Question 1

A 40-year-old client has never experienced an intimate relationship. A nursing student tells an instructor that this client remains in Erikson's developmental stage of intimacy versus isolation. What is the instructor's most appropriate reply?

A) "Erikson's stages of development are assessed by chronological age, not task achievement. This client is in the generativity versus stagnation stage, which occurs from 30 to 65 years of age."
B) "Erikson's stages of development are assessed by task achievement, not chronological age. This client is in the intimacy versus isolation stage, which occurs from 20 to 30 years of age."
C) "Erikson's stages of development are assessed by task achievement, not chronological age. This client is in the generativity versus stagnation stage, which occurs from 30 to 65 years of age."
D) "Erikson's stages of development are assessed by chronological age, not task achievement. This client is in the intimacy versus isolation stage, which occurs from 20 to 30 years of age."

"Erikson's stages of development are assessed by chronological age, not task achievement. This client is in the generativity versus stagnation stage, which occurs from 30 to 65 years of age."

Accepted Answer

1.This is correct. Erikson's stages of development are assessed by chronological age, not task achievement. This client is in Erikson's stage of generativity versus stagnation because she is 40 years old. The student has failed to recognize that even though the client did not successfully achieve the intimacy task of the intimacy versus isolation stage, the client must now be assessed at the age-appropriate developmental stage of generativity versus stagnation.
2.This is incorrect. Erikson's stages of development are assessed by chronological age, not task achievement. The client is not in the intimacy versus isolation stage, which occurs from 20 to 30 years of age.
3.This is incorrect. The client is not in the generativity versus stagnation stage, which occurs from 30 to 65 years of age.
4.This is incorrect. The client is not in the intimacy versus isolation stage, which occurs from 20 to 30 years of age.

Question 2

The nurse is providing care to the client who has just retired from a successful law practice. Which of the following would be the client's possible lost component of self-concept?&#10;A) Body image&#10;B) Moral-ethical self&#10;C) Self-consistency&#10;D) Self-ideal&#10;

Accepted Answer

1.This is incorrect. There is no indication that the client's body image is at risk for changes. This would have occurred if the client had undergone a radical procedure that would have altered their body (e.g., mastectomy, amputation of a limb).
2.This is incorrect. There is no indication that the client is losing their moral-ethical self. This would have occurred if the client had broken a law or had gone against their belief system.
3.This is correct. The client has to now let go of their old image of a lawyer to now a retiree.
4.This is incorrect. This would be an appropriate response if the client stated that he or she was unable to achieve his or her ideals or self-expectations.

Question 3

During an assertiveness training group, a client admits to aggressive behaviors. The client asks for suggestions for how to become more assertive and less aggressive. Which is the most appropriate nursing reply?

A) "Several techniques, including meditation and progressive muscle relaxation, appear helpful."
B) "There's not much that can be done about aggressive behavior because of biological responses."
C) "Certain types of medications have been proven effective in promoting assertive communication."
D) "There are several techniques, including 'I' statements and thought stopping, that promote assertive behaviors and decrease aggressive behaviors."

"There are several techniques, including 'I' statements and thought stopping, that promote assertive behaviors and decrease aggressive behaviors."

Accepted Answer

1.This is incorrect. These suggestions may facilitate anxiety reduction, not increase confidence with assertiveness.
2.This is incorrect. This is a false statement regarding aggressive behavior and gives the client no guidance toward assertiveness.
3.This is incorrect. This does not guide the client toward behavioral modification to increase assertive behaviors and decrease aggressive responses.
4.This is correct. This is the most appropriate nursing reply. These techniques promote assertive behaviors and would help diminish aggressive responses.

Question 4

The nurse encounters a client's angry family member in the hallway. The nurse states "You seem very angry right now. I don't want to discuss his matter with you while you are so upset. I will discuss this matter later today." What is the technique that the nurse used to avoid manipulation of the family member?

A) The nurse asks the family member to clarify the problem.
B) The nurse accepted negative aspects about oneself.
C) The nurse is defusing the situation with a cooling-off period.
D) The nurse is persistently repeating in a calm voice what is wanted.

Accepted Answer

1.This is incorrect. This is an example of inquiring assertively for more information.
2.This is incorrect. This is an example of agreeing assertively, where the individual assertively accepts negative aspects about oneself and admits when an error has been made.
3.This is correct. The nurse is using a defusing technique to put off further discussion with an angry individual until he or she is calmer.
4.This is incorrect. This is an example of responding as a broken record.

Question 5

The nurse is providing tools for clients to become more aware of their behavioral responses. One client states that they have difficulty not blaming others for "making me mad." The nurse should assign which nursing diagnosis to this client needing assistance with assertiveness?

A) Disturbed personal identity
B) Disturbed thought processes
C) Defensive coping
D) Impaired verbal communication

Accepted Answer

1.This is incorrect. There is no indication that the client is having issues with their personal identity.
2.This is incorrect. There is no indication that the client is having issues with disturbed thought processes.
3.This is correct. Defensive coping reflects a self-protective pattern that defends against underlying perceived threats to positive self-regard. Clients who are utilizing defensive coping lack assertiveness skills.
4.This is incorrect. The client does not have issues with verbal communication.

Question 6

The nurse is providing assertiveness training to a client. One of the instructions is for the client to close their eyes and to shout aloud "STOP" to shift ideas from intrusive to pleasant and desirable. What is the technique called?

A) Defusing
B) Thought stopping
C) Clouding or fogging
D) Agreeing assertively

Accepted Answer

1.This is incorrect. Defusing is a technique to diffuse a potential conflict by putting off further discussion with an angry individual until he or she is calmer.
2.This is correct. Thought stopping is a technique to shift an unwanted recurring thought toward a pleasant and desirable thought. This is often taught to clients with low self-esteem that have repetitive negative thoughts of which the mind refuses to let go.
3.This is incorrect. Clouding or fogging is concurring with the critic's argument without becoming defensive and without agreeing to change.
4.This is incorrect. Agreeing assertively accepts negative aspects about oneself and admitting when an error has been made.

Question 7

The nurse is assessing a client who had quietly arrived to their appointment early only to be ignored by the receptionist for an hour. The client speaks in a hesitant, monotone voice and states that it is OK, because "there were so many others waiting to be seen, too." What type of behavior is the client displaying at this time?

A) Passive-nonassertive
B) Aggressive
C) Assertive
D) Passive-aggressive

Accepted Answer

1.This is correct. The client is displaying nonassertive (passive) behaviors by avoiding unpleasant situations and confrontations with others. The client seldom lets their true feelings show and often harbors anger and resentment.
2.This is incorrect. The client is not displaying aggressive behaviors, as the client is not standing up for self and disregarding others' needs and feelings.
3.This is incorrect. This client is not able to stand up for self while protecting the rights of others.
4.This is incorrect. Although the client is displaying passive tendencies, there is no aggressive response. If the client had used resistant behaviors such as "forgetfulness" or dawdling, then this would be passive aggressive.

Question 8

The nurse is a volunteer for the American Red Cross and has visited victims of a tornado that occurred a month ago. Many of the area's adult residents' responses have included sadness and an increase in alcohol use, while the children have separation anxiety to the point of sleeping with their parents. Which is the correctly written priority nursing diagnosis for this population?

A) Ineffective community coping related to (R/T) natural disaster
B) Anxiety R/T fear of another disaster as evidenced by (AEB) inability to proceed with cleanup
C) Risk for injury R/T hopelessness
D) Risk for low self-esteem R/T loss events

Accepted Answer

1.This is correct. The priority nursing diagnosis is ineffective community coping, The AEB factors of increased alcohol use and separation anxiety show that the community has not been able to cope with the loss.
2.This is incorrect. Although the community may have anxiety, it does not appear to be fear of another disaster (no verbalization of the community members); this is not a priority nursing diagnosis.
3.This is incorrect. Although there may be a risk for injury this is not a priority at this time. The clients do not verbalize hopelessness or injury potential.
4.This is incorrect. Nurses should prioritize diagnoses and outcomes based on the potential safety risk to the client and/or others. A correctly written nursing diagnosis includes actual evidence if the problem is current and does not have evidence if the situation is potential.

Question 9

The nurse is providing care to a client who has become emotionally labile with paranoia after losing their career and home due to a motor vehicle accident. The nurse recognizes that the client is at what phase of crisis development?

A) Phase 1
B) Phase 2
C) Phase 3
D) Phase 4

Accepted Answer

1.This incorrect. In phase 1, the individual is exposed to a precipitating crisis. Symptoms include increased anxiety and the use of previously employed problem-solving techniques.
2.This is incorrect. In phase 2, previous problem-solving techniques do not relieve the stressor, which further increases anxiety. Coping techniques that have worked in the past are attempted, only to create feelings of helplessness when they are not successful.
3.This is incorrect. In phase 3, all possible resources, both internal and external, are called on to resolve the problem and relieve the discomfort. New problem-solving techniques may be used, and, if effectual, resolutions may occur at this phase, with the client returning to a higher level, lower level, or the previous level of precrisis functioning.
4.This is correct. In phase 4, if the resolution does not occur in previous phases, Caplan states that the "tension mounts beyond a further threshold or its burden increases over time to a breaking point. Major disorganization of the individual with drastic results often occurs" (p. 41). Anxiety may reach panic levels. Cognitive functions are disordered, emotions are labile, and behavior may reflect the presence of psychotic thinking.

Question 10

The rape crisis nurse has completed several counseling sessions with a client who was nearly raped while jogging. Which client statement made at the final session most clearly suggests that the goals of crisis intervention have been met?

A) "You've really been helpful. Can I count on you for continued support?"
B) "I use the indoor track on campus and avoid going outside."
C) "I'm really glad I didn't go home. It would have been hard to come back."
D) "I carry mace when I jog. It makes me feel safe and secure."

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Accepted Answer

1.This is incorrect. During the termination phase of counseling, the client would not rely upon a return to the therapist.
2.This is incorrect. This does not address the issue of the risk for another assault attempt.
3.This is incorrect. Although this may be a statement that would provide insight on how the client feels, it is an insight, not an intervention.
4.This is correct. The client is describing a plan of action to deal with a potential crisis similar to the one that precipitated this crisis. This statement indicates that the client has developed adaptive coping strategies and has achieved the goals of crisis intervention.

Deck 5: Promoting Self-Esteem