group setting. Encourage the client to participate in a group therapy
where the members share the same situations/feelings that they have to minimize the
feelings of isolation and provide an atmosphere where positive feedback and a more realistic
appraisal of self are available.
A client who is diagnosed with pedophilia and has been recently paroled as a sex offender
says "Im in treatment and I have served my time. Now this group has posters of me all over
the neighborhood telling about me with my picture on it" which of the following is an
appropriate response by the nurse?
1. "When children are hurt as you hurt them, people want you isolated"
2. "You're lucky it doesn't escalate into something pretty scary after your crime"
3. "You understand that people fear for their children, but you're feeling unfairly treated?"
4. "You seem angry, but you have committed serious crimes against several children, so
your neighbors are frightened?" - ANS-3. "You understand that people fear for their children,
but you're feeling unfairly treated?"
,A client with a diagnosis of narcissistic personality disorder has been given a day pass from
the psychiatric hospital. The client is due to return at 6 pm. At 5 pm the client telephones the
nurse in charge of the unit and says "6 o'clock is too early. I feel like coming back at 7:30."
The nurse would be most therapeutic by telling the client to:
A. Return immediately, to demonstrate control.
B. Return on time or restrictions will be imposed.
C. Come back at 6:45, as a compromise to set limits.
D. Come back as soon as possible or the police will be sent. - ANS-B. Return on time or
restrictions will be imposed.
This sets limits, points out reality, and places responsibility for behavior on the client. Be
clear with the client as to the unit/hospital/clinic policies. Give brief concrete reasons for the
rules, if asked, and then move on. Institutional policies provide structure and safety. Be very
clear about the consequences if policies/limits are not adhered to. Client needs to
understand the consequences of breaking the rules.
Option A: When limits or policies are not followed, enforce the consequences in a
matter-of-fact, nonjudgmental manner. Enforces that the client is responsible for his or her
own actions.
Option C: If the client becomes seductive, reiterate the therapeutic goals and boundaries of
treatment. The client is in the hospital/clinic for a reason. Being taken in by seductive
behavior undermines the effectiveness of the treatment.
Option D: Approach the client in a consistent manner in all interactions. Enhances feelings of
security and provides structure. Exceptions encourage manipulative behavior. If the client
becomes hostile or projects blame onto you or staff, project a neutral, calm demeanor, and
avoid power struggles. Focus on the client's underlying feelings.
A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know
what is really in those pills?" Which of the following is the best response?
A. Say, "You know it's your medicine."
B. Allow him to open the individual wrappers of the medication.
C. Say, "Don't worry about what is in the pills. It's what is ordered."
D. Ignore the comment because it's probably a joke. - ANS-B. Allow him to open the
individual wrappers of the medication.
This is correct because allowing a paranoid client to open his medication can help reduce
suspiciousness. Talk openly with the client about their beliefs and thoughts, showing
empathy and support. Help build trust and rapport with clients. Paranoid clients may be more
reluctant to trust anyone, but open communication generally offers more cooperation.
Explain all procedures clearly and carefully, and their purpose, before starting them.
Prevents aggressive behavior and suspicion. Promotes cooperation and compliance. Helps
develop trust.
Option A: This is incorrect because the client doesn't know that it's his medication and he's
obviously suspicious. Discuss feelings and help the client identify behaviors that cause
conflict or alienate others. Helping clients see the reality of their behaviors can help
treatment progress and lead to more appropriate behaviors and interactions.
, Option C: Discuss and have the client demonstrate (through role-play if appropriate) more
acceptable responses and reactions to behaviors and stressors. Helps the client develop
more positive coping skills for dealing with delusions, suspicions, and fears. Provide
reorientation as appropriate, but avoid confrontation of the delusions. The client may need to
be refocused to reality at times, but avoid confrontation that may be interpreted as
argumentative to avoid non-compliance and uncooperative behaviors.
Option D: Telling the client not to worry or ignoring the comment isn't supportive and doesn't
offer reassurance. Set behavior boundaries and enforce per facility protocols with
medications or restraints as necessary. Promote the safety of clients during agitated
moments and the safety of others from aggressive behaviors. Follow your facility's specific
protocol regarding superv
A client with antisocial personality disorder was admitted in a unit at Nurseslabs Hospital.
The newly admitted client stole money from an elderly in the unit. Which of the following is
the most appropriate for the nurse to say to this client?
A. "Why did you take the money?"
B. "Let's talk about how you felt when you took the money."
C. "The consequences of stealing are a loss of privileges."
D. "This client is defenseless against you." - ANS-C. "The consequences of stealing are loss
of privileges."
The most appropriate response is to reinforce the consequences of behavior that disregard
the rights of others. Be very clear about the consequences if policies/limits are not adhered
to. Client needs to understand the consequences of breaking the rules.
Option A: This client is likely to rationalize and excuse the behavior. Approach the client in a
consistent manner in all interactions. Enhances feelings of security and provides structure.
Exceptions encourage manipulative behavior.
Option B: The nurse should not encourage the client to provide excuses or explanations of
behaviors that are clearly against the rules. Be clear with the client as to the
unit/hospital/clinic policies. Give brief concrete reasons for the rules, if asked, and then move
on.
Option D: A client with antisocial personality disorder is unlikely to have compassion for
others and typically lacks respect for the rights of others. When limits or policies are not
followed, enforce the consequences in a matter-of-fact, nonjudgmental manner. Helps
minimize manipulations and might help encourage cooperation.
A client with antisocial personality is trying to convince a nurse that he deserves special
privileges and that an exception to the rules should be made for him. Which of the following
responses is the most appropriate?
A. "I believe we need to sit down and talk about this."
B. "Don't you know better than to try to bend the rules?"
C. "What you're asking me to do is unacceptable."
D. "Why don't you bring this request to the community meeting?" - ANS-C. "What you're
asking me to do is unacceptable."
These clients often try to manipulate the nurse to get special privileges or make exceptions
to the rules on their behalf. By informing the client directly when actions are inappropriate,
