Varcarolis' Foundations of
Psychiatric Mental
Health Nursing
9th Edition
By, Margaret Jordan Halter
Chapter 1 - 34
, 1
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Chapter 09: Therapeutic Communication
Halter: Varcarolis’ Foundations of Psychiatric-Mental Health Nursing: A ClinicalApproach,
9th Edition
MULTIPLE CHOICE
1. A client says to the nurse, “I dreamed I was stoned. When I woke up, I felt emotionally
drained, as though I hadn’t rested well.” Which response should the nurse use to clarify the
client’s comment?
a. “It sounds as though you were uncomfortable with the content of your dream.”
b. “I understand what you’re saying. Bad dreams leave me feeling tired, too.”
c. “So you feel as though you did not get enough quality sleep last night?”
d. “Can you give me an example of what you mean by ‘stoned’?”
ANS: D
The technique of clarification is therapeutic and helps the nurse examine the meaning of the
client’s statement. Asking for a definition of “stoned” directly asks for clarification. Restating
that the client is uncomfortable with the dream’s content is parroting, a nontherapeutic
technique. The other responses fail to clarify the meaning of the client’s comment.
PTS: 1 DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
2. A client diagnosed with schizophrenia tells the nurse, “The Central Intelligence Agency is
monitoring us through the fluorescent lights in this room. The CIA is everywhere, so be
careful what you say.” Which response by the nurse is most therapeutic?
a. “Let’s talk about something other than the CIA.”
b. “It sounds like you’re concerned about your privacy.”
c. “The CIA is prohibited from operating in health care facilities.”
d. “You have lost touch with reality, which is a symptom of your illness.”
ANS: B
It is important not to challenge the client’s beliefs, even if they are unrealistic. Challenging
undermines the client’s trust in the nurse. The nurse should try to understand the underlying
feelings or thoughts the client’s message conveys. The correct response uses the therapeutic
technique of reflection. The other comments are nontherapeutic. Asking to talk about
something other than the concern at hand is changing the subject. Saying that the CIA is
prohibited from operating in health care facilities gives false reassurance. Stating that the
client has lost touch with reality is truthful but uncompassionate.
PTS: 1 DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity
3. The client says, “My marriage is just great. My spouse and I always agree.” The nurse
observes the client’s foot moving continuously as the client twirls a shirt button. What
conclusion can the nurse draw about the client’s statement?
a. It is clear.
b. It may be distorted.
c. It is incongruous.
d. It is inadequate.
, Chapter 19: Sleep–Wake Disorders
Halter: Varcarolis’ Foundations of Psychiatric-Mental Health Nursing: A ClinicalApproach,
9th Edition
MULTIPLE CHOICE
1. A nurse would determine that which client has the highest risk for problems with sleep
physiology?
a. Retiree who volunteers twice a week at Habitat for Humanity
b. Corporate accountant who travels frequently
c. Parent with three teenagers
d. Lawn care worker
ANS: B
The corporate accountant is likely to work long hours and have significant stress associated
with work demands. Compounded by travel, these factors are likely to precipitate unstable
sleep patterns and inadequate sleep time. The retiree and lawn care worker engage in physical
activity during the day, which will promote natural fatigue and sleep. The parent’s sleep is
unlikely to be disturbed; teenagers sleep through the night.
PTS: 1 DIF: Cognitive Level: Analyze (Analysis)
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
2. Which comment is most likely from a client with chronic sleep deprivation?
a. “I turn on the television every night to get to sleep. I set the timer, so it goes off in
30 minutes.”
b. “I have diarrhea frequently that interferes with my sleep, so I stay at home most of
the time.”
c. “I only sleep about 7 hours a night, but I know I should sleep 8 or 9 hours.”
d. “When my alarm clock goes off every morning, it seems like I am dreaming.”
ANS: B
A discrepancy between hours of sleep obtained and hours required leads to sleep deprivation.
Adults with less than 6 hours of sleep per night often suffer from chronic sleep deprivation.
Common complaints include poor general health, physical and mental distress, limitations in
ADLs, depressive or anxious symptoms, and pain. One distracter indicates a problem with
sleep hygiene (television). The remaining distracters do not indicate a problem.
PTS: 1 DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity
3. The nurse provides health education for an adult experiencing sleep deprivation. Which
instruction has the highest priority?
a. “It’s important to limit your driving to short periods. Sleep deprivation increases
your risks for serious accidents.”
b. “Sleep deprivation is usually self-limiting. See your health care provider if it lasts
more than a year.”
c. “Turn the radio on with a soft volume as you prepare for bed each evening. It will
help you relax.”
d. “Three glasses of wine each evening helps many clients who suffer from sleep