- Staff praise a client for staying in group for 1 minute, then 3, then 5. This is:
Answer: Shaping by rewarding steps
Reinforcing gradually longer stays in group, from 1 minute to 3 to 5, rewards successive approximations toward the goal. That is shaping. Chaining is tempting because it involves steps, but chaining links separate tasks into a sequence, not increasing duration of one behavior toward a target.
- A client with a personality disorder tells the PN, "The night nurse is terrible and never helps me, but you are the only one who really understands." Which response by the PN is most appropriate?
Answer: "Let's talk about what is concerning you right now."
This response refocuses the conversation on the client's current feelings and needs without engaging in the client's attempt to split the staff. It is a neutral, therapeutic response that maintains professional boundaries. Defending the other nurse or validating the client's negative comments is not therapeutic.
- A client with post-traumatic stress disorder (PTSD) is experiencing a flashback. The client appears terrified and is shouting. What is the priority nursing action?
Answer: Stay with the client and speak in a calm, reassuring voice.
During a flashback, the client is re-experiencing a traumatic event and feels detached from reality. The priority is to provide a sense of safety and help orient them to the present. Staying with the client and using a calm, reassuring voice helps ground them without being intrusive. Touching the client may be perceived as a threat and could escalate their distress.
- During a one-on-one interaction, a client asks the PN for their home phone number. Which response by the PN is most appropriate?
Answer: "I can't give you my number, but we can talk about anything you need to right now."
This response clearly and gently sets a professional boundary by declining the request, while also redirecting the client back to the therapeutic relationship. It reinforces that their needs can be met within the professional context of the nurse-client relationship. Simply stating policy or questioning the client's motives is less therapeutic.
- A client in the dayroom of a mental health unit suddenly becomes agitated and starts shouting at another client. Which action should the practical nurse (PN) take first?
Answer: Move the other clients to a safe location away from the agitated client.
The priority action is to ensure the safety of all clients. Removing the other clients from the immediate area prevents the situation from escalating and protects them from potential harm. This is the first step in managing the crisis. After ensuring the safety of others, the nurse can then focus on de-escalating the agitated client.
- A client with major depression is withdrawn and remains in their room. Which action by the PN is most therapeutic?
Answer: Sit with the client in their room for a short period.
For a withdrawn client, the nurse's presence can be therapeutic, conveying acceptance and support without placing demands on the client to interact. This action demonstrates caring and can help build a therapeutic relationship. Forcing socialization can increase anxiety, while allowing complete isolation reinforces withdrawal.
- A client with a substance use disorder is admitted for detoxification. The client is becoming increasingly irritable, shaky, and diaphoretic. What is the priority action for the PN?
Answer: Report the client's symptoms to the RN immediately.
These symptoms (irritability, tremors, diaphoresis) are classic signs of alcohol withdrawal and can progress to more severe complications like seizures and delirium tremens. The PN's priority is to recognize these cues of a potentially life-threatening situation and report them to the RN immediately so that appropriate medical intervention can be initiated.
- A client diagnosed with schizophrenia tells the PN, "The voices are telling me I am a bad person." Which response by the PN is most therapeutic?
Answer: "That must be frightening. I do not hear any voices."
This response validates the client's feeling of fear without validating the hallucination itself. It also gently presents reality by stating, 'I do not hear any voices.' This is a therapeutic technique that builds trust and avoids arguing with the client about their perceptual disturbance.
- A client diagnosed with borderline personality disorder is showing favoritism toward one staff member while being critical of others. The PN recognizes this behavior as which defense mechanism?
Answer: Splitting
Splitting is a common defense mechanism in clients with borderline personality disorder. It is the inability to integrate positive and negative qualities of oneself or others into a cohesive whole. The client categorizes people or things as either 'all good' or 'all bad,' which leads to staff splitting.
- A client is experiencing command hallucinations to harm another client. The PN overhears the client muttering, 'I have to do it, I have to hurt him.' Which action should the PN take immediately?
Answer: Place the client in one-to-one observation and notify the RN.
Command hallucinations involving harm to others represent a psychiatric emergency. The immediate priority is to ensure the safety of everyone on the unit. This requires initiating constant observation of the client to prevent them from acting on the commands and immediately notifying the RN so that further interventions can be implemented.
- A client is experiencing a panic attack and reports shortness of breath, dizziness, and a feeling of impending doom. Which instruction by the PN is most helpful?
Answer: "Let's take some slow, deep breaths together."
During a panic attack, the client's ability to process information is severely limited. Providing simple, concrete directions is essential. Focusing on breathing helps to manage the physiological symptoms of hyperventilation and gives the client a tangible task to focus on, which can help them regain a sense of control. Exploring causes is not appropriate until the acute panic has subsided.
- A client with dementia is found in another client's room, searching for their spouse who died years ago. What is the most therapeutic response by the PN?
Answer: "You seem to be missing your spouse. Tell me about them."
This response uses validation therapy, which is effective for clients with dementia. It acknowledges the client's feelings and emotions without confronting their disorientation, which can cause further agitation. It validates their reality and opens a line of therapeutic communication, which can be used to gently redirect the client.
- A 32-year-old postpartum client with a history of anxiety becomes overwhelmed on a mother-baby unit, crying and stating, "I'm a terrible mom," while breathing rapidly. Mood is anxious, affect is tearful, communication is self-critical, and the client is pacing. Which strategy should the nurse use to address the client's anxiety?
Answer: Guide the client to sit, practice slow breathing, and use grounding by identifying items seen and felt in the room
This question tests the application of behavioral management techniques within psychosocial integrity. The primary behavioral issue is the client's overwhelming anxiety and self-doubt, with anxious mood, tearful affect, self-critical communication, and pacing. Guiding the client to sit, practice slow breathing, and use grounding by identifying items seen and felt is the most effective strategy because it anchors the client in the present and reduces physiological arousal. Telling the client many feel this way and to focus on the baby (B) minimizes feelings; asking about childhood (C) is not immediate; requesting anxiolytics first (D) skips non-pharmacologic options. The decision-making principle in behavioral management for postpartum anxiety involves using sensory grounding to interrupt negative thought patterns. This promotes quick stabilization. A transferable strategy for managing similar behavioral issues is to combine breathing with sensory awareness for rapid anxiety reduction in high-stress moments.
- An elderly client with Alzheimer's disease becomes increasingly restless and agitated each evening. Which action should the PN implement to help manage this behavior?
Answer: Keep the client's room well-lit during the evening hours.
This client is experiencing 'sundowning'. Keeping the environment well-lit can reduce shadows and disorientation, which often contribute to fear and agitation. This is a non-pharmacological intervention that promotes safety. Encouraging naps can disrupt nighttime sleep, and television can be overstimulating.
- An adolescent client on an inpatient unit becomes defiant and refuses to follow unit rules. Which approach by the PN is most effective in managing this behavior?
Answer: Consistently enforcing unit rules and consequences.
Adolescents respond best to structure and predictability. Consistently enforcing rules and consequences for all clients demonstrates fairness and helps the adolescent understand expectations and the outcomes of their choices. This approach is more effective than lecturing, ignoring the behavior, or being overly punitive.
- A client with obsessive-compulsive disorder (OCD) is spending 45 minutes washing their hands. What is the most appropriate action by the PN?
Answer: Allow the client to complete the ritual, then discuss their feelings.
For a client with OCD, a compulsive ritual is a way of managing anxiety. Forcibly stopping the ritual will likely increase anxiety significantly. The therapeutic approach is to allow the ritual to be completed while ensuring safety, and then engage the client to discuss the underlying feelings and triggers once the acute anxiety has subsided.
- A 26-year-old client with generalized anxiety disorder arrives at a community clinic reporting chest tightness and trembling before a job interview. Mood is anxious, affect is fearful, speech is rapid, and the client is wringing hands and unable to sit still. Which strategy should the nurse use to address the client's anxiety?
Answer: Teach slow diaphragmatic breathing and guide the client through a brief grounding exercise
This question tests the application of behavioral management techniques within psychosocial integrity. The primary behavioral issue is the client's acute anxiety symptoms, including chest tightness, trembling, anxious mood, fearful affect, rapid speech, hand-wringing, and inability to sit still. Teaching slow diaphragmatic breathing and guiding through a brief grounding exercise is the most effective strategy because it provides immediate, practical tools to interrupt the anxiety cycle and restore calm. Explaining symptoms as harmless and to ignore them (B) dismisses the client's experience; asking for a chronological stressor description (C) may overwhelm; delegating to the receptionist (D) is inappropriate for clinical intervention. The decision-making principle in behavioral management for anxiety involves selecting evidence-based relaxation techniques for symptom relief. These methods empower clients to self-regulate physiological responses. A transferable strategy for managing similar behavioral issues is to integrate breathing and grounding exercises into routine care for clients experiencing acute anxiety triggers.
- Which strategy is most important for the PN to use when managing the care of a client with manipulative behavior?
Answer: Ensuring that all staff members are consistent with the care plan.
Consistency is the key to managing manipulative behavior. A consistent team approach, where all staff members enforce the same rules, limits, and expectations outlined in the care plan, prevents the client from splitting staff and manipulating the situation for their own gain.
- Client with dementia fights bathing. Which intervention should the nurse try first?
Answer: Redirect to a calmer activity
For a client with dementia, fighting during bathing stems from confusion and fear, not defiance. Redirecting to a calmer activity lowers stress and avoids escalation, making it the safest first step. The tempting wrong choice is explaining why fighting is wrong, because dementia impairs reasoning and logic, so the client cannot process that information. Restraints and forcing the bath are also inappropriate and increase distress.
- A client is pacing the hallway and wringing their hands, stating, "I feel like something terrible is going to happen." What is the PN's initial action?
Answer: Stay with the client and ask, "What are you feeling right now?"
The client is exhibiting signs of moderate to severe anxiety. The PN's initial action should be to stay with the client to provide support and a sense of safety. Asking an open-ended question about their feelings helps the client to verbalize their anxiety and allows the nurse to collect more data.
