CSLB General Building (B) — All Questions
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A client newly diagnosed with a terminal illness states, "There must be a mistake in the lab results." Which stage of grief does this reflect?
- a.Denial✓
- b.Bargaining
- c.Acceptance
- d.Depression
Denial is characterized by disbelief and rejecting the reality of the diagnosis. Bargaining involves making deals, and acceptance involves coming to terms with the situation. Recognizing grief stages guides supportive communication.
Which therapeutic communication technique is demonstrated when the nurse restates the client's message in the nurse's own words?
- a.Giving advice
- b.Paraphrasing✓
- c.Offering false reassurance
- d.Changing the subject
Paraphrasing restates the client's message to confirm understanding and encourage further sharing. Giving advice and false reassurance are nontherapeutic. Effective communication supports the client's expression of feelings.
A client experiencing a panic attack is hyperventilating and pacing. What is the nurse's priority action?
- a.Leave the client alone to calm down
- b.Provide detailed education about anxiety disorders
- c.Stay with the client and speak calmly using short, simple statements✓
- d.Encourage the client to make a list of stressors immediately
During a panic attack the nurse should remain with the client and use a calm voice and simple directions to reduce stimulation. Detailed teaching and problem-solving are not effective during acute anxiety. Presence and reassurance promote safety.
The nurse suspects a client is a victim of elder abuse. What is the nurse's legal responsibility?
- a.Confront the suspected abuser directly
- b.Keep the suspicion private to avoid conflict
- c.Wait for the client to file a complaint
- d.Report the suspicion according to mandatory reporting laws✓
Nurses are mandatory reporters and must report suspected abuse to the appropriate authorities. Confronting the abuser or waiting for the client to act can endanger the client. Reporting protects vulnerable individuals.
A client with depression states, "I feel like a burden to everyone." Which response is most therapeutic?
- a."Tell me more about how you have been feeling."✓
- b."You shouldn't feel that way; everyone loves you."
- c."Let's talk about something more pleasant."
- d."At least you have a supportive family."
Encouraging the client to say more invites expression of feelings and conveys genuine interest. Minimizing feelings, changing the subject, and comparing to others block communication. Open-ended exploration is therapeutic.
A client with dementia becomes agitated in the evening. Which intervention is most appropriate?
- a.Increase environmental noise and activity
- b.Provide a calm, well-lit environment and a consistent routine✓
- c.Restrain the client to prevent wandering
- d.Frequently change caregivers to provide stimulation
A calm, well-lit environment with consistent routines and caregivers reduces evening agitation, sometimes called sundowning. Excess stimulation, restraints, and frequent caregiver changes worsen confusion. Predictability promotes security.
A client who has been assaulted appears withdrawn and avoids eye contact. What is the nurse's best initial approach?
- a.Insist the client describe the event in detail immediately
- b.Tell the client to move past the experience
- c.Provide a safe, private environment and allow the client to talk when ready✓
- d.Discuss the incident within earshot of other clients
Providing safety, privacy, and unhurried support helps a trauma survivor feel secure and regain a sense of control. Forcing disclosure or minimizing feelings is harmful. The nurse follows the client's pace.
Which behavior indicates a client may be at immediate risk for suicide and requires priority intervention?
- a.Expressing hope about future plans
- b.Attending group therapy sessions
- c.Discussing coping strategies with the nurse
- d.Giving away personal possessions and stating goodbyes✓
Giving away belongings and saying goodbye can signal a suicide plan and requires immediate assessment and safety measures. Hopeful statements and engagement in therapy are positive signs. Direct assessment of suicidal intent is essential.
A client from a culture that values family decision-making asks that all information be shared with the family. What is the nurse's best response?
- a.Respect the client's wishes and involve the family as the client directs✓
- b.Insist that only the client receive information
- c.Refuse because it violates confidentiality
- d.Share information only with the client's employer
Culturally sensitive care respects the client's preferences about who participates in decisions. When a competent client authorizes family involvement, the nurse honors that choice. Individual and cultural values guide communication.
A client experiencing alcohol withdrawal is anxious and tremulous. Which environment is most appropriate?
- a.A brightly lit, busy room to keep the client engaged
- b.A quiet room with reduced stimulation and frequent monitoring✓
- c.A shared room with several visitors
- d.A dark, isolated room with no supervision
A quiet, low-stimulation environment with close monitoring helps reduce agitation and detects worsening withdrawal. Excess stimulation can heighten anxiety, and isolation without supervision is unsafe. Safety and calm are priorities.
A client verbalizes anger at the nursing staff about the diagnosis. Which response by the nurse is most therapeutic?
- a."You have no reason to be angry with us."
- b."If you keep yelling, I will leave."
- c."You seem upset. Can you tell me what is troubling you?"✓
- d."Calm down and stop being difficult."
Acknowledging the client's feelings and inviting them to talk helps identify the underlying concern. Defensive or dismissive responses escalate anger and block communication. Reflecting emotion is a therapeutic technique.
Which coping strategy is considered adaptive for a client experiencing situational stress?
- a.Using alcohol to relax each evening
- b.Withdrawing from all social contact
- c.Denying that any problem exists
- d.Talking with a trusted friend and using relaxation techniques✓
Seeking social support and using relaxation are healthy, adaptive coping strategies. Alcohol use, social withdrawal, and denial are maladaptive and can worsen stress. Reinforcing positive coping supports mental health.
A client with a new colostomy states, "I don't want to look at it. It's disgusting." What is the nurse's best response?
- a."It is normal to have these feelings after surgery. Would you like to talk about it?"✓
- b."You will have to look at it eventually, so do it now."
- c."Most people adjust quickly, so don't worry."
- d."Let's not discuss it until you feel better."
Acknowledging feelings about an altered body image and inviting discussion supports adjustment. Pressuring the client or minimizing feelings is nontherapeutic. Emotional support precedes self-care teaching.
A confused older adult repeatedly asks to go home. Which nursing response is most therapeutic?
- a."You cannot go home; stop asking."
- b."You seem worried. You are safe here, and I will stay with you."✓
- c."Your family abandoned you here."
- d."I already told you the answer three times."
Providing reassurance, orientation, and a calm presence reduces anxiety in a confused client. Harsh or dismissive replies increase distress. Validating feelings and offering comfort are therapeutic.