Psychosocial Integrity — Questions and Answers
Question 1: A nurse is assessing a client who was admitted following a suicide attempt. The client says, 'I just want to be left alone — what's the point of anything?' Which nursing response is most therapeutic?
- 'I understand — sometimes things seem hopeless, but you have so much to live for.'
- 'You have family members who love you and need you to get better.'
- 'It sounds like you are feeling hopeless right now. Can you tell me more about what you are experiencing?' (Correct answer)
- 'You should not feel that way — we are here to help you feel better.'
Correct answer: 'It sounds like you are feeling hopeless right now. Can you tell me more about what you are experiencing?'
Therapeutic communication involves reflecting the client's expressed feeling and using an open-ended question to encourage further exploration. Offering false reassurance, minimizing feelings, or telling a client how they should feel are non-therapeutic responses that shut down communication.
Question 2: A nurse is caring for a client newly diagnosed with multiple sclerosis who says, 'This cannot be right. I am perfectly fine — there must be a mistake.' The nurse recognizes this as which stage of Kubler-Ross's grief model?
- Anger
- Bargaining
- Denial (Correct answer)
- Acceptance
Correct answer: Denial
Denial is the first stage of Kubler-Ross's grief model and is characterized by refusal to accept a difficult reality. It is a protective psychological response to overwhelming news. The nurse should allow the client to express feelings without reinforcing or challenging the denial.
Question 3: A nurse is caring for a client with schizophrenia who states, 'The government has implanted a device in my brain to monitor my thoughts.' How should the nurse respond?
- 'That is not possible — there is no device in your brain.'
- 'I understand that seems very real to you. Let's talk about how these thoughts are affecting you.' (Correct answer)
- 'If you take your medication, those thoughts will go away.'
- 'That sounds frightening. Have you told the doctor about the government?'
Correct answer: 'I understand that seems very real to you. Let's talk about how these thoughts are affecting you.'
The nurse should neither reinforce nor argue with a delusion. The therapeutic approach acknowledges that the experience feels real to the client and redirects to the emotional impact rather than the content of the belief. This maintains trust while avoiding reinforcement of the delusional thinking.
Question 4: A nurse is assessing a client who was recently diagnosed with breast cancer. The client is tearful and says, 'I feel completely out of control.' The nurse's priority intervention is to:
- Explain the full treatment plan in detail to give the client a sense of direction
- Reassure the client that breast cancer has excellent survival rates
- Acknowledge the client's feelings and involve her in decision-making about her care (Correct answer)
- Refer the client to a psychiatrist for evaluation of depression
Correct answer: Acknowledge the client's feelings and involve her in decision-making about her care
Acknowledging the client's feelings validates her experience and addresses the immediate psychosocial need. Involving the client in care decisions restores a sense of control and autonomy, which is central to coping with a new cancer diagnosis. Immediate psychiatric referral is premature.
Question 5: A nurse is working with a client who has been experiencing domestic violence. The client is not ready to leave the relationship. Which response by the nurse is most appropriate?
- 'You need to leave immediately — staying puts your life at risk.'
- 'I understand this is your choice. I am here to support you and provide resources when you are ready.' (Correct answer)
- 'Have you considered that you may be contributing to the situation?'
- 'I will need to report this to the police on your behalf for your safety.'
Correct answer: 'I understand this is your choice. I am here to support you and provide resources when you are ready.'
Respecting client autonomy is essential in domestic violence situations. Research shows that pressuring a victim to leave before they are ready can be dangerous. The nurse's role is to provide safety information, resources, and non-judgmental support without coercing the client.
Question 6: A nurse is performing a mental status examination and asks the client to interpret the proverb, 'People who live in glass houses should not throw stones.' Which cognitive domain is the nurse assessing?
- Orientation to person, place, and time
- Short-term memory and recall
- Abstract reasoning and thought processes (Correct answer)
- Attention span and concentration
Correct answer: Abstract reasoning and thought processes
Interpreting proverbs requires abstract reasoning — the ability to understand concepts beyond their literal meaning. Impaired abstract thinking is seen in schizophrenia, dementia, and other cognitive disorders. Clients with concrete thinking will interpret the proverb literally.
Psychosocial Integrity
A nurse is assessing a client who was admitted following a suicide attempt.
The client says, 'I just want to be left alone — what's the point of anything?' Which nursing response is most therapeutic?