One of these questions and answers make no sense whatsoever

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I went and bought Saunders yesterday. I took the Assessment quiz. I would like someone to please tell me the rationale behind this question because I cannot understand how anyone in their right mind could choose this as the correct answer.

The question is this:

A 63-year-old woman whose husband died 2 months ago says to the visiting nurse, "My daughter came over yesterday to help me move my husband's things out of our bedroom, and I was so angry with her for moving his slippers from where he always kept them under his side of our bed. She doesn't know how much I'm hurting." Which statement by the nurse would be therapeutic?

1. "It's OK to grieve and be angry with your daughter and anyone else for a time."

2. "I know just how you feel because I lost my husband last summer."

3. "Although it's a troubling time for you, try to focus on your children and grandchildren."

4. "You need to focus on the many good years you both enjoyed together and move on."

Rationale: The therapeutic statement is the one that gives the client permission to grieve and acknowledges that anger is part of loss and that it may be aimed at the people who are trying most to help and are closest. Options 2, 3, and 4, are all non-therapeutic. They do not encourage the client to express feelings. :argue:

First of all, this does not take into account anyone else's feelings but the grieving wife. Venting anger at people that are probably suffering and hurting in many cases equal to the wife over a misplaced pair of shoes is the absolute worst thing that woman could do. Not only does she risk cutting off the people that love her leaving her with no one but she can severely damage these relationships for many years to come. How stupid is that to suggest that it is "ok to be angry with these folks that are trying to help her?" Anger is one of the most damaging, hurtful aspects of our interactions with people and I think it would have been better to have said something like this, "It's OK to grieve, but keep in mind that everyone is hurting over this person that must have been so important to your family." In reality, I have seen nurses intervene to communicate these needs to the family and it helps to avert the damage that anger could have potentially caused. Anger should be reserved for something that is really an issue. How many people in the real world would be able to resolve this in their minds afterward and say, "Oh, I understand that she was just angry over the loss of her husband and she loved me enough to vent on me over a pair of shoes I was trying to put away." Like nobody.

:chair:

Vera

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Specializes in Nursing Professional Development.

I recognized #1 as the right answer even before I read the other responses. After I read them, I was even more confident in my belief that #1 was the correct response.

Anger is an OK emotion. It's a natural response and can be a positive force when channeled in a constructive direction. The nurse's job in this situation is to first acknowledge and accept the patient "where she's at" at the moment. After giving the patient a chance to vent her emotions, then and only then, will the nurse be successful in helping the patient find positive ways to deal with her feelings of anger.

After the nurse has provided a safe, accepting environment for the patient to vent the force of her emotions ... the patient will probably be more able to see that the daughter meant no harm, no disrespect, etc. ... that the daughter is probably also grieving for her dead father ... and needs to have HER grief acknowledged, too. Gradually, the widow can be helped to see that the daughter was "just trying to help" and that it would be best (and fair) to try to maintain a positive relationship with her daughter as both women grieved the loss of their husband/father.

Also, response #1 is provides an open invitation to the widow to talk further about her feelings and establish a trusting relationship with the nurse. The 3 wrong answers all shut down the widow's further communication and explanation of her feelings. They redirect her focus on other things rather than on the primary issues that are causing the problems. By avoiding the primary underlying issues, those issues will just be buried -- and be likely to resurface again as they are left unresolved.

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So then, it is assumed that the conversation won't end here? I didn't see that. Thank you! That helps me to understand this response. I couldn't in all good conscience leave the grieving widow with that statement and then walk away. That was my concern. But if it is meant to open the channels of communication, then I can see why it is the right answer.

Vera

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After further reflection this afternoon, I still contend that I would not give someone the green light to vent on others because of normal anger experienced after a death. I agree that the anger is normal and that having a non-judgmental attitude toward that anger is important to people. No problem. I believe I could make that clear without making a statement that would indicate that it is ok to vent anger on their loved ones. When folks are in a traumatic state of mind, they do things, without thinking, that come back on them later and may have extreme consequences depending on who they are getting angry with, how far they take that anger and what they expect to achieve through this. For example, the mom may not care if the daughter is her friend later. She might welcome an opinion that would suggest that she could let this daughter have it. Perhaps there is already a strain on their relationship from the past. In such a case, how might this advice translate to the mom and ultimately effect the daughter? What would something like this do to that relationship? Some people are more understanding than others and better equipped to handle someone else's grief. I just think there is a better way to give that kind of feedback than to communicate that this person's feelings are above the others that are suffering. People have a tendency, imvho, to hear what they want to hear depending on their circumstances and so I wouldn't want to ever suggest that venting on others was normal and keep it up until you feel better even if I plan on leading them in a different direction later. What if they only remember that one comment? It happens. This comment is advice that could have untoward results if the person actually acts upon it. I think it is an inappropriate answer.

Vera

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Probably not in real life, definitely not the best answer...but NCLEX is a $#$%***!!!:angryfire..and it's supposed to be ideal. I think the rationale behind that answer is that it allows the patient to go through the NORMAL grieving process, without judgement.

I mean, the other choices puts aside what the client feels and belittles self-expression, which is a key point in the NCLEX.

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I think one of the key words in the first sentence, to, is "for a time." The nurse is acknowledging the widow's need to grieve and express her feelings, but identifies that this behavior is not ideal for the rest of her life.

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Yep, folks often say you have to choose "the best" answer provided, even if all them seem less than ideal. I do better thinking of it as "what is this question probably testing for?" In this case, answer 2 is definitely inappropriate while both 3 & 4 are telling the person how to respond ("try to focus" "you need to focus") which is also inappropriate. So you're left with Answer 1. It may not be the best way to phrase the sentiment but it seems the point here is allowing the person to have their feelings.

Can I ask if you've started nursing school yet? I'm guessing not, or else just started; otherwise I'd think this question wouldn't bug you so much. You'd be used to this kind of "well, the other answers are worse, so this one is right" reasoning that can come into play on NCLEX-style questions. I'd also think you'd have had it oft-repeated in school that it's inappropriate to tell how they should deal with grief. Tell me if I'm wrong and you've been a nursing student for a year already!

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Specializes in Telemetry & Obs.
I went and bought Saunders yesterday. I took the Assessment quiz. I would like someone to please tell me the rationale behind this question because I cannot understand how anyone in their right mind could choose this as the correct answer.

The question is this:

A 63-year-old woman whose husband died 2 months ago says to the visiting nurse, "My daughter came over yesterday to help me move my husband's things out of our bedroom, and I was so angry with her for moving his slippers from where he always kept them under his side of our bed. She doesn't know how much I'm hurting." Which statement by the nurse would be therapeutic?

1. "It's OK to grieve and be angry with your daughter and anyone else for a time."

2. "I know just how you feel because I lost my husband last summer."

3. "Although it's a troubling time for you, try to focus on your children and grandchildren."

4. "You need to focus on the many good years you both enjoyed together and move on."

Rationale: The therapeutic statement is the one that gives the client permission to grieve and acknowledges that anger is part of loss and that it may be aimed at the people who are trying most to help and are closest. Options 2, 3, and 4, are all non-therapeutic. They do not encourage the client to express feelings. :argue:

First of all, this does not take into account anyone else's feelings but the grieving wife. Venting anger at people that are probably suffering and hurting in many cases equal to the wife over a misplaced pair of shoes is the absolute worst thing that woman could do. Not only does she risk cutting off the people that love her leaving her with no one but she can severely damage these relationships for many years to come. How stupid is that to suggest that it is "ok to be angry with these folks that are trying to help her?" Anger is one of the most damaging, hurtful aspects of our interactions with people and I think it would have been better to have said something like this, "It's OK to grieve, but keep in mind that everyone is hurting over this person that must have been so important to your family." In reality, I have seen nurses intervene to communicate these needs to the family and it helps to avert the damage that anger could have potentially caused. Anger should be reserved for something that is really an issue. How many people in the real world would be able to resolve this in their minds afterward and say, "Oh, I understand that she was just angry over the loss of her husband and she loved me enough to vent on me over a pair of shoes I was trying to put away." Like nobody.

:chair:

Vera

Have you studied Kubler-Ross' Stages of Grief??

Denial (this isn't happening to me!)

Anger (why is this happening to me?)

Bargaining (I promise I'll be a better person if...)

Depression (I don't care anymore)

Acceptance (I'm ready for whatever comes)

When in the throes of grief and loss a wife might not be able to think about how her husband's death affected the rest of the family. After all, *she's* the one left without a spouse and while her daughter may have lost a father, she more than likely still has her own husband.

Even your answer was judgemental because it told her to focus on someone besides herself...and in that moment she couldn't.

Have you experienced the death of a loved one?? The grief, pain and ANGER are overwhelming...anger at the one who dared leave you, anger at those that haven't suffered such a loss, anger that it could happen to you.

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Specializes in Cardiac.
Tell me if I'm wrong and you've been a nursing student for a year already!

Her profile says she's been a NICU RN for 10 years...

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Specializes in EMS, ER, GI, PCU/Telemetry.

yes, mental health NCLEX questions are big on DABDA and therapeutic communication.

in your mental health studies you will learn therapeutic vs nontherapeutic communication techniques as well as appropriate vs inappropriate coping mechanisms.

in looking at this question, i was able to eliminate 2, 3, and 4 right away. as you progress in nursing school... you will be able to do so too. none of them are "great" answers, but #1 is the best.

good luck! :)

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Specializes in Cardiac.

First of all, this does not take into account anyone else's feelings but the grieving wife.

The grieving wife is the patient. This isn't about everyone else's feelings. This is about the patient.

I also knew that #1 was the right answer quite easily...

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Specializes in Telemetry & Obs.
Her profile says she's been a NICU RN for 10 years...

In her posting history she said she was a NICU nurse 18 years ago, but let her license lapse...therefore she's taking NCLEX again.

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