Question 1

When teaching effective stress management techniques to Answers Correct B

a client one hour before surgery, which of the following Student's B
should the nurse recommend?
A) Biofeedback
* B) Deep breathing
C) Distraction
D) Imagery
Review Information: The correct answer is:
B) Deep breathing.

Deep breathing is a reliable and valid method for reducing stress, and can be taught
and reinforced in a short period pre-operatively.

Potter, P. & Perry, A. (2000).

Fundamentals of Nursing: Concepts, Process and Practice.
St. Louis: Mosby.

Thompson, J., McFarland, G., Hirsch, J., & Tucker, S. (1993).

Mosby''s Clinical Nursing. (3rd ed.).
St. Louis: Mosby.

Question 2
After having electroconvulsive treatments, a client is very Answers Correct D
upset because she is confused, loses money and cannot Student's D
remember telephone numbers. The MOST therapeutic
response for the nurse to make is
A) "You were seriously ill and needed the treatments."
"Don’t worry, the confusion will clear up in a few
B)
days."
"We will help you find your money and telephone
C)
numbers."
"I can understand your concern and that your
* D)
confusion is upsetting to you."
Review Information: The correct answer is:
D) "I can understand your concern and that your confusion is upsetting to you.".

Communicate caring and empathy, acknowledged feelings.

Arnold, E & Boggs, K. (1995)

Interpersonal Relationships Professional Communication Skills for Nurses.
Philadelphia: W B Saunders. p 108

Question 3
The parents of a child who has suddenly been hospitalized Correct D
for an acute illness state that they should have taken the Student's D
child to the pediatrician earlier. Which approach by the
nurse is BEST?
A) Focus on the child's needs and recovery
B) Explain the cause of the child's illness
C) Acknowledge that early care would have been better
* D) Accept their feelings without judgment
Review Information: The correct answer is:
D) Accept their feelings without judgment.

Parents often blame themselves for their child''s illness. Feeling helpless and angry is
normal and these feelings must be accepted.

Wong, page 1073-1074:

Wong, D. (1999).
Whaley & Wong’s nursing care of infants and children.
New York: Mosby

Ball and Bindler, page 210:

Ball, J. & Bindler, R. (2000).
Pediatric nursing: Caring for children.
Norwalk, CN: Appleton & Lange.

Question 4
A twelve year-old child is admitted with a broken arm and Answers Correct A
is told he must have surgery. The nurse finds him crying Student's D
and unwilling to talk. The MOST appropriate response by
the nurse would be to
* A) Give him privacy
Tell him he will get through the surgery with no
B)
problem
C) Try to distract him
D) Make arrangements for his friends to visit
Review Information: The correct answer is:
A) Give him privacy.

A twelve year-old child needs the opportunity to express his emotions privately.

Whaley, L. & Wong, D. (1996).

Nursing Care of Infants and Children. Br> St. Louis: CV Mosby.

Hazinski, M. (1997).
Nursing Care of the Critically Ill Child.
St. Louis: CV Mosby.

Question 5
The nurse is caring for a mother who has just delivered a Answers Correct C
stillborn baby. The MOST therapeutic comment to this Student's C
grieving mother would be
A) "You are young and will have other children."
B) "Nature has a way of getting rid of the imperfect."
* C) "Tell me about your experience."
"You have an angel in heaven watching over you
D)
now."
Review Information: The correct answer is:
C) "Tell me about your experience.".

The nurse must help the mother actualize the loss by encouraging her to talk about it.
Advice and cliches are not comforting.

Babcock, I., Lowdermilk, D., and Jensen, M. (1995).

Maternity nursing.
St. Louis: Mosby.

Wong, D. and Perry, S. (1998).

Maternal child nursing care.
St. Louis: Mosby.

Question 6
A client with a new diagnosis of diabetes mellitus is Answers Correct B
referred for home care. A family member present expresses Student's B
concern that the client seems depressed. The nurse should
focus assessment on
The results of a standardized tool that measures
A)
depression
* B) Observation of affect and behavior
C) Inquiry about use of alcohol
Family history of emotional problems and mental
D)
illness
Review Information: The correct answer is:
B) Observation of affect and behavior.

Although it is important to begin an assessment for depression immediately, the

assessment should not be aggressive unless the nurse has concerns about the risk of
suicide.

Agency for Health Care Policy and Research. (1993).

Depression in Primary Care: Vol 1. Detection and Diagnosis. AHCPR Pub. No. 03-
0550.
Rockville, MD.

Davis, B. (1997).
Depression among Elders. In KS Martin, BJ Larson, LA Gorski, and DM Hayko
(Eds.), Mosby''s Home Health Client Teaching Guides: Rx for Teaching, III D 1-8.
St. Louis: Mosby.
Question 7
Which of the following would indicate that the nurse-client Answers Correct D
relationship has passed from the orienting phase to the Student's D
working phase?
The client has revitalized a relationship with her
A) family to help her cope with the death of her
daughter
The nurse had recognized regression as a part of a
B)
defense mechanism
The client expresses a desire to be mothered and
C)
pampered
The client recognizes feelings and expresses them
* D)
appropriately
Review Information: The correct answer is:
D) The client recognizes feelings and expresses them appropriately.

During the working phase, the client is able to focus on unpleasant feelings and
express them appropriately.

Shives, L. (1998).
Basic Concepts of Psychiatric-Mental Health Nursing.
Philadelphia: J.B. Lippincott Co.

Varcarolis, E.(1998).
Foundations of Psychiatric Mental Health Nursing.
Philadelphia: W.B. Saunders. pp. 149.

Question 8
It is important that a feeling of trust be established in a Answers Correct C
nurse-client relationship. This feeling of trust can BEST be Student's C
established by the nurse’s
A) Honesty and sympathy
B) Demeanor and consistency
* C) Consistency and honesty
D) Sympathy and understanding
Review Information: The correct answer is:
C) Consistency and honesty.

Characteristics of a trusting relationship include respect, honesty, consistency, faith

and caring.

Arnold, E & Boggs, K. (1995)

Interpersonal Relationships Professional Communication Skills for Nurses.
Philadelphia: W B Saunders. p 109

Antai-Otong, B. (1995)
Psychiatric Nursing: Biological & Behavioral Concepts
Philadelphia: W.B. Saunders. p 10

Question 9
The nurse is caring for a post-op colostomy client. The Answers Correct D
client begins to cry saying, "I'll never be attractive again Student's D
with this ugly red thing." The FIRST response by the nurse
would be to
A) Arrange a consultation with a sex therapist
B) Suggest sexual positions that hide the colostomy
C) Invite the husband to participate in colostomy care
Determine the client's understanding of her
* D)
colostomy
Review Information: The correct answer is:
D) Determine the client''s understanding of her colostomy.

One of the greatest fears of colostomy clients is the fear that sexual intimacy is no
longer possible. However, the specific concern of the client needs to be assessed
before specific suggestions for dealing with the sexual concerns are given.

Nettina, Sandra (2000).

The Lippincott Manual of Nursing Practice. Sixth Edition.
Lippincott. Philadelphia-New York. 1996. Page 501-502.

Luckmann, Joan.
Saunders Manual of Nursing Care.
W.B.Saunders Company. Philadelphia. 1997. Page 1277-1279. (3)

Question 10
A client has just been diagnosed with breast cancer. The Answers Correct A
nurse enters the room and the client tells the nurse that she Student's B
is stupid. The MOST therapeutic response by the nurse is
to
* A) Explore what is going on with the client
B) Accept the client’s statement without comment
C) Tell the client that the comment is inappropriate
D) Leave the client's room
Review Information: The correct answer is:
A) Explore what is going on with the client.

The nurse assists the verbally aggressive client to put angry feelings into words/to
ventilate then to engage in problem solving.

Fortinash, K. & Holoday-Worret, P. (1995)

Psychiatric Nursing Care Plan.
St. Louis: C.V. Mosby, p. 118;

Keltner, N & Folks, D. (1997)

Psychotropic Drugs.
St. Louis: C.V. Mosby, p. 119

Question 11
The nurse assesses a 16 year-old’s use of coping Answers Correct B
mechanisms following a motor vehicle accident with Student's C
multiple serious injuries. Which of the following are
MOST likely to be displayed for an individual this age?
A) Ambivalence, dependence
* B) Denial, projection, regression
C) Intellectualization, rationalization, repression
D) Identification, assimilation
Review Information: The correct answer is:
B) Denial, projection, regression.

Helplessness and hopelessness may contribute to regressive, dependent behavior.

Denying or minimizing the seriousness of the illness is used to avoid facing the worst
situation.

Shives, L. (1998).
Basic Concepts of Psychiatric-Mental Health Nursing.
J.B. Lippincott Co., pp. 246.

Varcarolis, E.(1998).
Foundations of Psychiatric Mental Health Nursing.
W.B. Saunders., pp. 858.
Question 12
A two day-old child with spina bifida and meningomyocele Answers Correct D
is recovering after the initial surgery. As the nurse Student's D
accompanies the grandparents for a first visit, which of the
following grief responses can the nurse expect of the
grandparents?
A) Depression
B) Anger
C) Frustration
* D) Disbelief
Review Information: The correct answer is:
D) Disbelief.

The first phase of the grieving process is shock/disbelief.

Ashwill, J & Droske, S (1997).

Nursing care of children.
Philadelphia: Saunders.

Wong, D (1995).
Whaley and Wong''s Nursing care of infants and children.
St. Louis: Mosby.

Question 13
While the nurse is administering medications to a client, Answers Correct C
the client states "I do not want to take that medicine Student's C
today." Which of the following responses by the nurse
would be BEST?
"That's OK, its all right to skip your medication now
A)
and then."
B) "I will have to call your doctor and report this."
"Is there a reason why don't you want to take your
* C)
medicine?"
"Do you understand the consequences of refusing
D)
your prescribed treatment?"
Review Information: The correct answer is:
C) "Is there a reason why don''t you want to take your medicine?".

When a new problem is identified, it is important for the nurse to collect accurate
assessment data. This is crucial to ensure that client needs are adequately identified in
order to select the best nursing care approaches. The nurse should try to discover the
reason for the refusal which may be that the client has developed untoward side
effects.

Smeltzer, S.G., Bare, B.G.,

Brunner and Suddarth''s Textbook of Medical - Surgical Nursing 8th Ed.,
Lipppincott, N.Y.,1996; 29.

Kozier,B., Erb, G., Blaise, K.& Wilkinson, J.M.

Fundamentals of Nursing, Concepts, Process, and Practice 5th Ed.
Addison-Wessley, N.Y. 1995;

Question 14
A client expresses anger when his call light is not answered Answers Correct D
promptly. The BEST response for the nurse to make is Student's D
"I apologize for the delay. I was tied up with an
A)
emergency."
B) "Why are you upset about this?"
C) "I am surprised that you are upset."
* D) "I see this is frustrating for you."
Review Information: The correct answer is:
D) "I see this is frustrating for you.".

This is the most appropriate answer because the response gives credence to the client''s
concerns.

Biggers, Vivian, "Survival Skills for the Charge Nurse", video Mosby Year-Book,
1997

A Complaint is a Gift, Barlow, Janelle & Moller, Claus, Berrett-Kehler Publishers,

1996

Question 15
Which of the following statements by the nurse reflects the Answers Correct A
BEST use of therapeutic interaction techniques? Student's A
* A) "You look upset. Would you like to talk about it?"
"I'd like to know more about your children. Tell me
B)
about them."
"I understand that you lost your husband. I don't
C)
think I could go on if that happened to me."
"You look very sad. How long have you been this
D)
way? Have you been taking care of yourself?"
Review Information: The correct answer is:
A) "You look upset. Would you like to talk about it?".

Giving broad opening statements and making observations are examples of

therapeutic communication.

Shives, L. (1998).
Basic Concepts of Psychiatric-Mental Health Nursing.
Philadelphia: J.B. Lippincott Co.

Varcarolis, E.(1998).
Foundations of Psychiatric Mental Health Nursing.
Philadelphia: W.B. Saunders. pp. 181.

Types of Coping Mechanisms

1. Compensation - extra effort in one area to offset real or imagined lack in
another area
o Example: Short man becomes assertively verbal and excels in
business.
2. Conversion - A mental conflict is expressed through physical symptoms
o Example: Woman becomes blind after seeing her husband with
another woman.
3. Denial - treating obvious reality factors as though they do not exist
because they are consciously intolerable
o Example: Mother refuses to believe her child has been diagnosed
with lukemia. "She just has the flu."
4. Displacement - transferring unacceptable feelings aroused by one object
to another, more acceptable substitute
o Example: Adolescent lashes out at parents after not being invited to
party.
5. Dissociation - walling off specific areas of the personality from
consciousness
o Example: Adolescent talks about failing grades as if they belong to
someone else; jokes about them.
6. Fantasy - a conscious distortion of unconscious wishes and need to
obtain satisfaction
o Example: A student nurse fails the critical care exam and
daydreams about her heroic role in a cardiac arrest.
7. Fixation - becoming stagnated in a level of emotional development in
which one is comfortable
o Example: A sixty year old man who dresses and acts as if he were
still in the 1960's.
8. Identification - subconsciously attributing to oneself qualities of others
o Example: Elvis impersonators.
9. Intellectualization - use of thinking, ideas, or intellect to avoid emotions
o Example: Parent becomes extremely knowledgeable about child's
diabetes.
10. Introjection - incorporating the traits of others
o Example: Husband's symptoms mimic wife's before she died.
11. Projection - unconsciously projecting one's own unacceptable qualities or
feelings onto others
 o Example: Woman who is jealous of another woman's wealth
accuses her of being a gold-digger.
12. Rationalization - justifying behaviors, emotions, motives, considered
intolerable through acceptable excuses
o Example: "I didn't get chosen for the team because the coach plays
favorites."
13. Reaction Formation - expressing unacceptable wishes or behavior by
opposite overt behavior
o Example: Recovered smoker preaches about the dangers of
second hand smoke.
14. Regression - retreating to an earlier and more comfortable emotional
level of development
o Example: Four year old insists on climbing into crib with younger
sibling.
15. Repression - unconscious, deliberate forgetting of unacceptable or
painful thoughts, impulses, feelings or acts
o Example: Adolescent "forgets" appointment with counselor to
discuss final grades.
16. Sublimation - diversion of unacceptable instinctual drives into personally
and socially acceptable areas.
o Example: Young woman who hated school becomes a teacher.

crisis intervention
Problem-solving activity intended to correct or prevent the continuation of
a crisis, as in poison control centers or suicide prevention services.

II.
Therapeutic Communication - characterizes the Nurse-Client Relationship
A. Nurse-Client Relationship: A therapeutic professional relationship in
which two people interact
1. The nurse who possess the skills and ability to provide counseling,
crisis intervention, health teaching, etc. and
2. The client who seeks help for some problem
B. Phases of the Nurse-Client Relationship

Get a Clue

Here's one way to remember the five characteristics of

the Nurse-Client Relationship
Many Good Scholars Take Nursing

C. Five Characteristics of Nurse-Client Relationship

 1. Mutual definition: together, nurse and client define relationship
2. Goal direction: purpose, time, and place are specific
3. Specified boundaries: in time, space, content, and confidentiality
4. Therapeutic communication: Nurse eases trust and open
communication by these interpersonal techniques
5. Nurse helps client toward resolution

D. Therapeutic Communication
1. Consider the developmental level, culture, and physical condition of the
client
2. Focus not on subjective inferences but on actual objective behaviors
3. Focus not on judgment but on description
4. Instead of offering advice and solutions, share information and explore
alternatives
5. Focus not on "why" but on how and what
6. For confused or disoriented clients, focus on reality orientation
7. Ask open-ended questions and seek information
8. Focus on nursing interventions
9. To ease this process, use specific techniques
10. Certain techniques block therapeutic communication
E. Other Types of Therapeutic Interventions
1. Group Therapy
2. Family Therapy
3. Milieu Therapy

NINE INEFFECTIVE COMMUNICATION TECHNIQUES

1. Giving advice - Telling the client what to do. Giving an opinion or making
decisions for the client. Implies the client cannot handle life decisions and
that the nurse is accepting responsibility for client.
2. False reassurance - Using clichés, pat answers, cheery words and
comforting statements as an attempt to reassure client.
3. Changing the Subject - Introducing new topics inappropriately. May
result from poor listening skills
4. Social Response - Responding in a way that either focuses attention on
the nurse instead of the client, or is not goal-directed on behalf of the
client.
5. Invalidation - Ignoring or denying the client's thoughts or feelings.
6. Overloading - Talking rapidly, changing subjects or asking for more
information than can be absorbed at one time; for example, asking two
questions at once.
7. Underloading - Remaining silent and unresponsive, not picking up cues
and failing to give feedback.
 8. Incongruence - Sending verbal and nonverbal messages that contradict
one another; often called a double message.
9. Value Judgments - Giving one's own opinion, evaluating , moralizing or
implying one's own values by using words such as "should," "ought,"
"good," or "bad."

THERAPEUTIC COMMUNICATION TECHNIQUES

Not Necessarily Verbal

1. Acceptance - Recognizing the other person without inserting your own

values or judgments. May be verbal or nonverbal; with or without
understanding
2. Listening - Consciously receiving the client's message. Includes listening
actively, responsibly, and seriously
3. Empathy - Experiencing another's feeling temporarily; truly being with and
understanding another through active listening
4. Silence - Suspending talk for a therapeutic reason
5. Neutral response - Showing interest and involvement without saying
anything else
6. Eye contact - As appropriate to the client's culture

Verbal

7. Self-disclosure - Sharing personal information at an opportune moment

to convey understanding or to role model behavior
8. Clarification - Putting into words vague ideas or unclear thoughts of the
client. Purpose is to help nurse understand, or invite the client to explain
9. Restating - Repeating to the client the main thought he has expressed to
indicate the nurse is listening and interested. May encourage the client to
elaborate
10. Refocusing - Picking up on central topics or "cues" given by the client
11. Open-ended questions - Asking questions that cannot be answered
"yes" or "no." Used to broaden conversational opportunities and to enable
the client to communicate.
12. Incomplete sentences - Encouraging the client to continue with phrases
such as "Go on…"
13. Focusing - Helping the client to explore a specific topic

III. Grief
A. Loss
1. A universal phenomenon; it occurs across the lifespan
2. There are many types of loss
 a. Loss of external objects
b. Loss of significant other: through death, divorce
c. Loss of environment: by moving, taking a new job,
hospitalization
d. Loss of an aspect of self: may include a body part,
physiologic or psychologic function
3. Response to loss depends on
a. One's personality
b. Culture
c. Previous experience with loss
d. One's values
e. Perceived value of loss
f. Support system

B. Types of Grief
1. Anticipatory grief: Person learns of impending loss and responds with
processes of mourning, coping, interaction, planning, and psychosocial
reorganization
2. Disenfranchised grief: Person experiences a loss that is not or cannot be
openly acknowledged, publicly mourned, or socially supported
3. Mourning: Process used to resolve grief
4. Tasks of Mourning (common to the models of grief) spell R-E-A-L
a. Real: Accept that the loss is real
b. Experience the emotions associated with the loss
c. Adjust or re-adjust to life and activities
d. Let go: move on with one's own life
5. Grief Theory Models

FOUR THEORETIC MODELS OF GRIEF

A. Elizabeth Kubler-Ross: Five Stages

1. Denial
a. Unconscious avoidance which varies from a brief period to
the remainder of life
b. Allows one to mobilize defenses to cope
c. Positive adaptive responses - verbal denial; crying
d. Maladaptive responses - no crying, no acknowledgement of
loss
2. Anger
a. Expresses the realization of loss
b. May be overt or covert
c. Positive adaptive responses - verbal expressions of anger
 d. Maladaptive responses - persistent guilt or low self esteem,
aggression, self destructive ideation or behavior
3. Bargaining
a. An attempt to change reality of loss; person bargains for
treatment control, expresses wish to be alive for specific
events in near future
b. Maladaptive responses - bargains for unrealistic activities or
events in distant future
4. Depression and Withdrawal
a. Sadness resulting from actual and/or anticipated loss
b. Positive adaptive response - crying, social withdrawal
c. Maladaptive responses - self-destructive actions, despair
5. Acceptance
a. Resolution of feelings about death or other loss, resulting in
peaceful feelings
b. Positive adaptive behaviors - may wish to be alone, limit
social contacts, complete personal business
B. John Bowlby: Four Stages of Separation and Loss
1. Shock
2. Despair
3. Detachment
4. Resolution
C. E. Lindemann
1. Shock
2. Acute mourning
3. Resolution of grief
D. J.W. Wooden
1. Accepting the reality
2. Experiencing the pain
3. Adjusting to the changed environment
4. Withdrawing and reinvesting emotional energy

IV. Stress Management

A. Stress: a universal phenomenon, stress requires change or adaptation so
that the person can maintain equilibrium
B. Stress can be Internal or External
C. Nature of stressor involves:
1. Intensity
2. Scope
3. Duration
4. Other stressors: their number and nature
D. Categories of Stressors - and examples
1. Physical - drugs or alcohol
2. Psychological - such as adolescent emotional upheaval, or
unexpressed anger
3. Social - isolation, interpersonal loss
 4. Cultural - ideal body image
5. Microbiologic - infection
E. The greater the stressor, the greater the stress response
F. Stress response involves both localized and general adaptation

STRESS RESPONSE

A. Local responses to stress: Local Adaptation Syndrome (LAS):

1. Examples
a. Blood clotting
b. Wound healing
c. Reflex pain response
d. Inflammatory response
2. Characteristics
a. Localized response
b. Adaptive (that is, requires a stressor)
c. Short-term
d. Restorative

B. Whole-body response to stress: General Adaptation Syndrome (GAS)

1. Involves primarily nervous and endocrine systems, in 3 stages

The Three Stages of Stress spell A-R-E

 Alarm
 Resistance

 Exhaustion

2. Stage 1: Alarm reaction - exposure to adverse stimulus; body

mobilized to resist in form of compensatory behavior

a. Fight or flight response

1. Increased cardiac output
2. Increased heart rate
3. Increased respiratory rate
4. Pupils dilate
 5. Increased mental alertness
b. Sympathetic Nervous System response
1. Increased epinephrine
a. Increased heart rate
b. Increased oxygen intake
c. Increased blood sugar
2. Increased norepinephrine
a. Increased blood flow to skeletal muscle
b. Involves increased arterial blood pressure
c. Posterior Pituitary: Increased ADH
1. Increased water reabsorption
2. Decreased urine output
d. Anterior Pituitary: Increased ACTH
1. Increased cortisol secretion
a. Body turns fat and proteins into glycogen
b. Increased protein catabolism
c. Increased fat catabolism
2. Increased aldosterone secretion:
a. Body reabsorbs more sodium, more water
b. Kidneys produce less urine
c. Kidneys secrete more potassium
2. Stage 2: Resistance - When stimulus is excessive or prolonged,
alarm and mobilization give way to resistance
a. Stabilization
b. Hormonal levels return to normal
c. Parasympathetic nervous system activates
d. Body adapts to stressors
3. Stage 3: Exhaustion - If stressor continues, energy wanes and body
weakens
a. Physiological response as noted in alarm reaction
b. Decreased energy levels
c. Decreased physiologic adaptation
d. Death

EMOTIONAL/BEHAVIORAL INDICATORS OF STRESS

A. Behavior Patterns
1. Substance use/abuse
2. Changes in eating habits
3. Changes in activity
B. Mood

4. Loss of self esteem

5. Feelings of inadequacy
6. Increased irritability
7. Crying
B. Cognitive

8. Lack of motivation
9. Forgetfulness
10. Tendency to make mistakes
11. Decreased productivity
12. Poor judgment
13. Inability to concentrate
14. Preoccupation

PHYSIOLOGIC INDICATORS OF STRESS

1. Increased Blood Pressure

2. Tachycardia
3. Tachypnea
4. Sweaty palms
5. Cold Hands and Feet
6. Decreased urine output
7. Dilated Pupils
8. Change in appetite
9. Gastrointestinal changes: nausea, vomiting, diarrhea
10. Headache
11. Restlessness
12. Insomnia
13. Muscle tension

STRESS-RELATED DISORDERS

1. Hypertension
2. Ulcers
3. Skin Disorders
4. Cardiovascular disorders
5. Increased cholesterol
6. Migraines
7. Eating Disorders
8. Depression
9. Substance Abuse
10. Asthma
11. Cancer
12. Rheumatoid Arthritis
13. Anxiety disorders
14. Dysrhythmias
 15. Muscle tension/aches
16. Sleeping disorders
17. Gastrointestinal upset/disorders
18. Endocrine disorders

STRESS MANAGEMENT STRATEGIES

1. Balanced diet
2. Adequate rest
3. Regular physical exercise
4. Relaxation techniques such as
a. Breathing exercises
b. Meditation
c. Progressive relaxation
d. Prayer
e. Guided imagery
f. Relaxation response
g. Yoga
h. Biofeedback
5. Hypnosis or self-hypnosis
6. Humor
7. Therapeutic touch or massage
8. Social support
9. Spirituality
10. Crisis intervention
11. Cognitive restructuring: Nurse and client analyze client's appraisal of
stressors.
Emphasis is on restructuring client's unrealistic or negative thinking.

Coping Mechanisms

• People use coping mechanisms, also called ego defense mechanisms, to relieve
anxiety.
• They are usually unconscious; that is, the client is not aware of their use.
• Watch for excessive use of these mechanisms.

Therapeutic Communication
 • Show positive regard for the client.
• Give eye contact without staring.
• Show empathy and genuine caring.
• Show respect.
• Use open-ended questions.
• Be aware of your own body language. Appear relaxed. Use an open body posture.
Do not cross your arms.
• Respect confidentiality.

Grief

• The distinction between grieving and depression can be a matter of degree. Look
for signs of clinical depression.
• Grieving takes time; the amount of time varies with individuals.
• The stages of grief are not linear; they may come and go.
• Grief follows death; but also follows divorce, loss of job, loss of financial status,
loss of limb or other physical disability, etc.
• Chronic grief is an exaggerated, prolonged grief response characterized by efforts
to keep the deceased alive; chronic grief does not reach resolution. The mourner is
unable to get on with life.
• Pay attention to culturally diverse ways of responding to grief. This is important
in assessment of grief reaction and in respecting the customs and rituals of a
cultural group.
• Encourage client and family to talk about their feelings.
• Beware of personal reaction to death and over identification with client. When
necessary, seek assistance to cope with personal issues.
• Teach clients and their families about the up-and-down process of grieving.
• Refer to appropriate support groups

Stress Management

• Severity of reaction to a stressor depends on how it is interpreted/perceived by the

individual, the meaning or significance given to it.
• Learn about support groups in your community for appropriate referral.
• Stress is a normal part of life. People differ in how they cope with stressors.
• Physical and emotional stressors trigger the same stress response; however the
magnitude of the response may vary.
• There are individual differences in response to same stress.
• Duration and intensity of physiologic indicators are directly related to the duration
and intensity of the stress.
• Stress is classified as mild, moderate or severe.
• Prolonged stress decreases the adaptive capacity of the body.
• There are limits to a client's ability to handle stress.

biofeedback
A training program designed to develop one's ability to control the
autonomic (involuntary) nervous system.
confrontation
In psychiatry, a feedback procedure in which a patient's behavior and
apparent feelings are presented to facilitate better understanding of his
or her actions.
kinesics
Systematic
study of the
body and the
use of its static
and dynamic
position as a
means of
communication
.
relaxation
response
The
physiological
reaction
sought and
produced by
sitting quietly
and alone in a
quiet place
with the eyes
closed and the
arms and
hands relaxed,
paying careful
attention to
respiration,
and repeating
a brief word or
phrase at each
respiratory
cycle.