Psychiatric Mental Health Nursing Saunders NCLEX Final Review 2025

A client with a diagnosis of depression who has attempted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response by the nurse demon- strates therapeutic communication? 1. "You have everything to live for." 2. "Why do you see yourself as a failure?" 3. "Feeling like this is all part of being depressed." 4. "You've been feeling like a failure for a while?" - Correct Ans-4 Rationale: Responding to the feelings expressed by a client is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the cli- ent's experience and do not facilitate exploration of the client's expressed feelings. In addition, use of the word why is nontherapeutic. The nurse visits a client at home. The client states, "I haven't slept at all the last couple of nights." Which response by the nurse demonstrates thera- peutic communication? 1. "I see." 2. "Really?" 3. "You're having difficulty sleeping?" 4. "Sometimes I have trouble sleeping too." - Correct Ans-3 Rationale: The correct option uses the therapeutic communica- tion technique of restatement. Although restatement is a tech- nique that has a prompting component to it, it repeats the client's major theme, which assists the nurse to obtain a more specific perception of the problem from the client. The remain- ing options are not therapeutic responses since none encourages the client to expand on the problem. Offering personal experi- ences moves the focus away from the client and onto the nurse. A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat? 1. Using open-ended questions and silence 2. Sharing personal preference regarding food choices 3. Documenting reasons why the client does not want to eat 4. Offering opinions about the necessity of adequate nutrition - Correct Ans-1 Rationale: Open-ended questions and silence are strategies used to encourage clients to discuss their problems. Sharing personal food preferences is not a client-centered intervention. The remaining options are not helpful to the client because they do not encourage the client to express feelings. The nurse should not offer opinions and should encourage the client to identify the reasons for the behavior. The nurse should plan which goals of the termina- tion stage of group development? Select all that apply. 1. The group evaluates the experience. 2. The real work of the group is accomplished. 3. Group interaction involves superficial conversation. 4. Group members become acquainted with one another. 5. Some structuring of group norms, roles, and responsibilities takes place. 6. The group explores members'feelings about the group and the impending separation. - Correct Ans-1, 6 Rationale: The stages of group development include the initial stage, the working stage, and the termination stage. During the initial stage, the group members become acquainted with one another, and some structuring of group norms, roles, and responsibilities takes place. During the initial stage, group interaction involves superficial conversation. During the work- ing stage, the real work of the group is accomplished. During the termination stage, the group evaluates the experience and explores members'feelings about the group and the impending separation. Aclient diagnosed with terminal cancer says to the nurse, "I'm going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's dying." Which response by the nurse is therapeutic? 1. "Have you shared your feelings with your family?" 2. "I think we should talk more about your anger with your family." 3. "You're feeling angry that your family continues to hope for you to be cured?" 4. "You are probably very depressed, which is understandable with such a diagnosis." - Correct Ans-3 Rationale: Restating is a therapeutic communication tech- nique in which the nurse repeats what the client says to show understanding and to review what was said. While it is appro- priate for the nurse to attempt to assess the client's ability to discuss feelings openly with family members, it does not help the client to discuss the feelings causing the anger. The nurse's direct attempt to expect the client to talk more about the anger is premature. The nurse would never make a judgment regard- ing the reason for the client's feeling; this is nontherapeutic in the one-to-one relationship. On review of the client's record, the nurse notes that the admission was voluntary. Based on this information, the nurse plans care anticipating which client behavior? 1. Fearfulness regarding treatment measures 2. Anger and aggressiveness directed toward others 3. An understanding of the pathology and symptoms of the diagnosis 4. A willingness to participate in the planning of the care and treatment plan - Correct Ans-4 Rationale: In general, clients seek voluntary admission. If a cli- ent seeks voluntary admission, the most likely expectation is that the client will participate in the treatment program since he or she is actively seeking help. The remaining options are not characteristics of this type of admission. Fearfulness, anger, and aggressiveness are more characteristic of an involuntary admission. Voluntary admission does not guarantee that a cli- ent understands his or her illness, only the client's desire for help. A client admitted voluntarily for treatment of an anxiety disorder demands to be released from the hospital. Which action should the nurse take initially? 1. Contact the client's health care provider (HCP). 2. Call the client's family to arrange for transportation. 3. Attempt to persuade the client to stay "for only a few more days." 4. Tell the client that leaving would likely result in an involuntary commitment. - Correct Ans-1 Rationale: In general, clients seek voluntary admission. Volun- tary clients have the right to demand and obtain release. The nurse needs to be familiar with the state and facility policies and procedures. The initial nursing action is to contact the HCP, who has the authority to discuss discharge with the client. While arranging for safe transportation is appropriate, it is pre- maturein thissituation and should bedoneonlywith theclient's permission.Whileitisappropriatetodiscusswhytheclientfeels the need to leave and the possible outcomes of leaving against medical advice, attempting to get the client to agree to staying "for only a few more days" has little value and will not likely be successful. Many states require that the client submit a written release notice to the facility psychiatrist, who reevaluates the cli- ent's condition for possible conversion to involuntary status if necessary, according to criteria established by law. While this is a possibility, it should not be used as a threat with the client. When reviewing the admission assessment, the nurse notes that a client was admitted to the mental health unit involuntarily. Based on this type of admission, the nurse should provide which inter- vention for this client? 1. Monitor closely for harm to self or others. 2. Assist in completing an application for admission. 3. Supply the client with written information about his or her mental illness. 4. Provide an opportunity for the family to discuss why they felt the admission was needed. - Correct Ans-1 Rationale: Involuntary admission is necessary when a person is a danger to self or others or is in need of psychiatric treatment regardless of the client's willingness to consent to the hospital- ization.Awrittenrequestisacomponentofavoluntaryadmis- sion. Providing written information regarding the illness is likely premature initially. The family may have had no role to play in the client's admission. When a client is admitted to an inpatient mental health unit with the diagnosis of anorexia nervosa, a cognitive behavioral approach is used as part of the treatment plan. The nurse plans care based on which purpose of this approach? 1. Providing a supportive environment 2. Examining intrapsychic conflicts and past issues 3. Emphasizing social interaction with clients who withdraw 4. Helping the client to examine dysfunctional thoughts and beliefs - Correct Ans-4 Rationale: Cognitive behavioral therapy is used to help the client identify and examine dysfunctional thoughts and to iden- tifyandexaminevaluesandbeliefsthatmaintainthesethoughts. The remaining options, while therapeutic in cert